MS-DRG 815 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 815 by major payers:
$12,267.66
$13,859.01
$16,069.77
$16,467.96
| 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 815 | ||||||
United | 815 | $17956.51 | 1003961251 - CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND, CHILDREN'S HOSP MED CTR OF NO CALIFORNIA | 992646504 | CA | General Acute Care Hospital (282N00000X) |
United | 815 | $14635.42 | 1407815830 - ST. CATHERINE OF SIENA MEDICAL CENTER | 61562701 - (NY) ST CATHERINE OF SIENA MEDICAL CENTER | NY | Psychiatric Hospital Unit (273R00000X) |
United | 815 | $13120.90 | 1396109500 - GOTTLIEB MEMORIAL HOSPITAL | 362379649 - (IL) GOTTLIEB MEMORIAL HOSPITAL | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 815 | $10339.53 | 1205076528 - ENCOMPASS HEALTH REHABILITATION HOSPITAL OF EAST VALLEY, LLC, ENCOMPASS HEALTH REHABILITATION HOSPITAL OF EAST VALLEY | 262942698 - (AZ) ENCOMPASS HEALTH REHABILITATION HOSPITAL OF EAST VALLEY LLC | AZ | Rehabilitation Hospital (283X00000X) |
United | 815 | $11709.00 | 1043457955 - NEWARK BETH ISRAEL MEDICAL CENTER INC, NEWARK BETH ISRAEL MEDICAL CENTER | 223452311 | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 815 | $10563.62 | 1912997024 - MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION, MORRISTOWN HAMBLEN HEALTHCARE SYSTEM | 620545814 - (TN) MORRISTOWN HAMBLEN HOSP | TN | General Acute Care Hospital (282N00000X) |
United | 815 | $21269.00 | 1407020118 - BOARD OF TRUSTEE OF HOWARD COMMUNITY HOSPITAL, HOWARD REGIONAL HEALTH SYSTEM | 351865344 - (IN) COMMUNITY HOWARD REGIONAL HEALTH INC | IN | General Acute Care Hospital (282N00000X) |
United | 815 | $3564.00 | 1033214440 - JOHNSTON MEMORIAL HOSPITAL, JOHNSTON MEMORIAL HOSPITAL ER PHYSICIANS | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | General Acute Care Hospital (282N00000X) |
United | 815 | $11668.88 | 1023014206 - NORTON HOSPITALS, INC, NORTON HOSPITAL | 610703799 - (KY) NORTON HOSPITALS INC | KY | Psychiatric Hospital Unit (273R00000X) |
United | 815 | $9578.00 | 1992700983 - BAYLOR MEDICAL CENTER AT IRVING, BAYLOR SCOTT & WHITE MEDICAL CENTER - IRVING | 752586857 - (TX) BAYLOR MEDICAL CENTER AT IRVING | TX | General Acute Care Hospital (282N00000X) |
United | 815 | $11074.38 | 1386188068 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatric Hospital Unit (273R00000X) |
United | 815 | $28074.83 | 1861628752 - HUGHSTON HOSPITAL, INC., NORTHSIDE MEDICAL CENTER | 331216751 - (GA) HUGHSTON HOSPITAL INC | GA | Rehabilitation Hospital Unit (273Y00000X) |
United | 815 | $17956.51 | 1003961251 - CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND, CHILDREN'S HOSP MED CTR OF NO CALIFORNIA | 992646504 | CA | General Acute Care Hospital (282N00000X) |
United | 815 | $15042.33 | 1912997024 - MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION, MORRISTOWN HAMBLEN HEALTHCARE SYSTEM | 620545814 - (TN) MORRISTOWN HAMBLEN HOSP | TN | General Acute Care Hospital (282N00000X) |
United | 815 | $10984.04 | 1871584722 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS COUSHATTA RURAL HEALTH CENTER | 720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANA | LA | Critical Access Hospital Clinic/Center (261QC0050X) |
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 815 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 815 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 815 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 |
|---|---|---|
| 814-MS-DRG | High | Reticuloendothelial and Immunity Disorders with MCC |
| 815-MS-DRG | High | Reticuloendothelial and Immunity Disorders with CC |
| 816-APR-DRG | High | TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES |
| 816-MS-DRG | High | Reticuloendothelial and Immunity 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 815. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 815 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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