MS-DRG 016 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 | • Pre-MDC |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 016 by major payers:
$72,208.22
$76,417.60
$95,281.12
$98,982.65
| 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 016 | ||||||
United | 016 | $70867.50 | 1619931466 - HARDIN MEMORIAL HOSPITAL | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | General Acute Care Hospital (282N00000X) |
United | 016 | $91460.70 | 1669444899 - NORTHAMPTON HOSPITAL COMPANY LLC, EASTON HOSPITAL | 844475996 - (PA) ST LUKES HOSPITAL-EASTON CAMPUS | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 016 | $23540.09 | 1578960647 - MEMORIAL MEDICAL CLINIC | 746003411 | TX | Critical Access Hospital (282NC0060X) |
United | 016 | $6500.00 | 1740558832 - SAINT MICHAEL'S MEDICAL CENTER | 463487442 | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 016 | $93068.85 | 1043382567 - CARITAS ST. ELIZABETH'S MEDICAL CENTER | 272473667 | MA | General Acute Care Hospital (282N00000X) |
United | 016 | $64646.75 | 1871805150 - VHS REHABILITATION INSTITUTE OF MICHIGAN INC, REHABILITATION INSTITUTE OF MICHIGAN | 272844407 | MI | Rehabilitation Hospital (283X00000X) |
United | 016 | $113921.57 | 1386749893 - FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE, FRANCISCAN HEALTH - INDIANAPOLIS | 350913537 | IN | General Acute Care Hospital (282N00000X) |
United | 016 | $64646.75 | 1871805150 - VHS REHABILITATION INSTITUTE OF MICHIGAN INC, REHABILITATION INSTITUTE OF MICHIGAN | 272844407 | MI | Rehabilitation Hospital (283X00000X) |
United | 016 | $99580.28 | 1548581598 - SUMNER REGIONAL MEDICAL CENTER LLC | 272618766 | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 016 | $62846.44 | 1063923340 - BANNER HEALTH, BANNER PAYSON MEDICAL CENTER | 450233470 - BANNER HEALTH | AZ | Critical Access Hospital (282NC0060X) |
United | 016 | $4958.00 | 1780680215 - RUSSELL COUNTY MEDICAL CENTER, INC, RUSSELL COUNTY MEDICAL CENTER | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | VA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 016 | $134371.20 | 1417290958 - CARONDELET HEALTH NETWORK, O'RIELLY TRANSITIONS INTENSIVE OUTPATIENT PROGRAM | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 016 | $134371.20 | 1417290958 - CARONDELET HEALTH NETWORK, O'RIELLY TRANSITIONS INTENSIVE OUTPATIENT PROGRAM | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 016 | $170862.00 | 1255396024 - INSPIRA MEDICAL CENTERS, INC., INSPIRA MEDICAL CENTER ELMER | 210634484 - (NJ) INSPIRA MEDICAL CENTERS INC | NJ | General Acute Care Hospital (282N00000X) |
United | 016 | $137104.68 | 1457382798 - TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN | 752771437 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN | TX | 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 016 vs. Other Pre-MDC Codes
The MS-DRG 016 code is part of the Pre-MDC 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 016 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 |
|---|---|---|
| 014-APR-DRG | Moderate | Liver Transplant And/Or Intestinal Transplant |
| 014-MS-DRG | High | Allogeneic Bone Marrow Transplant |
| 016-MS-DRG | High | Autologous Bone Marrow Transplant with CC/MCC |
| 017-APR-DRG | Moderate | Liver Transplant And/Or Intestinal Transplant |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 016. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 016 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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