MS-DRG 136 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 136 by major payers:
$13,109.28
$13,587.89
$15,650.44
$16,184.57
| 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 136 | ||||||
United | 136 | $17663.35 | 1023308608 - ADVOCATE LUTHERAN GENERAL HOSPITAL | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Children's Hospital (282NC2000X) |
United | 136 | $19703.84 | 1649595448 - NEBRASKA SPINE HOSPITAL, LLC | 270263191 - (NE) NEBRASKA SPINE HOSPITAL LLC | NE | Special Hospital (284300000X) |
United | 136 | $19429.22 | 1255354700 - LEGACY MOUNT HOOD MEDICAL CENTER | 930591528 - (OR) LEGACY MOUNT HOOD MEDICAL CENTER | OR | General Acute Care Hospital (282N00000X) |
United | 136 | $7674.95 | 1730217613 - ADIRONDACK MEDICAL CENTER | 141731786 - (NY) ADIRONDACK MEDICAL CENTER | NY | Rural Acute Care Hospital (282NR1301X) |
United | 136 | $16133.38 | 1457715146 - PROSPECT CCMC, LLC, CROZER CHESTER MEDICAL CENTER | 811507712 | PA | General Acute Care Hospital (282N00000X) |
United | 136 | $2765.00 | 1558391045 - WELLMONT HEALTH SYSTEM, BRISTOL REGIONAL MEDICAL CENTER PSYCHIATRIC UNIT | 621636465 - WELLMONT HEALTH SYSTEM | TN | Psychiatric Hospital Unit (273R00000X) |
United | 136 | $18719.08 | 1164481529 - ST. CHARLES HOSPITAL | 111871039 - (NY) ST CHARLES HOSPITAL CORP | NY | General Acute Care Hospital (282N00000X) |
United | 136 | $12102.29 | 1093087157 - PRIME HEALTHCARE SERVICES ROXBOROUGH LLC, ROXBOROUGH MEMORIAL HOSPITAL | 454246163 - (PA) PRIME HEALTHCARE SERVICES ROXBOROUGH, LLC | PA | Psychiatric Hospital Unit (273R00000X) |
United | 136 | $10917.11 | 1538138003 - LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC, LAKEVIEW HOSPITAL | 410811697 - LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC | MN | General Acute Care Hospital (282N00000X) |
United | 136 | $28297.36 | 1659751360 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE MILWAUKIE HOSPITAL - GERIATRIC PSYCHIATRIC UNIT | 930924302 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | Psychiatric Hospital Unit (273R00000X) |
United | 136 | $4520.22 | 1376175687 - LAUDERDALE COMMUNITY HOSPITAL LLC, LAUDERDALE COMMUNITY HOSPITAL | 844580729 | TN | Critical Access Hospital (282NC0060X) |
United | 136 | $18839.15 | 1265532915 - FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE, FRANCISCAN HEALTH - INPATIENT REHAB UNIT | 350913537 | IN | Rehabilitation Hospital Unit (273Y00000X) |
United | 136 | $7674.95 | 1679698872 - ADIRONDACK MEDICAL CENTER | 141731786 - (NY) ADIRONDACK MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 136 | $13687.95 | 1326022732 - VHS ACQUISITION SUBSIDIARY NUMBER 1 INC, ABRAZO SCOTTSDALE CAMPUS | 621861138 - (AZ) VHS ACQUISITION SUBSIDIARY NUMBER 1 INC | AZ | General Acute Care Hospital (282N00000X) |
United | 136 | $19637.01 | 1427064310 - MARY IMMACULATE HOSPITAL LLC, MARY IMMACULATE HOSPITAL | 540548200 | VA | 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 136 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 136 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 136 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-APR-DRG | High | MAJOR CHEST & RESPIRATORY TRAUMA |
| 135-MS-DRG | High | Sinus and Mastoid Procedures with CC/MCC |
| 136-MS-DRG | High | Sinus and Mastoid Procedures without CC/MCC |
| 137-APR-DRG | High | MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 136. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 136 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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