MS-DRG 138 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 138 by major payers:
$10,562.09
$11,501.60
$12,999.94
$13,518.85
| 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 138 | ||||||
United | 138 | $11667.90 | 1568407310 - THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY, ESKENAZI HEALTH | 356005697 | IN | General Acute Care Hospital (282N00000X) |
United | 138 | $9603.21 | 1043297401 - INSIGHT CHICAGO, INC., INSIGHT HOSPITAL & MEDICAL CENTER CHICAGO | 862358048 - INSIGHT CHICAGO INC | IL | Psychiatric Hospital Unit (273R00000X) |
United | 138 | $19915.28 | 1205904687 - CLEVELAND CLINIC FOUNDATION | 340714585 - THE CLEVELAND CLINIC FOUNDATION | OH | General Acute Care Hospital (282N00000X) |
United | 138 | $12021.16 | 1811158215 - DLP HAYWOOD REGIONAL MEDICAL CENTER LLC., HAYWOOD REGIONAL MEDICAL CENTER | 300830918 | NC | General Acute Care Hospital (282N00000X) |
United | 138 | $7784.10 | 1487904546 - PEACEHEALTH, ST. JOSEPH MEDICAL CENTER | 910565889 - PEACEHEALTH ST JOSEPH MEDICAL CENTER | WA | Rural Acute Care Hospital (282NR1301X) |
United | 138 | $10068.63 | 1891862579 - BASSETT HOSPITAL OF SCHOHARIE COUNTY | 141772971 - (NY) BASSETT HOSPITAL OF SCHOHARIE COUNTY | NY | Critical Access Hospital (282NC0060X) |
United | 138 | $12405.05 | 1629015573 - LSUMC UNIVERSITY MEDICAL CENTER | 462605366 - (LA) UNIVERSITY HOSPITAL & CLINICS INC | LA | General Acute Care Hospital (282N00000X) |
United | 138 | $13401.59 | 1548217763 - FLUSHING HOSPITAL & MEDICAL CENTER | 111631781 - FLUSHING HOSPITAL & MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 138 | $2500.00 | 1134166036 - CLHG-WINN, LLC, WINN PARISH MEDICAL CENTER | 813465517 | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 138 | $6284.29 | 1831193499 - HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA, BEAUREGARD MEMORIAL HOSPITAL | 720491106 - WEST LOUISIANA HEALTH SERVICES INC | LA | Rural Acute Care Hospital (282NR1301X) |
United | 138 | $8607.66 | 1972503464 - KING'S DAUGHTERS MEDICAL CENTER | 640333594 - KINGS DAUGHTERS MEDICAL CENTER | MS | General Acute Care Hospital (282N00000X) |
United | 138 | $20435.11 | 1841258639 - MULTICARE HEALTH SYSTEM, MULTICARE CAPITAL MEDICAL CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 138 | $11672.75 | 1740920909 - THEDACARE REGIONAL MEDICAL CENTER, THEDACARE MEDICAL CENTER ORTHOPEDICS, SPINE, AND PAIN | 390824015 - (WI) THEDACARE REGIONAL MEDICAL CENTER- APPLETON INC | WI | General Acute Care Hospital (282N00000X) |
United | 138 | $11793.45 | 1073580726 - METHODIST HOSPITAL PLAINVIEW TEXAS, COVENANT HOSPITAL PLAINVIEW | 752426010 - (TX) METHODIST HOSPITAL PLAINVIEW TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 138 | $8219.82 | 1861690364 - DALLAS MEDICAL CENTER LLC, DALLAS MEDICAL CENTER | 271459658 - (TX) DALLAS MEDICAL CENTER, LLC | TX | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
MS-DRG 138 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 138 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 138 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 |
|---|---|---|
| 137-APR-DRG | High | MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS |
| 137-MS-DRG | High | Mouth Procedures with CC/MCC |
| 138-MS-DRG | High | Mouth Procedures without CC/MCC |
| 139-APR-DRG | High | OTHER 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 138. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 138 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 138) and we'll show you how you compare in 15 minutes or less.