MS-DRG 797 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 797 by major payers:
$10,485.10
$9,841.22
$13,746.96
$15,739.30
| 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 797 | ||||||
United | 797 | $7650.00 | 1326564071 - MULTICARE HEALTH SYSTEM, MULTICARE COVINGTON MEDICAL CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 797 | $18185.13 | 1225635592 - ASCENSION WISCONSIN EMERUS MENOMONEE FALLS, LLC, ASCENSION WISCONSIN HOSPITAL - WAUKESHA CAMPUS | 852744492 - ASCENSION WISCONSIN EMERUS MENOMONEE FALLS LLC | WI | General Acute Care Hospital (282N00000X) |
United | 797 | $27739.90 | 1609858950 - ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC, PROVIDENCE ST. JOSEPH HOSPITAL | 814791043 - (CA) ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC | CA | General Acute Care Hospital (282N00000X) |
United | 797 | $5033.00 | 1215979190 - VANDERBILT UNIVERSITY MEDICAL CENTER, VANDERBILT WILSON COUNTY HOSPITAL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 797 | $5675.00 | 1609957141 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 797 | $19736.75 | 1003991845 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE PORTLAND MEDICAL CENTER | 930386906 | OR | General Acute Care Hospital (282N00000X) |
United | 797 | $2252.00 | 1801104732 - NOT-FOR-PROFIT HOSPITAL CORPORATION, UNITED MEDICAL CENTER | 261335878 - (DC) UNITED MEDICAL CENTER | DC | General Acute Care Hospital (282N00000X) |
United | 797 | $8328.00 | 1467764555 - VANDERBILT MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Critical Access Hospital (282NC0060X) |
United | 797 | $16104.62 | 1134607005 - ADVOCATE NORTH SIDE HEALTH NETWORK, ADVOCATE ILLINOIS MASONIC MEDICAL CENTER REHAB UNIT | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 797 | $10653.99 | 1578886636 - UPLAND HILLS HEALTHM, INC., UPLAND HILLS HEALTH AUDIOLOGY | 421017512 - (WI) UPLAND HILLS HEALTH INC | WI | Critical Access Hospital (282NC0060X) |
United | 797 | $9469.00 | 1538245352 - MERCY HEALTH, MERCY FRANCISCAN HOSPITAL-WESTERN HILLS(REHABILITATION UNIT) | 311091597 | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 797 | $9469.00 | 1538245352 - MERCY HEALTH, MERCY FRANCISCAN HOSPITAL-WESTERN HILLS(REHABILITATION UNIT) | 311091597 | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 797 | $16609.47 | 1801835970 - ST. LUKE'S HOSPITAL OF DULUTH, ASPIRUS ST LUKES HOSPITAL | 410714079 - ST LUKES HOSPITAL OF DULUTH | MN | General Acute Care Hospital (282N00000X) |
United | 797 | $9300.70 | 1447379953 - MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC., MCCURTAIN MEMORIAL HOSPITAL NEW DIRECTIONS | 736617937 - (OK) MCCURTAIN MEMORIAL MEDICAL MANAGEMENT INC | OK | Psychiatric Hospital Unit (273R00000X) |
United | 797 | $11118.80 | 1447388335 - NORTON HOSPITALS INC, NORTON BROWNSBORO HOSPITAL | 610703799 - (KY) NORTON HOSPITALS INC | KY | General Acute Care Hospital (282N00000X) |
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 797 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 797 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 797 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 |
|---|---|---|
| 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 |
| 798-MS-DRG | High | Vaginal Delivery with Sterilization and/or D&C without CC/MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 797. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 797 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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