MS-DRG 158 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 158 by major payers:
$10,819.75
$12,459.08
$14,872.40
$15,242.80
| 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 158 | ||||||
United | 158 | $15498.00 | 1366459570 - NORTH SHORE UNIVERSITY HOSPITAL | 111562701 - (NY) NORTH SHORE UNIVERSITY HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 158 | $9270.32 | 1417227398 - PORTSMOUTH HOSPITAL CORPORATION, KING'S DAUGHTERS MEDICAL CENTER - OHIO | 453215312 - PORTSMOUTH HOSPITAL CORPORATION | OH | General Acute Care Hospital (282N00000X) |
United | 158 | $16700.60 | 1932654704 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH SURGERY/ORTHOPEDICS CLINIC | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 158 | $2533.00 | 1124053467 - HIGHLANDS HOSPITAL AND HEALTH CENTER | 251494705 - HIGHLANDS HOSPITAL AND HEALTH CENTER | PA | Psychiatric Hospital Unit (273R00000X) |
United | 158 | $4958.00 | 1922003730 - RUSSELL COUNTY MEDICAL CENTER, INC, RUSSELL COUNTY MEDICAL CENTER | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | VA | General Acute Care Hospital (282N00000X) |
United | 158 | $8931.00 | 1689606220 - TENET HEALTHSYSTEM HOSPITALS DALLAS, INC., RHD MEMORIAL MEDICAL CENTER | 271459658 - (TX) DALLAS MEDICAL CENTER, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 158 | $24981.64 | 1699705426 - TENET HOSPITALS LIMITED, DOCTORS HOSPITAL AT WHITE ROCK LAKE | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 158 | $18164.83 | 1649288085 - UPPER VALLEY MEDICAL CENTER, SUB PROVIDER REHAB | 310537095 - (OH) UPPER VALLEY MEDICAL CENTER | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 158 | $18146.25 | 1962577890 - INTEGRIS BASS BAPTIST HEALTH CENTER, INTEGRIS BASS BEHAVIORAL HEALTH CENTER ACUTE | 730612674 | OK | Psychiatric Hospital Unit (273R00000X) |
United | 158 | $10167.88 | 1992775449 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS ST. FRANCES CABRINI HOSPITAL | 720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANA | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 158 | $15406.08 | 1417951468 - MERCY HEALTH-LOURDES HOSPITAL LLC, LOURDES - REHAB | 610600313 | KY | Rehabilitation Hospital Unit (273Y00000X) |
United | 158 | $12466.70 | 1326022765 - VHS OF ARROWHEAD, INC, ABRAZO ARROWHEAD CAMPUS | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 158 | $15758.46 | 1255377149 - OHIOHEALTH CORPORATION, GRANT MEDICAL CENTER | 314394942 - OHIOHEALTH CORPORATION GRANT RIVERSIDE DOCTORS DUBLIN MET | OH | General Acute Care Hospital (282N00000X) |
United | 158 | $32571.46 | 1780748871 - LAWRENCE AND MEMORIAL HOSPITAL, INC. | 60646704 - (CT) LAWRENCE AND MEMORIAL HOSPITAL INC | CT | Rehabilitation Hospital Unit (273Y00000X) |
United | 158 | $2765.00 | 1225068711 - WELLMONT HEALTH SYSTEM, HANCOCK COUNTY HOSPITAL SWING BED UNIT | 621636465 - WELLMONT HEALTH SYSTEM | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
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 158 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 158 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 158 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 |
|---|---|---|
| 157-MS-DRG | High | Dental and Oral Diseases with MCC |
| 158-MS-DRG | High | Dental and Oral Diseases with CC |
| 159-MS-DRG | High | Dental and Oral Diseases 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 158. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 158 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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