MS-DRG 801 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 801 by major payers:
$20,621.75
$21,481.43
$25,965.77
$26,834.21
| 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 801 | ||||||
United | 801 | $5971.83 | 1790888089 - HOSPITAL AUTHORITY OF CANDLER COUNTY, CANDLER COUNTY HOSPITAL | 586004640 | GA | Critical Access Hospital (282NC0060X) |
United | 801 | $79665.13 | 1841687787 - JOHN MUIR MEDICAL CENTER | 680396600 | CA | General Acute Care Hospital (282N00000X) |
United | 801 | $1500.00 | 1255386512 - MCCAMEY COUNTY HOSPITAL DISTRICT, MCCAMEY COUNTY HOSPITAL DISTRICT-SWING BED | 751246166 - (TX) MCCAMEY COUNTY HOSPITAL DISTRICT | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 801 | $28577.07 | 1992813661 - SAINT ANTHONY MEDICAL CENTER, OSF SAINT ANTHONY MEDICAL CENTER | 362167864 | IL | General Acute Care Hospital (282N00000X) |
United | 801 | $42672.71 | 1497106843 - KECK MEDICAL CENTER | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | 801 | $36127.83 | 1649383035 - INTEGRIS BASS BAPTIST HEALTH CENTER | 730612674 | OK | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 801 | $34217.39 | 1659381895 - BON SECOURS-RICHMOND COMMUNITY HOSPITAL LLC, BON SECOURS RICHMOND COMMUNITY HOSPITAL PRO FEE SERVICE | 540647482 | VA | General Acute Care Hospital (282N00000X) |
United | 801 | $22215.48 | 1275531956 - COOKEVILLE REGIONAL MEDICAL CENTER | 626002166 | TN | General Acute Care Hospital (282N00000X) |
United | 801 | $6893.02 | 1265512917 - HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT, HARRISON COUNTY COMMUNITY HOSPITAL | 431530883 | MO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 801 | $13330.59 | 1346248317 - MAGNOLIA REGIONAL MEDICAL CENTER | 850512754 - (AR) MAGNOLIA REGIONAL HEALTH SYSTEM INC | AR | General Acute Care Hospital (282N00000X) |
United | 801 | $17863.01 | 1215151154 - PORTER HOSPITAL LLC, NORTHWEST HEALTH-PORTER | 208473972 | IN | General Acute Care Hospital (282N00000X) |
United | 801 | $8161.00 | 1659949121 - SCOTT & WHITE HOSPITAL BRENHAM, BAYLOR SCOTT & WHITE MEDICAL CENTER - BRENHAM | 742519752 - (TX) SCOTT & WHITE HOSPITAL BRENHAM | TX | Critical Access Hospital (282NC0060X) |
United | 801 | $10725.48 | 1578627196 - PENDER COMMUNITY HOSPITAL DISTRICT, PENDER COMMUNITY HOSPITAL | 470711662 - (NE) PENDER COMMUNITY HOSPITAL DISTRICT | NE | Critical Access Hospital (282NC0060X) |
United | 801 | $44393.21 | 1538547823 - MCLEOD HEALTH CHERAW | 473712858 - MCLEOD HEALTH CHERAW | SC | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 801 | $24161.58 | 1952312191 - ST MARY MEDICAL CENTER, OSF SAINT MARY MEDICAL CENTER | 370662581 | IL | 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 801 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 801 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 801 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 |
|---|---|---|
| 800-MS-DRG | High | Spleenic Procedures with CC |
| 801-MS-DRG | High | Spleenic Procedures without CC/MCC |
| 802-APR-DRG | Moderate | Acute Major Eye Infections |
| 802-MS-DRG | High | Other O.R. Procedures of the Blood and Blood Forming Organs 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 801. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 801 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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