MS-DRG 095 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 095 by major payers:
$28,408.16
$31,088.36
$37,683.65
$38,091.11
| 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 095 | ||||||
United | 095 | $30063.28 | 1104474006 - SSM SELECT REHAB ST. LOUIS, LLC, SSM HEALTH PT | 263694972 | MO | Rehabilitation Hospital (283X00000X) |
United | 095 | $29965.00 | 1528348489 - SHERMAN GRAYSON HOSPITAL LLC, WILSON N. JONES REGIONAL MEDICAL CENTER - BHS | 272025690 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 095 | $25140.41 | 1144209271 - SUMMIT HEALTHCARE ASSOCIATION, SUMMIT HEALTHCARE REGIONAL MEDICAL CENTER | 860320447 - SUMMIT HEALTHCARE ASSOCIATION | AZ | Rural Acute Care Hospital (282NR1301X) |
United | 095 | $13968.00 | 1821244757 - JOHN T MATHER MEMORIAL HOSPITAL, INTENSIVISTS | 111639818 - (NY) JOHN T MATHER MEMORIAL HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 095 | $93689.77 | 1750988770 - KECK MEDICAL CENTER OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 095 | $55049.30 | 1164883492 - NAVICENT HEALTH | 582149128 - MEDICAL CENTER OF CENTRAL GEORGIA INC | GA | General Acute Care Hospital (282N00000X) |
United | 095 | $63254.92 | 1477584993 - JFK MEMORIAL HOSPITAL, INC., JOHN F. KENNEDY MEMORIAL HOSPITAL | 752919774 | CA | General Acute Care Hospital (282N00000X) |
United | 095 | $66323.39 | 1821026816 - EAST COOPER COMMUNITY HOSPITAL, INC., EAST COOPER MEDICAL CENTER | 953931540 | SC | General Acute Care Hospital (282N00000X) |
United | 095 | $63254.92 | 1477584993 - JFK MEMORIAL HOSPITAL, INC., JOHN F. KENNEDY MEMORIAL HOSPITAL | 752919774 | CA | General Acute Care Hospital (282N00000X) |
United | 095 | $22637.98 | 1972795730 - DALLAS MEDICAL CENTER LLC, DALLAS MEDICAL CENTER | 271459658 - (TX) DALLAS MEDICAL CENTER, LLC | TX | Psychiatric Hospital Unit (273R00000X) |
United | 095 | $98349.92 | 1578778726 - YALE NEW HAVEN HOSPITAL | 60646652 - YALE NEW HAVEN HOSPITAL | CT | General Acute Care Hospital (282N00000X) |
United | 095 | $15581.79 | 1114627072 - STONEBRIDGE HEALTH SYSTEMS, LLC | 464145136 - (LA) STONEBRIDGE HEALTH SYSTEMS LLC | LA | Psychiatric Hospital (283Q00000X) |
United | 095 | $48164.53 | 1104113380 - PROVIDENCE HEALTH & SERVICES, PROVIDENCE PORTLAND MEDICAL CENTER - CHILD & ADOLESCENT PSYCHIATRIC | 930386906 | OR | Psychiatric Hospital Unit (273R00000X) |
United | 095 | $34048.91 | 1992747125 - MEMORIAL HERMANN HEALTH SYSTEM, MEMORIAL HERMANN HOSPITAL REHABILITATION UNIT | 741152597 - (TX) MEMORIAL HERMANN HEALTH SYSTEM | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 095 | $56750.73 | 1104845015 - TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | 751438726 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | 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 095 vs. Other Diseases & Disorders of the Nervous System Codes
The MS-DRG 095 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 095 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 |
|---|---|---|
| 094-APR-DRG | Moderate | Extracorporeal Membrane Oxygenation (Ecmo) |
| 094-MS-DRG | High | Bacterial and Tubercular Infections of Nervous System with MCC |
| 095-MS-DRG | High | Bacterial and Tubercular Infections of Nervous System with CC |
| 096-APR-DRG | Moderate | Extracorporeal Membrane Oxygenation (Ecmo) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 095. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 095 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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