MS-DRG 154 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 154 by major payers:
$17,238.09
$20,967.19
$25,428.98
$25,939.14
| 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 154 | ||||||
United | 154 | $8899.00 | 1669462420 - ST JOSEPHS UNIVERSITY MEDICAL CENTER INC., ST JOSEPHS HOSPITAL AND MEDICAL CENTER | 221487602 - ST JOSEPHS HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 154 | $15038.98 | 1306227764 - PRIME HEALTHCARE SERVICES-PORT HURON LLC | 472361878 | MI | General Acute Care Hospital (282N00000X) |
United | 154 | $20170.00 | 1710958582 - MERCY HOSPITAL OZARK | 710689680 - MERCY HOSPITAL OZARK | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 154 | $20548.97 | 1689624686 - DENVER HEALTH AND HOSPITAL AUTHORITY | 841343242 | CO | General Acute Care Hospital (282N00000X) |
United | 154 | $15615.12 | 1598053472 - MORTON HOSPITAL, A STEWARD FAMILY HOSPITAL, INC., MORTON HOSPITAL | 451209304 - (MA) MORTON HOSPITAL, A STEWARD FAMILY HOSPITAL, INC. | MA | General Acute Care Hospital (282N00000X) |
United | 154 | $27647.09 | 1821099474 - DEKALB MEDICAL PSYCH UNIT | 581966795 - (GA) EMORY UNIVERSITY | GA | Psychiatric Hospital Unit (273R00000X) |
United | 154 | $13786.04 | 1437171568 - METHODIST CHILDREN'S HOSPITAL, COVENANT CHILDREN'S HOSPITAL | 752428911 - (TX) METHODIST CHILDRENS HOSPITAL | TX | Children's Hospital (282NC2000X) |
United | 154 | $25188.13 | 1366433195 - CLEVELAND CLINIC MERCY HOSPITAL, MERCY MEDICAL CENTER | 341893439 - CLEVELAND CLINIC MERCY HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 154 | $20837.71 | 1295843753 - VALLEY BAPTIST MEDICAL CENTER | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 154 | $37034.10 | 1013924372 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION, METROPOLITAN HOSPITAL CENTER | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | 154 | $1875.00 | 1558472803 - TISHOMINGO HEALTH SERVICES, INC., TISHOMINGO HEALTH SWING BED | 640741047 - TISHOMINGO HEALTH SERVICES INC | MS | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 154 | $42734.28 | 1689233645 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 154 | $5927.00 | 1700979465 - BAPTIST HEALTH CARE, INC | 590657322 - BAPTIST HEALTH CARE INC | FL | General Acute Care Hospital (282N00000X) |
United | 154 | $19676.65 | 1730710898 - FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC, FROEDTERT COMMUNITY HOSPITAL | 843381796 | WI | General Acute Care Hospital (282N00000X) |
United | 154 | $29146.55 | 1154764819 - ST. CATHERINE OF SIENA MEDICAL CENTER | 61562701 - (NY) ST CATHERINE OF SIENA MEDICAL CENTER | NY | 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 154 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 154 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 154 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 |
|---|---|---|
| 153-MS-DRG | High | Otitis Media and URI without MCC |
| 154-MS-DRG | High | Other Ear, Nose, Mouth and Throat Diagnoses with MCC |
| 155-MS-DRG | High | Other Ear, Nose, Mouth and Throat Diagnoses with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 154. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 154 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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