MS-DRG 798 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 798 by major payers:
$10,028.55
$9,816.67
$13,619.37
$15,672.36
| 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 798 | ||||||
United | 798 | $14416.50 | 1194194720 - PRIME HEALTHCARE SERVICES-LEHIGH ACRES LLC | 474849671 | FL | General Acute Care Hospital (282N00000X) |
United | 798 | $7636.00 | 1063072932 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 798 | $16723.72 | 1538671946 - THE BARIATRIC CENTER OF KANSAS CITY LLC | 823025378 - (KS) THE BARIATRIC CENTER OF KANSAS CITY LLC | KS | Special Hospital (284300000X) |
United | 798 | $15109.91 | 1154399749 - OHI WEST, INC, BAYFRONT HEALTH ST PETERSBURG | 845074208 - (FL) OHI WEST INC | FL | General Acute Care Hospital (282N00000X) |
United | 798 | $12200.00 | 1831139773 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE MEDICAL CENTER | 620840204 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 798 | $12224.78 | 1225195464 - CANNON COUNTY HOSPITAL LLC, STONES RIVER HOSPITAL | 474063232 | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 798 | $8884.00 | 1164876546 - BBH PBMC, LLC, PRINCETON BAPTIST MEDICAL CENTER | 474775351 | AL | General Acute Care Hospital (282N00000X) |
United | 798 | $13027.12 | 1740475847 - ALTRU HEALTH SYSTEM, ALTRU HEALTH SYSTEM (CHRONIC PAIN PROGRAM) | 450310462 - ALTRU HEALTH SYSTEM | ND | Rehabilitation Hospital Unit (273Y00000X) |
United | 798 | $14416.50 | 1194194720 - PRIME HEALTHCARE SERVICES-LEHIGH ACRES LLC | 474849671 | FL | General Acute Care Hospital (282N00000X) |
United | 798 | $20798.00 | 1184649345 - HACKENSACK UNIVERSITY MEDICAL CENTER | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | Children's Hospital (282NC2000X) |
United | 798 | $8443.00 | 1750360798 - THE MERCY HOSPITAL INC, MERCY REHABILITATION HOSPITAL | 43398280 - (MA) THE MERCY HOSPITAL INC | MA | Rehabilitation Hospital Unit (273Y00000X) |
United | 798 | $11468.83 | 1598717480 - HURLEY MEDICAL CENTER | 386005601 | MI | General Acute Care Hospital (282N00000X) |
United | 798 | $7650.00 | 1326564071 - MULTICARE HEALTH SYSTEM, MULTICARE COVINGTON MEDICAL CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 798 | $10548.00 | 1801851258 - VIRGINIA MASON MEDICAL CENTER | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 798 | $11825.84 | 1629090402 - CARLE EUREKA HOSPITAL, ADVOCATE EUREKA HOSPITAL | 850688306 - (IL) CARLE EUREKA HOSPITAL | IL | 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 798 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 798 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 798 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 |
|---|---|---|
| 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 |
| 799-MS-DRG | High | Spleenic Procedures with 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 798. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 798 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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