MS-DRG 805 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 805 by major payers:
$10,953.71
$10,022.86
$13,586.41
$15,753.09
| 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 805 | ||||||
United | 805 | $13731.48 | 1902868391 - BAPTIST HEALTH, BAPTIST HEALTH MEDICAL CENTER- HOT SPRING COUNTY | 710236856 - (AR) BAPTIST HEALTH | AR | General Acute Care Hospital (282N00000X) |
United | 805 | $5533.00 | 1487603585 - CAMBRIDGE PUBLIC HEALTH COMMISSION, CAMBRIDGE HEALTH ALLIANCE | 43320571 | MA | General Acute Care Hospital (282N00000X) |
United | 805 | $11218.46 | 1205482023 - OCHSNER MORGAN CITY LLC, OCHSNER ST. MARY | 842237042 | LA | General Acute Care Hospital (282N00000X) |
United | 805 | $2567.00 | 1679733497 - TALLAHATCHIE GENERAL HOSPITAL | 646010664 | MS | Critical Access Hospital (282NC0060X) |
United | 805 | $20404.63 | 1942404165 - ST JUDE HOSPITAL INC, PROVIDENCE ST. JUDE MEDICAL CENTER | 951643325 - (CA) ST JUDE HOSPITAL | CA | Rehabilitation Hospital (283X00000X) |
United | 805 | $17361.67 | 1629369681 - UNIVERSITY OF KANSAS HOSPITAL AUTHORITY, UNIVERSITY OF KANSAS HOSPITAL / UNIVERSITY OF KANSAS CANCER CENTER | 481202402 - UNIVERSITY OF KANSAS HOSPITAL AUTHORITY | KS | General Acute Care Hospital (282N00000X) |
United | 805 | $11248.00 | 1801826839 - BAYLOR SCOTT & WHITE MEDICAL CENTER | 824052186 - (TX) BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIAL | TX | General Acute Care Hospital (282N00000X) |
United | 805 | $12325.29 | 1750661534 - AHS SOUTHCREST HOSPITAL, LLC., HILLCREST HOSPITAL SOUTH | 452711804 | OK | General Acute Care Hospital (282N00000X) |
United | 805 | $11653.90 | 1407804669 - THE LOWELL GENERAL HOSPITAL, LOWELL GENERAL HOSPITAL | 42103590 - (MA) THE LOWELL GENERAL HOSPITAL | MA | General Acute Care Hospital (282N00000X) |
United | 805 | $10345.00 | 1447597240 - BAYLOR UNIVERSITY MEDICAL CENTER | 751837454 - (TX) BAYLOR UNIVERSITY MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 805 | $10345.00 | 1609855139 - TEXAS HEART HOSPITAL OF THE SOUTHWEST, LLC, BAYLOR SCOTT & WHITE HEART AND VASCULAR HOSPITAL - DALLAS | 412101361 - (TX) TEXAS HEART HOSPITAL OF THE SOUTHWEST, L.L.P | TX | General Acute Care Hospital (282N00000X) |
United | 805 | $25601.68 | 1831220714 - INOVA HEALTH CARE SERVICES, INOVA FAIRFAX HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | General Acute Care Hospital (282N00000X) |
United | 805 | $21602.71 | 1295225274 - UCH-MHS, UCHEALTH EMERGENCY ROOM - FOUNTAIN | 460796114 - (CO) UCH-MHS | CO | General Acute Care Hospital (282N00000X) |
United | 805 | $17814.30 | 1285049072 - CARLE HOSPITAL | 371119538 - THE CARLE FOUNDATION HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 805 | $11218.46 | 1205482023 - OCHSNER MORGAN CITY LLC, OCHSNER ST. MARY | 842237042 | LA | General Acute Care Hospital (282N00000X) |
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 805 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 805 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 805 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 |
|---|---|---|
| 804-APR-DRG | Moderate | Acute Major Eye Infections |
| 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 |
| 806-MS-DRG | High | Vaginal Delivery without Sterilization or D&C with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 805. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 805 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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