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 | $10968.63 | 1033710116 - MCLAREN MACOMB | 381218516 - (MI) MCLAREN MACOMB | MI | Rehabilitation Hospital Unit (273Y00000X) |
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 | $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 | $6893.02 | 1538252721 - VILLA MARIA NURSING & REHABILITATION CENTER, ST. CATHERINE'S REHABILITATION HOSPITAL | 591284678 - (FL) VILLA MARIA NURSING & REHABILITATION CENTER | FL | Rehabilitation Hospital (283X00000X) |
United | 804 | $2626.00 | 1447285432 - WELLMONT HEALTH SYSTEM, LONESOME PINE SWING BED | 621636465 - WELLMONT HEALTH SYSTEM | VA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
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 | $38711.48 | 1861559007 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | Rehabilitation Hospital Unit (273Y00000X) |
United | 804 | $61716.80 | 1396778197 - TWIN CITIES COMMUNITY HOSPITAL, INC., TWIN CITIES COMMUNITY HOSPITAL | 752918765 - (CA) TWIN CITIES COMMUNITY HOSPITAL INC | CA | General Acute Care Hospital (282N00000X) |
United | 804 | $11832.12 | 1427132604 - GENESIS HEALTH SYSTEM, GENESIS MEDICAL CENTER - SILVIS | 363616314 - GENESIS HEALTH SYSTEM | IL | General Acute Care Hospital (282N00000X) |
United | 804 | $12153.86 | 1891870812 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 804 | $29745.06 | 1518902592 - AHS HOSPITAL CORP., OVERLOOK HOSPITAL | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 804 | $18497.33 | 1659461895 - NEBRASKA METHODIST HOSPITAL, METHODIST HOSPITAL | 470376604 - NEBRASKA METHODIST HOSPITAL | NE | Rehabilitation Hospital Unit (273Y00000X) |
United | 804 | $19192.10 | 1932284411 - FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC, FOUNDATION SURGICAL HOSPITAL OF SAN ANTONIO | 203793927 - (TX) FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 804 | $26866.03 | 1982738571 - TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | 751977850 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | TX | Chronic Disease Hospital (281P00000X) |
United | 804 | $7020.31 | 1174563779 - ANDREWS COUNTY HOSPITAL DISTRICT, PERMIAN REGIONAL MEDICAL CENTER | 751997880 - (TX) ANDREWS COUNTY HOSPITAL DISTRICT | TX | Rural Acute Care Hospital (282NR1301X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 804) and we'll show you how you compare in 15 minutes or less.