MS-DRG 135 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 Ear, Nose, Mouth & Throat |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 135 by major payers:
$25,505.38
$31,291.56
$37,887.93
$38,970.74
| 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 135 | ||||||
United | 135 | $34705.41 | 1619176997 - PROVIDENCE HEALTH & SERVICES WASHINGTON | 910567732 | WA | General Acute Care Hospital (282N00000X) |
United | 135 | $43727.83 | 1013998426 - WSNCHS NORTH, INC., ST. JOSEPH HOSPITAL | 113438973 - ST JOSEPH HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 135 | $14631.00 | 1396857488 - COOPERMAN BARNABAS MEDICAL CENTER INC | 221494440 - (NJ) SAINT BARNABAS MEDICAL CENTER | NJ | General Acute Care Hospital (282N00000X) |
United | 135 | $3500.00 | 1891852703 - GEISINGER BLOOMSBURG HOSPITAL | 232193572 - (PA) GEISINGER-BLOOMSBURG HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 135 | $26293.56 | 1093791170 - HOSPITAL DEVELOPMENT OF WEST PHOENIX INC, ABRAZO WEST CAMPUS AND ABRAZO MARYVALE CAMPUS | 621867232 - (AZ) HOSPITAL DEVELOPMENT OF WEST PHOENIX INC | AZ | General Acute Care Hospital (282N00000X) |
United | 135 | $37830.16 | 1285662239 - NORTH BROWARD HOSPITAL DISTRICT, BROWARD HEALTH MEDICAL CENTER | 596012065 - NORTH BROWARD HOSPITAL DISTRICT | FL | General Acute Care Hospital (282N00000X) |
United | 135 | $46531.82 | 1831599604 - SOUTHESTERN REGIONAL MEDICAL CENTER, SRMC-HOSPITALIST | 560530233 - SOUTHEASTERN REGIONAL MEDICAL CENTER | NC | Hospitalist Physician (208M00000X) |
United | 135 | $34444.96 | 1841442274 - OKLAHOMA HEART HOSPITAL SOUTH LLC | 261131647 - (OK) OKLAHOMA HEART HOSPITAL SOUTH LLC | OK | General Acute Care Hospital (282N00000X) |
United | 135 | $21710.08 | 1841394418 - THE DCH HEALTHCARE AUTHORITY, NORTHPORT MEDICAL CENTER | 636000271 - (AL) THE DCH HEALTH CARE AUTHORITY | AL | General Acute Care Hospital (282N00000X) |
United | 135 | $24675.14 | 1891777983 - CENTRAL VALLEY GENERAL HOSPITAL | 770324630 - (CA) CENTRAL VALLEY GENERAL HOSPITAL | CA | General Acute Care Hospital (282N00000X) |
United | 135 | $15713.13 | 1962537498 - MENDOTA COMMUNITY HOSPITAL, OSF SAINT PAUL MEDICAL CENTER | 362167785 - MENDOTA COMMUNITY HOSPITAL | IL | Critical Access Hospital (282NC0060X) |
United | 135 | $64868.23 | 1417106907 - OVERLOOK HOSPITAL | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 135 | $44588.46 | 1043394745 - MOUNT ST. MARY'S HOSPITAL OF NIAGARA FALLS, MOUNT ST. MARY'S HOSPITAL AND HEALTH CENTER | 161523353 - (NY) MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS | NY | General Acute Care Hospital (282N00000X) |
United | 135 | $34705.41 | 1619176997 - PROVIDENCE HEALTH & SERVICES WASHINGTON | 910567732 | WA | General Acute Care Hospital (282N00000X) |
United | 135 | $31381.21 | 1730166224 - INSIGHT CHICAGO, INC., INSIGHT HOSPITAL & MEDICAL CENTER CHICAGO | 862358048 - INSIGHT CHICAGO INC | IL | 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 135 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 135 code is part of the Diseases & Disorders of the Ear, Nose, Mouth & Throat 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 135 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 |
|---|---|---|
| 135-MS-DRG | High | Sinus and Mastoid Procedures with CC/MCC |
| 136-APR-DRG | High | RESPIRATORY MALIGNANCY |
| 136-MS-DRG | High | Sinus and Mastoid 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 135. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 135 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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