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See a sample rate comparisonMS-DRG 804 Fee Schedule
Last Verified: October 2026
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.
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
| Key Fact | Detail |
|---|---|
| Service Type | Diseases & Disorders of Blood, Blood Forming Organs, Immunologic Disorders |
| 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
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MS-DRG 804
5 of 25 sample ratesHigher to lower in this preview
Twin Cities Community Hospital, Inc., Twin Cities Community Hospital
Twin Cities Community Hospital Inc
$61,716.80Published rateFoundation Bariatric Hospital Of San Antonio, LLC, Foundation Surgical Hospital Of San Antonio
Foundation Bariatric Hospital Of San Antonio, LLC
$19,192.10Published rateDecatur County Memorial Hospital, Decatur County Memorial Hospital Diagnostic Center
Decatur County Memorial Hospital
$14,372.79Published ratePmc Hospital, LLC, St. Luke'S Patients Medical Center
Pmc Hospital, LLC
$11,533.62Published rateWellmont Health System, Lonesome Pine Swing Bed
Wellmont Health System
$2,626.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 804 vs. Other Diseases & Disorders of Blood, Blood Forming Organs, Immunologic Disorders Codes
The MS-DRG 804 code is part of the Diseases & Disorders of Blood, Blood Forming Organs, Immunologic Disorders 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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