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See a sample rate comparisonMS-DRG 116 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.
INTRAOCULAR 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 116 by major payers:
$21,315.06
$22,560.11
$26,333.60
$27,206.42
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MS-DRG 116
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Fort Worth
Texas Health Harris Methodist Hospital Southwest Fort Worth
$54,401.00Published rateSt. Barnabas, Physicians Of St. Barnabas Hospital/Internal Medicine
St Barnabas Hospital
$35,889.92Published rateThedacare Medical Center, Shawano Medical Center, Inc.
Thedacare Medical Center-Shawano Inc
$24,423.30Published rateRiverside Medical Center
$15,943.46Published rateClhg-Winn, LLC, Winn Parish Medical Center
$2,500.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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