MS-DRG 811 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 811 by major payers:
$16,067.84
$18,639.40
$22,040.63
$22,544.29
| 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 811 | ||||||
United | 811 | $12375.51 | 1467427674 - HOSPITAL DISTRICT NO 6 OF HARPER COUNTY KANSAS, PATTERSON HEALTH CENTER | 480993940 - (KS) HOSPITAL DISTRICT NO 6 OF HARPER COUNTY KANSAS | KS | Critical Access Hospital (282NC0060X) |
United | 811 | $10551.00 | 1730620428 - JERSEY CITY MEDICAL CENTER-RWJ BARNABAS HEALTH | 222783298 - (NJ) JERSEY CITY MEDICAL CENTER | NJ | General Acute Care Hospital (282N00000X) |
United | 811 | $13708.83 | 1760243562 - HH HEALTH SYSTEM | 934333907 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 811 | $16518.41 | 1689282147 - BAPTIST HEALTHCARE SYSTEM INC, BAPTIST HEALTH HARDIN | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | General Acute Care Hospital (282N00000X) |
United | 811 | $20747.55 | 1063713659 - RCHP-WILMINGTON, LLC, CLINTON MEMORIAL HOSPITAL | 273633811 | OH | General Acute Care Hospital (282N00000X) |
United | 811 | $11042.00 | 1609983790 - MONMOUTH MEDICAL CENTER INC | 223452412 | NJ | General Acute Care Hospital (282N00000X) |
United | 811 | $11042.00 | 1609983790 - MONMOUTH MEDICAL CENTER INC | 223452412 | NJ | General Acute Care Hospital (282N00000X) |
United | 811 | $19357.53 | 1609804822 - BAPTIST HEALTH, BAPTIST HEALTH MEDICAL CENTER - HEBER SPRINGS | 710236856 - (AR) BAPTIST HEALTH | AR | Critical Access Hospital (282NC0060X) |
United | 811 | $33252.07 | 1861009672 - NORCAL HEALTHCONNECT LLC, HEALDSBURG HOSPITAL | 852390012 | CA | Critical Access Hospital (282NC0060X) |
United | 811 | $2060.00 | 1699714717 - GREENWOOD LEFLORE HOSPITAL | 646000400 - (MS) GREENWOOD LEFLORE HOSPITAL | MS | General Acute Care Hospital (282N00000X) |
United | 811 | $31474.33 | 1942267869 - MARIN GENERAL HOSPITAL | 942823538 - (CA) MARIN GENERAL HOSPITAL | CA | Psychiatric Hospital Unit (273R00000X) |
United | 811 | $13346.87 | 1669403846 - KITTSON MEMORIAL HOSPITAL ASSOCIATION, KITTSON MEMORIAL HOSPITAL ASSOCIATION | 410724034 - (MN) KITTSON MEMORIAL HOSPITAL ASSOCIATION | MN | Critical Access Hospital (282NC0060X) |
United | 811 | $24931.66 | 1730121104 - UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC | 311479038 | OH | Psychiatric Hospital Unit (273R00000X) |
United | 811 | $18883.41 | 1033284666 - FRANCISCAN HEALTH MICHIGAN CITY, FRANCISCAN ST. ANTHONY HEALTH - MICHIGAN CITY | 350876394 - (IN) FRANCISCAN HEALTH MICHIGAN CITY | IN | Psychiatric Hospital Unit (273R00000X) |
United | 811 | $28327.92 | 1760764849 - BEAVERCREEK MEDICAL CENTER, SOIN MEDICAL CENTER | 270712680 - (OH) BEAVERCREEK MEDICAL CENTER | OH | 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 811 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 811 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 811 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 |
|---|---|---|
| 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 |
| 811-MS-DRG | High | Red Blood Cell Disorders with MCC |
| 812-APR-DRG | High | POISONING OF MEDICINAL AGENTS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 811. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 811 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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