MS-DRG 807 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 807 by major payers:
$7,221.79
$7,933.81
$10,011.27
$10,340.27
| 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 807 | ||||||
United | 807 | $6313.08 | 1235344409 - DARDANELLE COMMUNITY HOSPITAL LLC, RIVER VALLEY MEDICAL CENTER | 834538290 - (AR) DARDANELLE REGIONAL LLC | AR | Critical Access Hospital (282NC0060X) |
United | 807 | $4980.72 | 1467493551 - MERCY HEALTH, MERCY HEALTH ST VINCENT MEDICAL CENTER | 344428250 - MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC | OH | General Acute Care Hospital (282N00000X) |
United | 807 | $12086.00 | 1295780476 - HTI MEMORIAL HOSPITAL CORPORATION, TRISTAR SKYLINE MEDICAL CENTER | 621560757 | TN | General Acute Care Hospital (282N00000X) |
United | 807 | $9315.00 | 1316992134 - NAPLES HMA LLC, PHYSICIANS REGIONAL MEDICAL CENTER-PINE RIDGE | 204401957 | FL | General Acute Care Hospital (282N00000X) |
United | 807 | $12086.00 | 1295780476 - HTI MEMORIAL HOSPITAL CORPORATION, TRISTAR SKYLINE MEDICAL CENTER | 621560757 | TN | General Acute Care Hospital (282N00000X) |
United | 807 | $9027.37 | 1235183542 - CLEVELAND CLINIC HEALTH SYSTEM, SOUTH POINTE HOSPITAL | 340714593 - CLEVELAND CLINIC HEALTH SYSTEM EAST REGION | OH | General Acute Care Hospital (282N00000X) |
United | 807 | $10293.00 | 1932125606 - WEST PENN ALLEGHENY HEALTH SYSTEM INC., FORBES REGIONAL HOSPITAL - PSYCH | 250969492 - (PA) HIGHMARK HEALTH | PA | Psychiatric Hospital Unit (273R00000X) |
United | 807 | $5268.00 | 1457448037 - BAPTIST HEALTH CARE, INC. | 590657322 - BAPTIST HEALTH CARE INC | FL | Psychiatric Hospital Unit (273R00000X) |
United | 807 | $6358.83 | 1720212095 - EAST TEXAS MEDICAL CENTER HENDERSON, ETMC SWING BED | 824019349 | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 807 | $6358.83 | 1720212095 - EAST TEXAS MEDICAL CENTER HENDERSON, ETMC SWING BED | 824019349 | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 807 | $10875.87 | 1619934627 - ST. CLOUD HOSPITAL | 410695596 - (MN) ST CLOUD HOSPITAL | MN | Rehabilitation Hospital Unit (273Y00000X) |
United | 807 | $6159.00 | 1619115383 - ASCENSION SETON, ASCENSION SETON HAYS | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 807 | $5071.62 | 1740287531 - GUTHRIE CORTLAND MEDICAL CENTER | 150532079 - (NY) GUTHRIE CORTLAND MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 807 | $3720.00 | 1225083074 - OLEAN GENERAL HOSPITAL | 160743102 - OLEAN GENERAL HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 807 | $13500.58 | 1396882205 - VANDERBILT UNIVERSITY MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | 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 807 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 807 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 807 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 |
|---|---|---|
| 806-MS-DRG | High | Vaginal Delivery without Sterilization or D&C with CC |
| 807-MS-DRG | High | Vaginal Delivery without Sterilization or D&C without CC/MCC |
| 808-MS-DRG | High | Major Hematological and Immunological Diagnoses except Sickle Cell Crisis and Coagulation Disorders 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 807. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 807 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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