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 | $6167.12 | 1477939296 - SELECT SPECIALTY HOSPITAL | 352498003 | GA | Special Hospital (284300000X) |
United | 797 | $10114.11 | 1023105566 - INGALLS MEMORIAL HOSPITAL, THE INGALLS MEMORIAL HOSPITAL | 362170866 - (IL) INGALLS MEMORIAL HOSPITAL | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 797 | $1591.00 | 1740698109 - SEILING MUNICIPAL HOSPITAL AUTHORITY | 731430977 | OK | Critical Access Hospital (282NC0060X) |
United | 797 | $9196.29 | 1902818883 - GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1, SAMARITAN HEALTHCARE | 916001698 | WA | General Acute Care Hospital (282N00000X) |
United | 797 | $2122.00 | 1316180748 - MISSISSIPPI COUNTY HOSPITAL SYSTEM, GREAT RIVER MEDICAL CENTER | 716042625 - (AR) MISSISSIPPI COUNTY HOSPITAL SYSTEM | AR | General Acute Care Hospital (282N00000X) |
United | 797 | $7610.77 | 1336167675 - FIRSTHEALTH OF THE CAROLINAS, INC, MONTGOMERY MEMORIAL HOSPITAL (ACUTE) | 561936354 - (NC) FIRST HEALTH OF THE CAROLINAS INC | NC | Critical Access Hospital (282NC0060X) |
United | 797 | $5167.00 | 1073622007 - CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY, ERLANGER BLEDSOE SWING BED | 626000101 - ERLANGER MEDICAL CENTER | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 797 | $8328.00 | 1467764555 - VANDERBILT MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Critical Access Hospital (282NC0060X) |
United | 797 | $8366.87 | 1083903744 - HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUIS, ST. BERNARD PARISH HOSPITAL | 261576974 - (LA) HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST BERNARD STATE OF LOUIS | LA | Rural Acute Care Hospital (282NR1301X) |
United | 797 | $19189.00 | 1255317848 - GREENE MEMORIAL HOSPITAL INC, KETTERING HEALTH GREENE MEMORIAL | 310809436 - (OH) GREENE MEMORIAL HOSPITAL INC | OH | General Acute Care Hospital (282N00000X) |
United | 797 | $6366.00 | 1417037045 - MOUNT CARMEL HEALTH SYSTEM | 311439334 - MOUNT CARMEL HEALTH SYSTEM | OH | General Acute Care Hospital (282N00000X) |
United | 797 | $4810.00 | 1912918277 - JAY HOSPITAL, INC. | 592425149 - JAY HOSPITAL INC | FL | Rural Acute Care Hospital (282NR1301X) |
United | 797 | $18661.91 | 1841376092 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE PORTLAND MEDICAL CENTER | 930386906 | OR | Rehabilitation Hospital Unit (273Y00000X) |
United | 797 | $17618.47 | 1043455199 - SISTERS OF CHARITY HOSPITAL, ST. JOSEPH CAMPUS | 160743187 - (NY) SISTERS OF CHARITY HOSPITAL OF BUFFALO NEW YORK | NY | General Acute Care Hospital (282N00000X) |
United | 797 | $3630.00 | 1154563963 - BONNER GENERAL HOSPITAL INC., BONNER GENERAL HEALTH | 820207116 - (ID) BONNER GENERAL HOSPITAL INC | ID | Critical Access Hospital (282NC0060X) |
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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