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 | $9075.33 | 1841274057 - SAINT LUKE'S HOSPITAL OF TRENTON, WRIGHT MEMORIAL HOSPITAL | 431707306 - SAINT LUKES HOSPITAL OF TRENTON | MO | Critical Access Hospital (282NC0060X) |
United | 809 | $20614.83 | 1265063010 - HONORHEALTH, HONORHEALTH SONORAN CROSSING MEDICAL CENTER | 860181654 - HONORHEALTH | AZ | General Acute Care Hospital (282N00000X) |
United | 809 | $11251.76 | 1649226952 - ANDERSON REGIONAL MEDICAL CENTER, ANDERSON REGIONAL MEDICAL CENTER | 640362400 - (MS) ANDERSON REGIONAL MEDICAL CENTER | MS | General Acute Care Hospital (282N00000X) |
United | 809 | $44554.19 | 1487640207 - DISTRICT HOSPITAL PARTNERS L P, THE GEORGE WASHINGTON UNIVERSITY HOSPITAL | 232896725 | DC | General Acute Care Hospital (282N00000X) |
United | 809 | $14835.70 | 1801885413 - DISTRICT HOSPITAL HOLDINGS INC, LAKESIDE MEDICAL CENTER | 352226306 - (FL) DISTRICT HOSPITAL HOLDINGS INC | FL | Rural Acute Care Hospital (282NR1301X) |
United | 809 | $13705.24 | 1336841568 - ERLANGER HEALTH | 626000101 - ERLANGER MEDICAL CENTER | TN | Critical Access Hospital (282NC0060X) |
United | 809 | $22896.15 | 1972535052 - OHIOHEALTH CORPORATION, DOCTORS HOSPITAL | 314394942 - OHIOHEALTH CORPORATION GRANT RIVERSIDE DOCTORS DUBLIN MET | OH | General Acute Care Hospital (282N00000X) |
United | 809 | $12933.83 | 1700919768 - LARKIN COMMUNITY HOSPITAL | 650729921 - (FL) LARKIN COMMUNITY HOSPITAL, INC. | FL | Psychiatric Hospital Unit (273R00000X) |
United | 809 | $19208.98 | 1144742537 - COMMUNITY MERCY HEALTH PARTNERS, MERCY HEALTH-URBANA HOSPITAL | 310785684 - COMMUNITY MERCY HEALTH PARTNERS | OH | Psychiatric Hospital Unit (273R00000X) |
United | 809 | $33668.62 | 1427041581 - NORWALK HOSPITAL ASSOCIATION | 66068853 - (CT) NORWALK HOSPITAL ASSOCIATION | CT | 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 | $54531.16 | 1790969269 - THE NEW YORK AND PRESBYTERIAN HOSPITAL, NEW YORK-PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | 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 | $24883.93 | 1902818883 - GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1, SAMARITAN HEALTHCARE | 930386906 | WA | General Acute Care Hospital (282N00000X) |
United | 809 | $21886.76 | 1336475789 - LEE MEMORIAL HEALTH SYSTEM, LEE MEMORIAL SENIOR BEHAVIOR UNIT | 992646504 | FL | Psychiatric Hospital Unit (273R00000X) |
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 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.
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