MS-DRG 155 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 155 by major payers:
$10,673.78
$12,877.67
$14,786.75
$15,154.03
| 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 155 | ||||||
United | 155 | $23717.93 | 1427103589 - SWEDISH HEALTH SERVICES, SWEDISH MEDICAL CENTER, CHERRY HILL | 910373400 - (WA) SWEDISH HEALTH SERVICES | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 155 | $3524.00 | 1962435792 - HOUSTON HOSPITALS INC, HOUSTON MEDICAL CENTER | 711045290 - (GA) HOUSTON HOSPITALS INC | GA | General Acute Care Hospital (282N00000X) |
United | 155 | $17362.16 | 1396745832 - ARIZONA SPINE AND JOINT HOSPITAL LLC | 364399746 - (AZ) ARIZONA SPINE AND JOINT HOSPITAL LLC | AZ | General Acute Care Hospital (282N00000X) |
United | 155 | $10530.07 | 1689627903 - ORO VALLEY HOSPITAL LLC, NORTHWEST TRANSITIONS | 522379881 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 155 | $10412.59 | 1194730382 - FARMERS UNION HOSPITAL ASSOCIATION, GREAT PLAINS REGIONAL MEDICAL CENTER - PSYCHIATRIC UNIT | 730579295 - (OK) FARMERS UNION HOSPITAL ASSOCIATION | OK | Psychiatric Hospital Unit (273R00000X) |
United | 155 | $11100.50 | 1154571180 - PORTER HOSPITAL LLC, NORTHWEST HEALTH-PORTER | 208473972 | IN | Rehabilitation Hospital Unit (273Y00000X) |
United | 155 | $8193.26 | 1306827878 - KANSAS SURGERY & RECOVERY CENTER LLC | 481148580 - (KS) KANSAS SURGERY & RECOVERY CENTER, LLC. | KS | General Acute Care Hospital (282N00000X) |
United | 155 | $16358.94 | 1467871624 - GREENVILLE HEALTH SYSTEM, GHS CANCER INST-EASLEY | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 155 | $26555.60 | 1225023179 - GILA RIVER HEALTH CARE CORPORATION, HU HU KAM MEMORIAL HOSPITAL | 860810876 - (AZ) GILA RIVER HEALTH CARE CORPORATION | AZ | Critical Access Hospital (282NC0060X) |
United | 155 | $18802.69 | 1326002049 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | General Acute Care Hospital (282N00000X) |
United | 155 | $10530.07 | 1689627903 - ORO VALLEY HOSPITAL LLC, NORTHWEST TRANSITIONS | 522379881 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 155 | $18256.55 | 1063463156 - NOVANT HEALTH MATTHEWS MEDICAL CENTER LLC, NOVANT HEALTH MATTHEWS MEDICAL CENTER | 561376368 - (NC) NOVANT HEALTH MATTHEWS MEDICAL CENTER LLC | NC | General Acute Care Hospital (282N00000X) |
United | 155 | $21329.02 | 1306938071 - ADVENTIST HEALTH SYSTEM-SUNBELT, INC, ADVENTHEALTH ORLANDO | 590724459 - (FL) ADVENTIST HEALTH SYSTEM-SUNBELT INC | FL | General Acute Care Hospital (282N00000X) |
United | 155 | $9872.82 | 1427050376 - SCHUYLKILL MEDICAL CENTER, GOOD SAMARITAN REGIONAL MEDICAL CENTER | 231352202 - (PA) LEHIGH VALLEY HOSPITAL - SCHUYKILL | PA | General Acute Care Hospital (282N00000X) |
United | 155 | $8595.66 | 1376584110 - CLARKSDALE HMA LLC, NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER | 853959101 | MS | 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 155 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 155 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 155 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 |
|---|---|---|
| 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 |
| 156-MS-DRG | High | Other Ear, Nose, Mouth and Throat Diagnoses without CC/MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 155. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 155 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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