MS-DRG 116 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 Eye |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 116 by major payers:
$21,315.06
$22,560.11
$26,333.60
$27,206.42
| 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 116 | ||||||
United | 116 | $24156.63 | 1154308518 - INSIGHT CHICAGO, INC., INSIGHT HOSPITAL & MEDICAL CENTER CHICAGO | 862358048 - INSIGHT CHICAGO INC | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 116 | $25352.66 | 1720085137 - NAPLES COMMUNITY HOSPITAL INC, NCH HEALTHCARE SYSTEM INC | 590694358 - (FL) NAPLES COMMUNITY HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 116 | $16686.00 | 1669420766 - MCDONOUGH COUNTY HOSPITAL DISTRICT, MCDONOUGH DISTRICT HOSPITAL | 376016777 | IL | General Acute Care Hospital (282N00000X) |
United | 116 | $8366.75 | 1316537228 - DUBOIS REGIONAL MEDICAL CENTER, PENN HIGHLANDS CLEARFIELD-A CAMPUS OF PENN HIGHLANDS DUBOIS | 251490707 - DUBOIS REGIONAL MEDICAL CENTER | PA | General Acute Care Hospital (282N00000X) |
United | 116 | $30847.41 | 1467484972 - OHIOHEALTH CORPORATION, RIVERSIDE METHODIST HOSPITAL | 314394942 - OHIOHEALTH CORPORATION GRANT RIVERSIDE DOCTORS DUBLIN MET | OH | General Acute Care Hospital (282N00000X) |
United | 116 | $18342.91 | 1558446617 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 116 | $36091.82 | 1174580831 - PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION, PASSAVANT AREA HOSPITAL | 370661230 - (IL) MEMORIAL HEALTH SYSTEM | IL | Critical Access Hospital (282NC0060X) |
United | 116 | $30033.08 | 1750381281 - LAWRENCE GENERAL HOSPITAL | 42103586 - LAWRENCE GENERAL HOSPITAL | MA | General Acute Care Hospital (282N00000X) |
United | 116 | $35889.92 | 1215251996 - ST. BARNABAS, PHYSICIANS OF ST. BARNABAS HOSPITAL/INTERNAL MEDICINE | 131740122 - (NY) ST BARNABAS HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 116 | $46211.69 | 1386189520 - FLORIDA HOSPITAL CELEBRATION HEALTH | 590724459 - (FL) ADVENTIST HEALTH SYSTEM-SUNBELT INC | FL | General Acute Care Hospital (282N00000X) |
United | 116 | $39460.71 | 1467764555 - VANDERBILT MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Critical Access Hospital (282NC0060X) |
United | 116 | $2500.00 | 1134166036 - CLHG-WINN, LLC, WINN PARISH MEDICAL CENTER | 813465517 | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 116 | $12893.26 | 1013122571 - MIDWEST SURGICAL HOSPITAL, L.L.C. | 383712521 - (NE) MIDWEST SURGICAL HOSPITAL, LLC | NE | Special Hospital (284300000X) |
United | 116 | $19203.00 | 1356828172 - HMH HOSPITALS CORPORATION, RARITAN BAY MEDICAL CENTER-OLD BRIDGE | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 116 | $15943.46 | 1982093837 - RIVERSIDE MEDICAL CENTER | 362414944 - (IL) RIVERSIDE MEDICAL CENTER | IL | Psychiatric Hospital Unit (273R00000X) |
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 116 vs. Other Diseases & Disorders of the Eye Codes
The MS-DRG 116 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 116 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 |
|---|---|---|
| 115-APR-DRG | High | OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES |
| 115-MS-DRG | High | Extraocular Procedures except Orbit |
| 116-MS-DRG | High | Intraocular Procedures with CC/MCC |
| 117-MS-DRG | High | Intraocular 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 116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 116 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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