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See a sample rate comparisonMS-DRG 138 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.
MOUTH PROCEDURES WITHOUT 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 138 by major payers:
$10,562.09
$11,501.60
$12,999.94
$13,518.85
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MS-DRG 138
5 of 25 sample ratesHigher to lower in this preview
University Of Colorado Hospital Authority
$23,386.50Published rateThe Presbyterian Hospital, Novant Health Presbyterian Medical Center
Presbyterian Healthcare Services
$14,224.84Published rateThe Health And Hospital Corporation Of Marion County, Eskenazi Health
$11,667.90Published rateEphrata Community Hospital, Wellspan Ephrata Community Hospital
$8,403.45Published rateClhg-Winn, LLC, Winn Parish Medical Center
$2,500.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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.
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