MS-DRG 796 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Pregnancy, Childbirth & the Puerperium |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 796 by major payers:
$14,043.94
$11,768.02
$16,763.46
$20,400.03
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for MS-DRG 796 | ||||||
United | 796 | $25532.00 | 1255479697 - EVANGELICAL COMMUNITY HOSPITAL, CRNA GROUP | 240795411 - (PA) EVANGELICAL COMMUNITY HOSPITAL | PA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 796 | $19005.14 | 1174942924 - , VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 796 | $10706.00 | 1588269898 - WEST PENN ALLEGHENY HEALTH SYSTEM, INC, AHN WEXFORD HOSPITAL | 250969492 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 796 | $5251.00 | 1497775381 - SOUTHCOAST HOSPITALS GROUP, INC, ST. LUKE'S HOSPITAL - PSYCH | 222592333 - SOUTHCOAST HOSPITALS GROUP INC | MA | Psychiatric Hospital Unit (273R00000X) |
United | 796 | $9250.67 | 1144339839 - SIMPSON COMMUNITY HEALTHCARE, INC., SIMPSON GENERAL HOSPITAL | 870741588 - (MS) SIMPSON COMMUNITY HEALTHCARE INC | MS | Critical Access Hospital (282NC0060X) |
United | 796 | $29451.90 | 1518969419 - AHS HOSPITAL CORP, HACKETTSTOWN MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 796 | $1400.00 | 1225038938 - BALLINGER MEMORIAL HOSPITAL DISTRICT, BALLINGER MEMORIAL HOSPITAL | 752312009 | TX | Critical Access Hospital (282NC0060X) |
United | 796 | $7448.95 | 1104821461 - MADISON COUNTY HOSPITAL HEALTH SYSTEMS, INC., MADISON COUNTY MEMORIAL HOSPITAL | 592319288 - (FL) MADISON COUNTY HOSPITAL HEALTH SYSTEMS INC | FL | Critical Access Hospital (282NC0060X) |
United | 796 | $41788.21 | 1043402050 - CENTRAL SUFFOLK HOSPITAL, PECONIC BAY MEDICAL CENTER PROFESSIONAL GROUP PRACTICE | 111661359 - (NY) CENTRAL SUFFOLK HOSPITAL | NY | Hospitalist Physician (208M00000X) |
United | 796 | $5646.00 | 1013942432 - PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA, JACKSON NORTH MEDICAL CENTER PSY | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | Psychiatric Hospital Unit (273R00000X) |
United | 796 | $1825.00 | 1114627072 - STONEBRIDGE HEALTH SYSTEMS, LLC | 464145136 - (LA) STONEBRIDGE HEALTH SYSTEMS LLC | LA | Psychiatric Hospital (283Q00000X) |
United | 796 | $8259.55 | 1598964157 - SELECT SPECIALTY HOSPITAL, SELECT SPECIALTY HOSPITAL - PENSACOLA | 30508545 - (FL) SELECT SPECIALTY HOSPITAL | FL | Long Term Care Hospital (282E00000X) |
United | 796 | $20506.00 | 1073504528 - SOUTHERN OCEAN COUNTY HOSPITAL | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 796 | $27976.51 | 1356528269 - MULTICARE HEALTH SYSTEM, MULTICARE DEACONESS HOSPITAL | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 796 | $2320.00 | 1134166036 - CLHG-WINN, LLC, WINN PARISH MEDICAL CENTER | 813465517 | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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MS-DRG 796 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 796 code is part of the Pregnancy, Childbirth & the Puerperium services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The MS-DRG 796 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 795-MS-DRG | High | Normal Newborn |
| 796-MS-DRG | High | Vaginal Delivery with Sterilization and/or D&C with MCC |
| 797-MS-DRG | High | Vaginal Delivery with Sterilization and/or D&C with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 796. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 796 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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