MS-DRG 809 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 809 by major payers:
$14,601.63
$16,321.94
$19,589.34
$19,925.29
| 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 809 | ||||||
United | 809 | $21921.44 | 1871568725 - CANONSBURG GENERAL HOSPITAL, CANONSBURG GENERAL HOSPITAL-REHAB | 251737079 - (PA) HIGHMARK HEALTH | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 809 | $46513.89 | 1104856095 - DESERT REGIONAL MEDICAL CENTER, INC., DESERT REGIONAL MEDICAL CENTER | 752694137 | CA | General Acute Care Hospital (282N00000X) |
United | 809 | $46513.89 | 1104856095 - DESERT REGIONAL MEDICAL CENTER, INC., DESERT REGIONAL MEDICAL CENTER | 752694137 | CA | General Acute Care Hospital (282N00000X) |
United | 809 | $12685.50 | 1700824398 - MIAMI COUNTY MEDICAL CENTER INC, MIAMI COUNTY MEDICAL CENTER | 481155548 - (KS) MIAMI COUNTY MEDICAL CENTER INC | KS | General Acute Care Hospital (282N00000X) |
United | 809 | $16120.17 | 1477537363 - VHS OF PHOENIX INC, ABRAZO CENTRAL CAMPUS | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 809 | $32585.03 | 1770626426 - DIGNITY HEALTH, ST. ROSE DOMINICAN HOSPITAL, SIENA CAMPUS | 880455713 - (NV) DIGNITY HEALTH | NV | General Acute Care Hospital (282N00000X) |
United | 809 | $16120.17 | 1477537363 - VHS OF PHOENIX INC, ABRAZO CENTRAL CAMPUS | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 809 | $20614.83 | 1265063010 - HONORHEALTH, HONORHEALTH SONORAN CROSSING MEDICAL CENTER | 860181654 - HONORHEALTH | AZ | General Acute Care Hospital (282N00000X) |
United | 809 | $16581.94 | 1699541870 - STATE UNIVERSITY OF IOWA, UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER DOWNTOWN | 426004813 | IA | General Acute Care Hospital (282N00000X) |
United | 809 | $26808.57 | 1750940987 - UCH-MHS, MEMORIAL HEALTH SYSTEM | 460796114 - (CO) UCH-MHS | CO | General Acute Care Hospital (282N00000X) |
United | 809 | $12054.32 | 1790174860 - PRIME HEALTHCARE SERVICES MESQUITE LLC | 472177648 | TX | General Acute Care Hospital (282N00000X) |
United | 809 | $24554.71 | 1427618305 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 809 | $16581.94 | 1699541870 - STATE UNIVERSITY OF IOWA, UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER DOWNTOWN | 426004813 | IA | General Acute Care Hospital (282N00000X) |
United | 809 | $33668.62 | 1427041581 - NORWALK HOSPITAL ASSOCIATION | 66068853 - (CT) NORWALK HOSPITAL ASSOCIATION | CT | General Acute Care Hospital (282N00000X) |
United | 809 | $14018.00 | 1073954186 - NORTHWEST HOSPITAL LLC, NORTHWEST MEDICAL CENTER | 621762430 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
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 809 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 809 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 809 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 |
|---|---|---|
| 808-MS-DRG | High | Major Hematological and Immunological Diagnoses except Sickle Cell Crisis and Coagulation Disorders with MCC |
| 809-MS-DRG | High | Major Hematological and Immunological Diagnoses except Sickle Cell Crisis and Coagulation Disorders with CC |
| 810-APR-DRG | High | HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION |
| 810-MS-DRG | High | Major Hematological and Immunological Diagnoses except Sickle Cell Crisis and Coagulation Disorders without CC/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 809. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 809 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 809) and we'll show you how you compare in 15 minutes or less.