MS-DRG 802 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 802 by major payers:
$39,331.51
$46,759.32
$56,121.76
$57,624.04
| 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 802 | ||||||
United | 802 | $40500.58 | 1386687036 - VAN BUREN HMA LLC, SPARKS MEDICAL CENTER- VAN BUREN | 825426152 - (AR) BAPTIST HEALTH REGIONAL HOSPITALS | AR | General Acute Care Hospital (282N00000X) |
United | 802 | $90372.81 | 1720004450 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | General Acute Care Hospital (282N00000X) |
United | 802 | $41120.03 | 1396786307 - SARTORI MEMORIAL HOSPITAL INC, MERCYONE CEDAR FALLS MEDICAL CENTER | 420758901 - (IA) SARTORI MEMORIAL HOSPITAL INC | IA | Psychiatric Hospital Unit (273R00000X) |
United | 802 | $106622.71 | 1821484262 - HDMC HOLDINGS, LLC, HI-DESERT MEDICAL CENTER | 473550779 | CA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 802 | $64720.14 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 802 | $72197.86 | 1326002049 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | General Acute Care Hospital (282N00000X) |
United | 802 | $3783.00 | 1225068711 - WELLMONT HEALTH SYSTEM, HANCOCK COUNTY HOSPITAL SWING BED UNIT | 621636465 - WELLMONT HEALTH SYSTEM | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 802 | $41110.48 | 1316505043 - ETHICUS HOSPITAL DFW LLC, LEGENT ORTHOPEDIC HOSPITAL | 263044485 - (TX) ETHICUS HOSPITAL DFW | TX | General Acute Care Hospital (282N00000X) |
United | 802 | $85145.59 | 1053382655 - FOLEY HOSPITAL COMPANY LLC, SOUTH BALDWIN REGIONAL MEDICAL CENTER | 621811413 - (AL) FOLEY HOSPITAL CORPORATION | AL | General Acute Care Hospital (282N00000X) |
United | 802 | $119667.78 | 1275632895 - NYU LANGONE HOSPITALS | 133971298 - NYU LANGONE HOSPITALS | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 802 | $4958.00 | 1922003730 - RUSSELL COUNTY MEDICAL CENTER, INC, RUSSELL COUNTY MEDICAL CENTER | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | VA | General Acute Care Hospital (282N00000X) |
United | 802 | $53639.00 | 1497917918 - PHELPS MEMORIAL HOSPITAL ASSOCIATION, PHELPS HOSPITAL | 131725076 - (NY) PHELPS MEMORIAL HOSPITAL ASSOCIATION | NY | Psychiatric Hospital (283Q00000X) |
United | 802 | $37178.44 | 1962594622 - NORTHWEST IOWA HOSPITAL CORPORATION, ST LUKES REGIONAL MEDICAL CENTER | 421019872 - (IA) NORTHWEST IOWA HOSPITAL CORPORATION | IA | General Acute Care Hospital (282N00000X) |
United | 802 | $106622.71 | 1821484262 - HDMC HOLDINGS, LLC, HI-DESERT MEDICAL CENTER | 473550779 | CA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 802 | $36445.39 | 1730722406 - UOFL HEALTH-LOUISVILLE INC | 843178470 - UOFL HEALTH-LOUISVILLE INC | KY | Rehabilitation Hospital Unit (273Y00000X) |
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 802 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 802 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 802 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 |
|---|---|---|
| 801-APR-DRG | Moderate | Acute Major Eye Infections |
| 801-MS-DRG | High | Spleenic Procedures without CC/MCC |
| 802-MS-DRG | High | Other O.R. Procedures of the Blood and Blood Forming Organs with MCC |
| 803-APR-DRG | Moderate | Acute Major Eye Infections |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 802. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 802 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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