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See a sample rate comparisonMS-DRG 819 Fee Schedule
Last Verified: October 2026
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.
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC
| 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 819 by major payers:
$10,333.53
$11,657.25
$13,078.47
$13,292.34
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MS-DRG 819
5 of 25 sample ratesHigher to lower in this preview
Westchester County Health Care Corporation, Mid-Hudson Valley Division Of Westchester Medical Center
Peo Mid-Hudson Valley Staffco
$31,934.34Published rateOhi West, Inc, Bayfront Health St Petersburg
Ohi West Inc
$19,497.19Published rateFairfield Medical Center
$11,920.90Published rateDardanelle Community Hospital LLC, River Valley Medical Center
Dardanelle Regional LLC
$8,088.25Published rateUhs-Corona Inc, Corona Regional Medical Center
$4,818.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 819 vs. Other Pregnancy, Childbirth & the Puerperium Codes
The MS-DRG 819 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 819 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 |
|---|---|---|
| 818-MS-DRG | High | OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC |
| 819-MS-DRG | High | OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC |
| 820-MS-DRG | High | LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES 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 819. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 819 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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