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See a sample rate comparisonMS-DRG 154 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.
OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH 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 154 by major payers:
$17,238.09
$20,967.19
$25,428.98
$25,939.14
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MS-DRG 154
5 of 25 sample ratesHigher to lower in this preview
University Of Colorado Hospital Authority
$42,734.28Published rateVanderbilt University Medical Center, Vanderbilt Wilson County Hospital
Vanderbilt University Medical Center
$23,241.44Published rateCarondelet Health Network, St Mary'S Hospital
$15,879.63Published rateBaylor University Medical Center
$10,345.00Published rateTishomingo Health Services, Inc., Tishomingo Health Swing Bed
Tishomingo Health Services Inc
$1,875.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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