MS-DRG 137 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 137 by major payers:
$17,232.51
$18,906.96
$22,122.93
$22,863.82
| 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 137 | ||||||
United | 137 | $31446.11 | 1487218509 - SMSJ TUCSON HOLDINGS, LLC, CARONDELET MARANA HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 137 | $10969.21 | 1114078979 - SAINT ANTHONYS HEALTH CENTER | 370813229 - (IL) OSF HEALTHCARE SYSTEM | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 137 | $17046.14 | 1164474755 - METHODIST MEDICAL CENTER OF ILLINOIS | 370661223 - METHODIST MEDICAL CENTER OF ILLINOIS | IL | General Acute Care Hospital (282N00000X) |
United | 137 | $23974.10 | 1295126340 - LEHIGH VALLEY HOSPITAL | 231689692 - LEHIGH VALLEY HOSPITAL | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 137 | $30414.50 | 1427068345 - UNIVERSITY COMMUNITY HOSPITAL, INC, FLORIDA HOSPITAL CARROLLWOOD | 591113901 - (FL) UNIVERSITY COMMUNITY HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 137 | $36602.23 | 1154980118 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 137 | $21611.16 | 1275557654 - DLP FRYE REGIONAL MEDICAL CENTER LLC, FRYE REGIONAL MEDICAL CENTER | 352547114 | NC | Rehabilitation Hospital Unit (273Y00000X) |
United | 137 | $32118.84 | 1114079142 - TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | 751047527 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | TX | Psychiatric Hospital Unit (273R00000X) |
United | 137 | $24704.86 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 137 | $14191.58 | 1447363783 - BLACKWELL HMA LLC, ALLIANCEHEALTH BLACKWELL | 730927647 | OK | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 137 | $19489.17 | 1548248321 - STATE UNIVERSITY OF IOWA, UNIVERSITY OF IOWA HOSPITALS & CLINICS-PSYCHIATRIC MENTAL HEALTH UNIT | 426004813 | IA | Psychiatric Hospital Unit (273R00000X) |
United | 137 | $43770.32 | 1851787295 - HDMC HOLDINGS, LLC, HI-DESERT MEDICAL CENTER | 473550779 | CA | General Acute Care Hospital (282N00000X) |
United | 137 | $11229.36 | 1831602903 - SAVANNAH HEALTH SERVICES, LLC, MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER | 821969974 | GA | Psychiatric Hospital Unit (273R00000X) |
United | 137 | $21414.28 | 1295723229 - ST FRANCIS MEDICAL CENTER, INC | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 137 | $26114.02 | 1194900654 - HUNTINGTON HOSPITAL ASSOCIATION | 111630914 - (NY) HUNTINGTON HOSPITAL ASSOCIATION | NY | Psychiatric Hospital Unit (273R00000X) |
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 137 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 137 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 137 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 |
|---|---|---|
| 136-APR-DRG | High | RESPIRATORY MALIGNANCY |
| 136-MS-DRG | High | Sinus and Mastoid Procedures without CC/MCC |
| 137-MS-DRG | High | Mouth Procedures with CC/MCC |
| 138-APR-DRG | High | BRONCHIOLITIS & RSV PNEUMONIA |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 137. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 137 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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