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See a sample rate comparisonMS-DRG 135 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.
SINUS AND MASTOID PROCEDURES WITH CC/MCC
| 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
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MS-DRG 135
5 of 25 sample ratesHigher to lower in this preview
Overlook Hospital
Atlantic Health System Inc
$64,868.23Published rateCitizens Baptist Medical Center
$40,644.85Published rateOklahoma Heart Hospital South LLC
$34,444.96Published rateThe Dch Healthcare Authority, Northport Medical Center
The Dch Health Care Authority
$21,710.08Published rateThe Brookdale Hospital Medical Center
Brookdale Hospital Medical Center
$1,632.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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