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MS-DRG 086 Fee Schedule

Last Verified: December 2025

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.

Traumatic Stupor and Coma <1 Hour with CC
Key FactDetail
Service Type

Diseases & Disorders of the Nervous System

Common Place of Service

21 - Inpatient Hospital

22 - On Campus Outpatient Hospital

Complexity LevelHigh

National average reimbursement for MS-DRG 086 by major payers:

bcbs

$14,563.17

uhc

$17,136.27

aetna

$20,628.73

cigna

$21,010.41

Preview provider-level rates for...
For billing codeMS-DRG 086
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for MS-DRG 086

United
086$15676.241992840862 - ST. JOSEPH HEALTH SERVICES OF RI, PATHOLOGY GROUP464661337RIGeneral Acute Care Hospital (282N00000X)
United
086$24343.381336465004 - ST JOSEPH MEDICAL CENTER, FRANCISCAN HEALTH SYSTEM910564491 - (WA) FRANCISCAN HEALTH SYSTEMWAGeneral Acute Care Hospital (282N00000X)
United
086$12550.251487904546 - PEACEHEALTH, ST. JOSEPH MEDICAL CENTER910565889 - PEACEHEALTH ST JOSEPH MEDICAL CENTERWARural Acute Care Hospital (282NR1301X)
United
086$13152.951285227629 - SCRANTON HOSPITAL COMPANY LLC, REGIONAL HOSPITAL OF SCRANTON274564798PAMedicare Defined Swing Bed Hospital Unit (275N00000X)
United
086$67872.671205605409 - SOUTH CAROLINA COASTAL MEDICAL CENTER LLC934580630SCGeneral Acute Care Hospital (282N00000X)
United
086$5185.001982609558 - TROPHY CLUB MEDICAL CENTER LP, BAYLOR SCOTT & WHITE MEDICAL CENTER - TROPHY CLUB481260190 - (TX) TROPHY CLUB MEDICAL CENTER LPTXGeneral Acute Care Hospital (282N00000X)
United
086$23168.091790860856 - CARONDELET HEALTH NETWORK, ST JOSEPH'S HOSPITAL474131755AZGeneral Acute Care Hospital (282N00000X)
United
086$23168.091790860856 - CARONDELET HEALTH NETWORK, ST JOSEPH'S HOSPITAL474131755AZGeneral Acute Care Hospital (282N00000X)
United
086$2536.001821020421 - SOLIS HEALTHCARE, LP, ROXBOROUGH MEMORIAL HOSPITAL454246163 - (PA) PRIME HEALTHCARE SERVICES ROXBOROUGH, LLCPAGeneral Acute Care Hospital (282N00000X)
United
086$12016.001285800326 - HENDERSONVILLE HOSPITAL CORPORATION, TRISTAR HENDERSONVILLE MEDICAL CENTER621321255 - (TN) HENDERSONVILLE HOSPITAL CORPORATIONTNPsychiatric Hospital Unit (273R00000X)
United
086$24891.531982663423 - ST. CATHERINE OF SIENA MEDICAL CENTER61562701 - (NY) ST CATHERINE OF SIENA MEDICAL CENTERNYGeneral Acute Care Hospital (282N00000X)
United
086$13152.951285227629 - SCRANTON HOSPITAL COMPANY LLC, REGIONAL HOSPITAL OF SCRANTON274564798PAMedicare Defined Swing Bed Hospital Unit (275N00000X)
United
086$5123.001801826839 - BAYLOR SCOTT & WHITE MEDICAL CENTER824052186 - (TX) BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIALTXGeneral Acute Care Hospital (282N00000X)
United
086$8956.281689650616 - MEMORIAL HOSPITAL OF POLK COUNTY, CHI ST. LUKE'S HEATH MEMORIAL LIVINGSTON760436439 - (TX) MEMORIAL MEDICAL CENTER LIVINGSTONTXRural Acute Care Hospital (282NR1301X)
United
086$23178.841992733513 - EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL, FOOTHILL PRESBYTERIAN HOSPITAL952413054 - (CA) EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITALCAGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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MS-DRG 086 vs. Other Diseases & Disorders of the Nervous System Codes

The MS-DRG 086 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 086 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.

CodeComplexityDescription
085-MS-DRGHighTraumatic Stupor and Coma <1 Hour with MCC
086-MS-DRGHighTraumatic Stupor and Coma <1 Hour with CC
087-APR-DRGModerateAutologous Bone Marrow Transplant
087-MS-DRGHighTraumatic Stupor and Coma <1 Hour 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 086. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 086 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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