MS-DRG 096 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 096 by major payers:
$26,105.69
$29,983.87
$37,683.52
$37,985.52
| 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 096 | ||||||
United | 096 | $31501.60 | 1164495255 - CATAWBA VALLEY MEDICAL CENTER | 560789196 | NC | General Acute Care Hospital (282N00000X) |
United | 096 | $29264.16 | 1558463745 - ST MARY MEDICAL CENTER INC | 352007327 - (IN) ST MARY MEDICAL CENTER INC | IN | General Acute Care Hospital (282N00000X) |
United | 096 | $42344.14 | 1982789046 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 096 | $29854.73 | 1942509427 - MIDTOWN | 356005697 | IN | General Acute Care Hospital (282N00000X) |
United | 096 | $17305.39 | 1376546440 - ROME MEMORIAL HOSPITAL, INC. | 161471634 - (NY) ROME MEMORIAL HOSPITAL INC | NY | General Acute Care Hospital (282N00000X) |
United | 096 | $8557.00 | 1730508250 - PRIME HEALTHCARE SERVICES, ST. MARY'S HOSPITAL | 463499370 | NJ | General Acute Care Hospital (282N00000X) |
United | 096 | $21310.92 | 1255346961 - ST. JOSEPH MERCY PORT HURTON | 472361878 | MI | General Acute Care Hospital (282N00000X) |
United | 096 | $5840.41 | 1639101751 - MASSACHUSETTS EYE AND EAR INFIRMARY | 42103591 - (MA) MASS GENERAL BRIGHAM INCORPORATED | MA | General Acute Care Hospital (282N00000X) |
United | 096 | $39082.01 | 1679678197 - FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE, FRANCISCAN HEALTH - MOORESVILLE | 350913537 | IN | General Acute Care Hospital (282N00000X) |
United | 096 | $25453.47 | 1306825997 - WILLIAM BEAUMONT HOSPITAL, BEAUMONT HOSPITAL, TROY | 381459362 - WILLIAM BEAUMONT HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 096 | $4898.00 | 1053393231 - SHELBY COUNTY HEALTH CARE CORPORATION, REGIONAL ONE HEALTH REHABILITATION HOSPITAL | 621113169 - (TN) SHELBY COUNTY HEALTH CARE CORPORATION | TN | Rehabilitation Hospital (283X00000X) |
United | 096 | $55082.62 | 1447734272 - IACC/EHI NW, LLC, INTEGRIS COMMUNITY HOSPITAL - MOORE | 352635546 - (OK) IACCEHI NW LLC | OK | General Acute Care Hospital (282N00000X) |
United | 096 | $8557.00 | 1730508250 - PRIME HEALTHCARE SERVICES, ST. MARY'S HOSPITAL | 463499370 | NJ | General Acute Care Hospital (282N00000X) |
United | 096 | $39314.07 | 1033854153 - BOSTON MEDICAL CENTER CORPORATION, BMC BROCKTON BEHAVIORAL HEALTH CENTER | 43314093 - (MA) BOSTON MEDICAL CENTER CORPORATION | MA | Psychiatric Hospital Unit (273R00000X) |
United | 096 | $23660.35 | 1487629978 - PERSON MEMORIAL HOSPITAL | 452909143 | NC | 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 096 vs. Other Diseases & Disorders of the Nervous System Codes
The MS-DRG 096 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 096 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 |
|---|---|---|
| 095-APR-DRG | High | CLEFT LIP & PALATE REPAIR |
| 095-MS-DRG | High | Bacterial and Tubercular Infections of Nervous System with CC |
| 096-MS-DRG | High | Bacterial and Tubercular Infections of Nervous System without CC/MCC |
| 097-APR-DRG | High | TONSIL & ADENOID PROCEDURES |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 096. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 096 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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