MS-DRG 816 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 816 by major payers:
$8,382.02
$9,478.64
$10,587.28
$10,910.91
| 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 816 | ||||||
United | 816 | $5052.35 | 1699754812 - HARDIN COUNTY GENERAL HOSPITAL, HARDIN MEDICAL CENTER | 626002428 - (TN) HARDIN COUNTY GENERAL HOSPITAL | TN | General Acute Care Hospital (282N00000X) |
United | 816 | $16180.87 | 1033120423 - TEXAS HEALTH HUGULEY, INC., TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH | 452694620 - (TX) TEXAS HEALTH HUGULEY INC | TX | General Acute Care Hospital (282N00000X) |
United | 816 | $9651.63 | 1073799664 - THEDACARE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER, INC. | 390871113 - (WI) THEDACARE MEDICAL CENTER-WAUPACA INC | WI | Critical Access Hospital (282NC0060X) |
United | 816 | $12574.09 | 1538236385 - ST VINCENT JENNINGS HOSPITAL INC, SWING BED | 743107055 - (IN) ST VINCENT CARMEL HOSPITAL INC | IN | Critical Access Hospital (282NC0060X) |
United | 816 | $10413.90 | 1316324403 - INDIANA SPINE HOSPITAL, LLC, INDIANA SPINE HOSPITAL | 473759447 - (IN) INDIANA SPINE HOSPITAL | IN | Special Hospital (284300000X) |
United | 816 | $11089.79 | 1104136142 - PARK NICOLLET- METHODIST HOSPITAL | 410132080 - (MN) PARK NICOLLET HEALTH SERVICES | MN | General Acute Care Hospital (282N00000X) |
United | 816 | $15870.12 | 1124341672 - BANNER IRONWOOD MEDICAL CENTER | 900412842 | AZ | General Acute Care Hospital (282N00000X) |
United | 816 | $7320.66 | 1578529954 - AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY, A.O. FOX MEMORIAL HOSPITAL | 150539039 - (NY) AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY | NY | General Acute Care Hospital (282N00000X) |
United | 816 | $12359.61 | 1265195770 - MERCY HEALTH, MERCY HEALTH - ST. CHARLES PHYSICAL MEDICINE & REHABILITATION | 344428250 - MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 816 | $10963.83 | 1467537886 - MERCY HEALTH SERVICES-IOWA CORP, MERCY MEDICAL CENTER-NORTH IOWA | 311373080 - MERCY HEALTH SERVICES IOWA CORP | IA | Rural Acute Care Hospital (282NR1301X) |
United | 816 | $7277.79 | 1043213911 - CONDELL MEDICAL CENTER | 262525968 - (IL) ADVOCATE HEALTH CARE NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 816 | $4382.02 | 1811905375 - CAMERON REGIONAL MEDICAL CENTER INC, CAMERON COMMUNITY HOSPITAL | 440668347 - (MO) CAMERON REGIONAL MEDICAL CENTER INC | MO | General Acute Care Hospital (282N00000X) |
United | 816 | $13684.12 | 1255317848 - GREENE MEMORIAL HOSPITAL INC, KETTERING HEALTH GREENE MEMORIAL | 310809436 - (OH) GREENE MEMORIAL HOSPITAL INC | OH | General Acute Care Hospital (282N00000X) |
United | 816 | $7267.25 | 1134162746 - LONE STAR HMA L P, MESQUITE COMMUNITY HOSPITAL | 472177648 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 816 | $7721.56 | 1962451195 - BROOKDALE HOSPITAL MEDICAL CENTER, BROOKDALE EMERGENCY PHYSICIANS ASSOCIATES | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | 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 816 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 816 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 816 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 |
|---|---|---|
| 815-APR-DRG | High | OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES |
| 815-MS-DRG | High | Reticuloendothelial and Immunity Disorders with CC |
| 816-MS-DRG | High | Reticuloendothelial and Immunity Disorders without CC/MCC |
| 817-APR-DRG | High | INTENTIONAL SELF-HARM & ATTEMPTED SUICIDE |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 816 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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