MS-DRG 125 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 125 by major payers:
$9,154.85
$11,179.75
$13,034.16
$13,452.66
| 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 125 | ||||||
United | 125 | $12872.45 | 1568415974 - ST. JOSEPH'S MEDICAL CENTER, ESSENTIA HEALTH-ST. JOSEPH'S MEDICAL CENTER | 410695602 - (MN) ST JOSEPH S MEDICAL CENTER | MN | General Acute Care Hospital (282N00000X) |
United | 125 | $10322.08 | 1205816725 - MERCY MEDICAL CENTER-DYERSVILLE, MERCYONE DYERSVILLE MEDICAL CENTER | 202552602 - (IA) MERCY MEDICAL CENTERDYERSVILLE | IA | Critical Access Hospital (282NC0060X) |
United | 125 | $24275.58 | 1982738571 - TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | 751977850 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | TX | Chronic Disease Hospital (281P00000X) |
United | 125 | $3963.36 | 1003192311 - EL CAMPO MEMORIAL HOSPITAL | 452750258 - (TX) EL CAMPO MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 125 | $5494.77 | 1699745893 - OKLAHOMA SPINE HOSPITAL LLC, OKLAHOMA SPINE HOSPITAL | 731538478 - (OK) OKLAHOMA SPINE HOSPITAL, LLC | OK | General Acute Care Hospital (282N00000X) |
United | 125 | $10943.83 | 1326022765 - VHS OF ARROWHEAD, INC, ABRAZO ARROWHEAD CAMPUS | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 125 | $20013.32 | 1659360709 - BON SECOURS COMMUNITY HOSPITAL | 141347717 - BON SECOURS CHARITY HEALTH SYSTEM INC | NY | General Acute Care Hospital (282N00000X) |
United | 125 | $10060.33 | 1114023512 - DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC, THE WOMEN'S HOSPITAL | 352062016 - (IN) DEACONESS WOMENS HOSPITAL OF SOUTHERN INDIANA, LLC | IN | General Acute Care Hospital (282N00000X) |
United | 125 | $9733.34 | 1619019791 - WITHAM MEMORIAL HOSPITAL, WITHAM HEALTH SERVICES | 351151208 - (IN) WITHAM MEMORIAL HOSPITAL | IN | Psychiatric Hospital Unit (273R00000X) |
United | 125 | $8821.78 | 1700901873 - EAST TEXAS MEDICAL CENTER REHABILITATION HOSPITAL | 824037220 | TX | Rehabilitation Hospital (283X00000X) |
United | 125 | $12269.90 | 1558531293 - HEALTH & HOSPITAL CORPORATION OF MARION COUNTY, WISHARD HEALTH SERVICES | 356005697 | IN | General Acute Care Hospital (282N00000X) |
United | 125 | $9902.55 | 1942260971 - TPG HOSPITAL LLC, NORTHWEST SURGICAL HOSPITAL | 731612939 | OK | General Acute Care Hospital (282N00000X) |
United | 125 | $7204.79 | 1215359922 - DLP WILSON MEDICAL CENTER LLC, WILSON MEDICAL CENTER | 464317222 | NC | General Acute Care Hospital (282N00000X) |
United | 125 | $15107.00 | 1952326977 - AMISUB (SFH), INC., ST. FRANCIS HOSPITAL | 752522262 | TN | General Acute Care Hospital (282N00000X) |
United | 125 | $9313.07 | 1487607784 - NORTHWEST HOSPITAL LLC, NORTHWEST MEDICAL CENTER | 522379881 | AZ | 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 125 vs. Other Diseases & Disorders of the Eye Codes
The MS-DRG 125 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 125 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 |
|---|---|---|
| 124-MS-DRG | High | Other Disorders of the Eye with MCC or Thrombolytic Agent |
| 125-MS-DRG | High | Other Disorders of the Eye without 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 125. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 125 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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