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See a sample rate comparisonMS-DRG 113 Fee Schedule
Last Verified: October 2026
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.
ORBITAL PROCEDURES WITH CC/MCC
| Key Fact | Detail |
|---|---|
| Service Type | Diseases & Disorders of the Eye |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 113 by major payers:
$24,653.09
$29,024.96
$35,484.70
$36,516.90
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MS-DRG 113
5 of 25 sample ratesHigher to lower in this preview
Medstar Washington Hospital Center
Washington Hospital Center Corporation
$59,960.12Published rateVirginia Mason Medical Center
$43,087.30Published rateAdvocate Health And Hospitals Corporation
$34,372.53Published rateMercy Health Youngstown LLC, Mercy Health St Joseph Warren Hospital
Humility Of Mary Health Partners
$8,272.49Published rateMena Hospital Commission, Mena Regional Health System Psych Unit
Mena Hospital Commission
$1,518.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 113 vs. Other Diseases & Disorders of the Eye Codes
The MS-DRG 113 code is part of the Diseases & Disorders of the Eye 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 113 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 |
|---|---|---|
| 113-MS-DRG | High | ORBITAL PROCEDURES WITH CC/MCC |
| 114-APR-DRG | High | DENTAL DISEASES & DISORDERS |
| 114-MS-DRG | High | ORBITAL PROCEDURES 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 113. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 113 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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