MS-DRG 086 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 086 by major payers:
$14,563.17
$17,136.27
$20,628.73
$21,010.41
| 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 086 | ||||||
United | 086 | $33393.33 | 1740609908 - GREENVILLE HEALTH SYSTEM, GHS CANCER INST-FARIS | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 086 | $12153.29 | 1093819393 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST ORANGE HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 086 | $5123.00 | 1801826839 - BAYLOR SCOTT & WHITE MEDICAL CENTER | 824052186 - (TX) BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIAL | TX | General Acute Care Hospital (282N00000X) |
United | 086 | $23004.47 | 1841245594 - SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC. | 350868157 - SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS INC | IN | General Acute Care Hospital (282N00000X) |
United | 086 | $31616.11 | 1467506857 - BANNER -- UNIVERSITY MEDICAL CENTER PHOENIX | 270036499 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 086 | $74527.74 | 1184654923 - DOCTORS MEDICAL CENTER OF MODESTO, INC., DOCTORS MEDICAL CENTER OF MODESTO | 952588614 | CA | General Acute Care Hospital (282N00000X) |
United | 086 | $14154.79 | 1093712655 - CHATHAM HOSPITAL INC | 560611546 - (NC) CHATHAM HOSPITAL INC | NC | Critical Access Hospital (282NC0060X) |
United | 086 | $29247.36 | 1053972760 - ADVENTHEALTH POLK SOUTH INC, ADVENTHEALTH LAKE WALES | 834672945 | FL | General Acute Care Hospital (282N00000X) |
United | 086 | $20119.93 | 1598971855 - OVERLAKE HOSPITAL MEDICAL CENTER LAB | 910652651 - (WA) OVERLAKE HOSPITAL MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 086 | $9014.62 | 1215151154 - PORTER HOSPITAL LLC, NORTHWEST HEALTH-PORTER | 351088541 | IN | General Acute Care Hospital (282N00000X) |
United | 086 | $25448.13 | 1871660522 - HIGHLINE MEDICAL CENTER | 910712166 - (WA) HIGHLINE MEDICAL CENTER | WA | Long Term Care Hospital (282E00000X) |
United | 086 | $8956.28 | 1689650616 - MEMORIAL HOSPITAL OF POLK COUNTY, CHI ST. LUKE'S HEATH MEMORIAL LIVINGSTON | 760436439 - (TX) MEMORIAL MEDICAL CENTER LIVINGSTON | TX | Rural Acute Care Hospital (282NR1301X) |
United | 086 | $18494.73 | 1003832098 - NASSAU HEALTH CARE CORPORATION, NUMC -DEPARTMENT OF PM&R, FPP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 086 | $24520.35 | 1952512469 - VALLEY BAPTIST MEDICAL CENTER, VALLEY BAPTIST MEDICAL FACILITY BROWNSVILLE | 452663071 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 086 | $11542.08 | 1003062407 - CALHOUN HEALTH SERVICES | 813257997 - (MS) BAPTIST MEMORIAL HOSPITAL - CALHOUN INC | MS | Critical Access Hospital (282NC0060X) |
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 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.
| Code | Complexity | Description |
|---|---|---|
| 085-MS-DRG | High | Traumatic Stupor and Coma <1 Hour with MCC |
| 086-MS-DRG | High | Traumatic Stupor and Coma <1 Hour with CC |
| 087-APR-DRG | Moderate | Autologous Bone Marrow Transplant |
| 087-MS-DRG | High | Traumatic 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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