MS-DRG 803 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 803 by major payers:
$21,375.35
$24,068.41
$28,481.86
$28,961.30
| 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 803 | ||||||
United | 803 | $49293.57 | 1992815195 - OCHSNER BAPTIST MEDICAL CENTER | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | General Acute Care Hospital (282N00000X) |
United | 803 | $47825.03 | 1831550060 - LEXINGTON MEDICAL CENTER | 852276567 - LEXINGTON HEALTH INC | SC | General Acute Care Hospital (282N00000X) |
United | 803 | $20313.30 | 1881792547 - MERCY HOSPITALS EAST COMMUNITIES, MERCY HOSPITAL ST LOUIS | 430653493 - MERCY HOSPITALS EAST COMMUNITIES | MO | Psychiatric Hospital Unit (273R00000X) |
United | 803 | $22246.36 | 1225125859 - BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INC, BMH-NORTH MISSISSIPPI | 640772726 - BAPTIST MEMORIAL HOSPITAL-NORTH MISSISSIPPI INC | MS | Rehabilitation Hospital Unit (273Y00000X) |
United | 803 | $10369.00 | 1902901333 - CLARA MAASS MEDICAL CENTER | 221500556 | NJ | General Acute Care Hospital (282N00000X) |
United | 803 | $34394.82 | 1942287362 - OCHSNER CLINIC FOUNDATION, OCHSNER FOUNDATION HOSPITAL PSYCH | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Psychiatric Hospital Unit (273R00000X) |
United | 803 | $34425.62 | 1619187192 - AVERA MCKENNAN, OUTPATIENT PHYSICAL THERAPY - O.I. | 460224743 - AVERA MCKENNAN | SD | General Acute Care Hospital (282N00000X) |
United | 803 | $30519.08 | 1407854771 - THE TOLEDO HOSPITAL | 344428256 - (OH) TOLEDO HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 803 | $500.00 | 1457694804 - HOUSTON COUNTY COMMUNITY HOSPITAL | 462490116 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 803 | $61123.42 | 1568785137 - STATEN ISLAND UNIVERSITY HOSPITAL | 112868878 - (NY) STATEN ISLAND UNIVERSITY HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 803 | $40016.17 | 1710938949 - NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC, THOMASVILLE MEDICAL CENTER | 560636250 - NOVANT HEALTH THOMASVILLE MEDICAL CENTER LLC | NC | Psychiatric Hospital Unit (273R00000X) |
United | 803 | $30464.69 | 1285786228 - INOVA HEALTH CARE SERVICES, INOVA LOUDOUN HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | Psychiatric Hospital Unit (273R00000X) |
United | 803 | $12772.40 | 1083624647 - SCOTLAND COUNTY MEMORIAL HOSPITAL | 430915648 | MO | Critical Access Hospital (282NC0060X) |
United | 803 | $21918.91 | 1689627903 - ORO VALLEY HOSPITAL LLC, NORTHWEST TRANSITIONS | 522379881 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 803 | $22227.78 | 1386796670 - ST. ANTHONY'S HOSPITAL ASSOCIATION, ST. VINCENT MORRILTON | 710245507 - (AR) ST ANTHONYS HOSPITAL ASSOCIATION | AR | 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 803 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 803 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 803 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 |
|---|---|---|
| 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 |
| 803-MS-DRG | High | Other O.R. Procedures of the Blood and Blood Forming Organs with CC |
| 804-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 803. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 803 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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