MS-DRG 117 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 117 by major payers:

$12,380.39

$14,524.61

$17,058.19

$17,706.66
| 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 117 | ||||||
United | 117 | $25999.65 | 1013130145 - BANNER HEALTH | 900412842 | AZ | General Acute Care Hospital (282N00000X) |
United | 117 | $11655.34 | 1144210253 - ASCENSION PROVIDENCE HOSPITAL | 381358212 - ASCENSION PROVIDENCE HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 117 | $11824.69 | 1477101376 - SSM SELECT REHAB ST. LOUIS, LLC, SSM HEALTH PHYSICAL THERAPY | 263694972 | MO | Rehabilitation Hospital (283X00000X) |
United | 117 | $12369.37 | 1316505043 - ETHICUS HOSPITAL DFW LLC, LEGENT ORTHOPEDIC HOSPITAL | 263044485 - (TX) ETHICUS HOSPITAL DFW | TX | General Acute Care Hospital (282N00000X) |
United | 117 | $11824.69 | 1477101376 - SSM SELECT REHAB ST. LOUIS, LLC, SSM HEALTH PHYSICAL THERAPY | 263694972 | MO | Rehabilitation Hospital (283X00000X) |
United | 117 | $13319.62 | 1518945799 - FORT SANDERS REGIONAL MEDICAL CENTER, PATRICIA NEAL REHABILITATION CENTER | 620528340 - (TN) FORT SANDERS REGIONAL MEDICAL CENTER | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 117 | $4158.00 | 1013346550 - MOUNTAIN STATES HEALTH ALLIANCE, UNICOI COUNTY HOSPITAL | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | TN | General Acute Care Hospital (282N00000X) |
United | 117 | $24770.05 | 1629138029 - ROCKWALL REGIONAL HOSPITAL, LLC, TEXAS HEALTH PRESBYTERIAN HOSPITAL ROCKWALL | 202848116 - (TX) ROCKWALL REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 117 | $6098.00 | 1497910012 - HUMC OPCO LLC, HOBOKEN UNIVERSITY MEDICAL CENTER | 452147328 - (NJ) HUMC OPCO LLC (D/B/A CAREPOINT HEALTH - HOBOKEN UNIVERSITY MED CENTER) | NJ | Rehabilitation Hospital Unit (273Y00000X) |
United | 117 | $32142.27 | 1538657267 - PALMETTO HEALTH | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | Hospitalist Physician (208M00000X) |
United | 117 | $10403.00 | 1508835828 - THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO | 310537486 - (OH) THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO DTD 01251995 | OH | General Acute Care Hospital (282N00000X) |
United | 117 | $18211.08 | 1437107208 - CASA GRANDE COMMUNITY HOSPITAL, CASA GRANDE REGIONAL MEDICAL CENTER | 450233470 - BANNER HEALTH | AZ | General Acute Care Hospital (282N00000X) |
United | 117 | $9420.13 | 1194969618 - HASAN AMIR | 161768258 | OH | Hospitalist Physician (208M00000X) |
United | 117 | $9972.11 | 1255384533 - COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP, MEDICAL CITY LEWISVILLE | 621682210 - (TX) DE MARKETING AND SALES | TX | General Acute Care Hospital (282N00000X) |
United | 117 | $17906.91 | 1477578060 - NASSAU HEALTH CARE CORPORATION, NUMC DEPARTMENT OF ORTHOPEDICS, FPP | 113465690 | NY | 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 117 vs. Other Diseases & Disorders of the Eye Codes
The MS-DRG 117 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 117 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 |
|---|---|---|
| 116-APR-DRG | Moderate | Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies |
| 116-MS-DRG | High | Intraocular Procedures with CC/MCC |
| 117-MS-DRG | High | Intraocular Procedures without CC/MCC |
| 121-APR-DRG | High | OTHER RESPIRATORY & CHEST 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 117. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 117 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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