MS-DRG 819 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 819 by major payers:
$10,333.53
$11,657.25
$13,078.47
$13,292.34
| 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 819 | ||||||
United | 819 | $14835.80 | 1538193123 - ST. MARY'S MEDICAL CENTER, INC, ST. MARY'S MEDICAL CENTER | 752932830 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 819 | $9635.51 | 1851496152 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. CLARE HOSPITAL - FENTON | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 819 | $7538.10 | 1932213600 - RUSH UNIVERSITY MEDICAL CENTER | 362174823 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | 819 | $5392.00 | 1336404169 - MANCHESTER MEMORIAL HOSPITAL | 812216981 | CT | General Acute Care Hospital (282N00000X) |
United | 819 | $13590.63 | 1417152745 - HONORHEALTH, SCOTTSDALE HEALTHCARE THOMPSON PEAK MEDICAL CENTER | 860181654 - HONORHEALTH | AZ | General Acute Care Hospital (282N00000X) |
United | 819 | $14538.59 | 1720454341 - SMSJ TUCSON HOLDINGS LLC, BRIDGES GEROPSYCHIATRIC PROGRAM AT ST. MARYS HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 819 | $18690.50 | 1598755324 - ST. ANTHONY COMMUNITY HOSPITAL | 141340100 - (NY) BON SECOURS CHARITY HEALTH SYSTEM INC | NY | General Acute Care Hospital (282N00000X) |
United | 819 | $9559.04 | 1063489458 - OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY, LLC | 731623669 - (OK) OKLAHOMA CENTER FOR ORTHOPAEDIC MULTISPECIALTY SURGERY LLC | OK | General Acute Care Hospital (282N00000X) |
United | 819 | $9253.44 | 1174687040 - AITKIN COMMUNITY HOSPITAL, INC., RIVERWOOD HEALTHCARE CENTER | 410745522 - (MN) AITKIN COMMUNITY HOSPITAL INC | MN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 819 | $11795.73 | 1760413777 - THEDACARE MEDICAL CENTER, COMMUNITY HEALTH NETWORK, INC AND BERLIN MEMORIAL HOSPITAL | 390806359 - (WI) THEDACARE MEDICAL CENTER-BERLIN INC | WI | Critical Access Hospital (282NC0060X) |
United | 819 | $15541.25 | 1407803638 - ASCENSION NE WISCONSIN, INC, ASCENSION NE WISCONSIN-ST ELIZABETH CAMPUS | 390816818 - ASCENSION NE WISCONSIN INC | WI | General Acute Care Hospital (282N00000X) |
United | 819 | $11595.00 | 1386897148 - JERSEY CITY MEDICAL CENTER, LIBERTY HOSPITALIST SERVICES | 222783298 - (NJ) JERSEY CITY MEDICAL CENTER | NJ | Hospitalist Physician (208M00000X) |
United | 819 | $7625.00 | 1265423917 - KINGMAN HEALTHCARE, INC, KINGMAN HOSPITAL, INC | 942916102 - KINGMAN HEALTHCARE INC | AZ | General Acute Care Hospital (282N00000X) |
United | 819 | $12578.49 | 1033107214 - SWEDISH EDMONDS, PUBLIC HOSPITAL DISTRICT 2 OF SNOHOMISH COUNTY | 272305304 - (WA) SWEDISH EDMONDS | WA | General Acute Care Hospital (282N00000X) |
United | 819 | $11508.74 | 1952900920 - VANDERBILT BEDFORD HOSPITAL, LLC, VANDERBILT BEDFORD HOSPITAL | 853419620 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
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 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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