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See a sample rate comparisonHealthcare 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 | Injuries, Poisonings & Toxic Effects of Drugs |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 904 by major payers:

$39,860.99

$49,222.88

$59,812.34

$61,824.32
Choose a payer to see a sample of rates for MS-DRG 904.
Brookdale Hospital Medical Center
Monroe Health Services Inc
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Rate Benchmarking
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonPayer Contract Negotiation
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalMS-DRG 904 vs. Other Injuries, Poisonings & Toxic Effects of Drugs Codes
The MS-DRG 904 code is part of the Injuries, Poisonings & Toxic Effects of Drugs 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 904 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 |
|---|---|---|
| 903-APR-DRG | Moderate | Major Larynx & Trachea Procedures |
| 903-MS-DRG | High | WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC |
| 904-MS-DRG | High | SKIN GRAFTS FOR INJURIES WITH CC/MCC |
| 905-MS-DRG | High | SKIN GRAFTS FOR INJURIES 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 904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 904 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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