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See a sample rate comparisonMS-DRG 155 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 CC
| 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
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MS-DRG 155
5 of 25 sample ratesHigher to lower in this preview
Emanuel Medical Center, Inc., Emanuel Family Practice - Monte Vista
$31,251.05Published rateThe University Of Chicago Medical Centers
University Of Chicago Medical Center
$18,623.44Published ratePrime Healthcare Services
Prime Healthcare Services - Kansas City LLC
$15,454.34Published rateSchuylkill Medical Center, Good Samaritan Regional Medical Center
Lehigh Valley Hospital - Schuykill
$9,872.82Published rateHouston Hospitals Inc, Houston Medical Center
Houston Hospitals Inc
$3,524.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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