MS-DRG 069 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 | • Diseases & Disorders of the Nervous System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 069 by major payers:
$9,362.23
$10,943.18
$13,532.93
$13,586.30
| 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 069 | ||||||
United | 069 | $3032.00 | 1134227606 - SOUTH SHORE HOSPITAL INC. | 42769210 - SOUTH SHORE HOSPITAL INC | MA | General Acute Care Hospital (282N00000X) |
United | 069 | $8607.58 | 1154406254 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 069 | $11049.37 | 1831970532 - VHS SAN ANTONIO PARTNERS, LLC | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 069 | $17200.55 | 1568493922 - UNIVERSITY OF CALIFORNIA IRVINE, UCI HEALTH - LOS ALAMITOS | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | CA | General Acute Care Hospital (282N00000X) |
United | 069 | $9393.96 | 1689282147 - BAPTIST HEALTHCARE SYSTEM INC, BAPTIST HEALTH HARDIN | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | General Acute Care Hospital (282N00000X) |
United | 069 | $14617.80 | 1407803638 - ASCENSION NE WISCONSIN, INC, ASCENSION NE WISCONSIN-ST ELIZABETH CAMPUS | 390816818 - ASCENSION NE WISCONSIN INC | WI | General Acute Care Hospital (282N00000X) |
United | 069 | $15516.33 | 1245207521 - PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S, UPHS PRESBYTERIAN MEDICAL CENTER | 232810852 - PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 069 | $19420.02 | 1003956913 - MISSION HOSPITAL REGIONAL MEDICAL CENTER, PROVIDENCE MISSION HOSPITAL | 951643360 - (CA) MISSION HOSPITAL REGIONAL MEDICAL CENTER | CA | Rehabilitation Hospital (283X00000X) |
United | 069 | $7729.77 | 1578881652 - OSS ORTHOPAEDIC HOSPITAL, LLC, OSS HEALTH | 800458999 - (PA) OSS HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 069 | $2765.00 | 1346379534 - TAKOMA REGIONAL HOSPITAL,INC, GREENEVILLE COMMUNITY HOSPITAL REHABILITATION | 510603966 - TAKOMA REGIONAL HOSPITAL INC | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 069 | $16183.80 | 1568492916 - INDIANA UNIVERSITY HEALTH NORTH HOSPITAL INC, IU HEALTH NORTH HOSPITAL | 351932442 - (IN) INDIANA UNIVERSITY HEALTH NORTH HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 069 | $15311.70 | 1801851258 - VIRGINIA MASON MEDICAL CENTER | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 069 | $9918.69 | 1487253449 - VANDERBILT BEDFORD HOSPITAL, LLC, VANDERBILT BEDFORD HOSPITAL | 853419620 | TN | General Acute Care Hospital (282N00000X) |
United | 069 | $12240.73 | 1558365890 - METHODIST HEALTHCARE | 620479367 - METHODIST HEALTHCARE-MEMPHIS | TN | General Acute Care Hospital (282N00000X) |
United | 069 | $17063.73 | 1760426969 - SAINT MARY'S HOSPITAL, INC., ST. MARY'S HOSPITAL CORPORATION | 60646844 - (CT) SAINT MARYS HOSPITAL INC | CT | 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 069 vs. Other Diseases & Disorders of the Nervous System Codes
The MS-DRG 069 code is part of the Diseases & Disorders of the Nervous System 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 069 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 |
|---|---|---|
| 068-APR-DRG | Moderate | Pancreas Transplant |
| 068-MS-DRG | High | Non-specific CVA and Precerebral Occlusion without Infarction without MCC |
| 069-MS-DRG | High | Transient Ischemia without Thrombolytic |
| 070-APR-DRG | High | Allogeneic Bone Marrow 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 069. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 069 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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