MS-DRG 804 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 804 by major payers:
$14,865.49
$15,141.02
$17,872.45
$18,261.43
| 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 804 | ||||||
United | 804 | $15812.29 | 1154748416 - AGH LAVEEN LLC, DIGNITY HEALTH ARIZONA GENERAL HOSPITAL | 471587223 - (AZ) AGH LAVEEN LLC | AZ | General Acute Care Hospital (282N00000X) |
United | 804 | $37507.01 | 1003854688 - SCRIPPS HEALTH, SCRIPPS MEMORIAL HOSPITAL ENCINITAS REHAB UNIT | 951684089 - SCRIPPS HEALTH | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 804 | $12260.13 | 1124272547 - ADVOCATE CONDELL MEDICAL CENTER | 262525968 - (IL) ADVOCATE HEALTH CARE NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 804 | $9307.98 | 1710396932 - OSF HEALTHCARE SYSTEM, OSF SAINT ANTHONY'S HEALTH CENTER | 370813229 - (IL) OSF HEALTHCARE SYSTEM | IL | General Acute Care Hospital (282N00000X) |
United | 804 | $38711.48 | 1861559007 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | Rehabilitation Hospital Unit (273Y00000X) |
United | 804 | $12153.86 | 1669558771 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 804 | $38711.48 | 1861559007 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | Rehabilitation Hospital Unit (273Y00000X) |
United | 804 | $10968.63 | 1033710116 - MCLAREN MACOMB | 381218516 - (MI) MCLAREN MACOMB | MI | Rehabilitation Hospital Unit (273Y00000X) |
United | 804 | $11494.00 | 1992700983 - BAYLOR MEDICAL CENTER AT IRVING, BAYLOR SCOTT & WHITE MEDICAL CENTER - IRVING | 752586857 - (TX) BAYLOR MEDICAL CENTER AT IRVING | TX | General Acute Care Hospital (282N00000X) |
United | 804 | $14372.79 | 1952300477 - DECATUR COUNTY MEMORIAL HOSPITAL | 351141109 - DECATUR COUNTY MEMORIAL HOSPITAL | IN | Critical Access Hospital (282NC0060X) |
United | 804 | $7383.00 | 1992703540 - DUKE UNIVERSITY HEALTH SYSTEM, INC., DUKE UNIVERSITY HOSPITAL | 562070036 - DUKE UNIVERSITY HEALTH SYSTEM INC | NC | General Acute Care Hospital (282N00000X) |
United | 804 | $29652.30 | 1114015971 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE ST VINCENT MEDICAL CENTER | 930386929 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | General Acute Care Hospital (282N00000X) |
United | 804 | $17660.84 | 1992776421 - WHITE COUNTY COMMUNITY HOSPITAL LLC, HIGHLANDS MEDICAL CENTER | 474063406 | TN | General Acute Care Hospital (282N00000X) |
United | 804 | $32504.64 | 1336172105 - TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | General Acute Care Hospital (282N00000X) |
United | 804 | $17477.32 | 1073799664 - THEDACARE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER, INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | 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 804 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 804 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 804 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 |
|---|---|---|
| 803-APR-DRG | Moderate | Acute Major Eye Infections |
| 803-MS-DRG | High | Other O.R. Procedures of the Blood and Blood Forming Organs with CC |
| 804-MS-DRG | High | Other O.R. Procedures of the Blood and Blood Forming Organs without CC/MCC |
| 805-MS-DRG | High | Vaginal Delivery without Sterilization or D&C 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 804. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 804 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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