MS-DRG 813 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 813 by major payers:
$18,127.53
$19,368.80
$24,757.97
$24,785.07
| 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 813 | ||||||
United | 813 | $17483.67 | 1013925924 - COMMUNITY MEMORIAL HOSPITAL DISTRICT, SYRACUSE AREA HEALTH | 470761817 - (NE) COMMUNITY MEMORIAL HOSPITAL DISTRICT | NE | Critical Access Hospital (282NC0060X) |
United | 813 | $1190.00 | 1942260609 - ARKANSAS SURGICAL HOSPITAL, LLC | 710858717 - (AR) ARKANSAS SURGICAL HOSPITAL, LLC | AR | General Acute Care Hospital (282N00000X) |
United | 813 | $27563.68 | 1659456994 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 813 | $26235.50 | 1841307865 - ST. JOSEPH'S MEDICAL CENTER | 410695602 - (MN) ST JOSEPH S MEDICAL CENTER | MN | Psychiatric Hospital Unit (273R00000X) |
United | 813 | $37197.73 | 1629071758 - BRIGHTON COMMUNITY HOSPITAL ASSOCIATION, INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL | 840482695 - (CO) BRIGHTON COMMUNITY HOSPITAL ASSOCIATION | CO | General Acute Care Hospital (282N00000X) |
United | 813 | $16682.80 | 1689838245 - ODESSA REGIONAL HOSPITAL LP | 621795574 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 813 | $19673.52 | 1952012379 - CPH HOSPITAL MANAGEMENT LLC, COAST PLAZA HOSPITAL | 451738512 - (CA) AVANTI HOSPITALS, LLC | CA | Psychiatric Hospital Unit (273R00000X) |
United | 813 | $24727.75 | 1336520840 - SAINT THOMAS STONES RIVER HOSPITAL, LLC, ASCENSION SAINT THOMAS STONES RIVER | 474063232 | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 813 | $19737.00 | 1518197011 - UNITED SURGEONS, LLC, UNITY PHYSICIANS HOSPITAL | 352194353 - (IN) UNITED SURGEONS, LLC | IN | General Acute Care Hospital (282N00000X) |
United | 813 | $25297.33 | 1669752234 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 813 | $33343.44 | 1396831426 - EPHRATA COMMUNITY HOSPITAL, WELLSPAN EPHRATA COMMUNITY HOSPITAL MEDICAL REHAB UNIT | 231370484 - EPHRATA COMMUNITY HOSPITAL | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 813 | $15301.98 | 1427050376 - SCHUYLKILL MEDICAL CENTER, GOOD SAMARITAN REGIONAL MEDICAL CENTER | 231352202 - (PA) LEHIGH VALLEY HOSPITAL - SCHUYKILL | PA | General Acute Care Hospital (282N00000X) |
United | 813 | $27849.39 | 1689672693 - SAINT CLARE HOSPITAL, ST. CLARE HOSPITAL | 911487485 | WA | General Acute Care Hospital (282N00000X) |
United | 813 | $9229.25 | 1831140979 - SUTTON COUNTY HOSPITAL DISTRICT, LILLIAN M HUDSPETH MEMORIAL HOSPITAL | 752152933 | TX | Critical Access Hospital (282NC0060X) |
United | 813 | $17028.00 | 1871137513 - CANYON ATLANTIC | 843385649 | TX | 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 813 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 813 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 813 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 |
|---|---|---|
| 812-APR-DRG | High | POISONING OF MEDICINAL AGENTS |
| 812-MS-DRG | High | Red Blood Cell Disorders without MCC |
| 813-MS-DRG | High | Coagulation Disorders |
| 814-MS-DRG | High | Reticuloendothelial and Immunity 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 813. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 813 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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