Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonMS-DRG 159 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.
DENTAL AND ORAL DISEASES WITHOUT CC/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 159 by major payers:
$8,110.14
$9,420.58
$10,523.06
$10,835.49
Compare published rates across providers.
Choose a payer to see a sample of rates for MS-DRG 159.
MS-DRG 159
5 of 25 sample ratesHigher to lower in this preview
Hcn Ep Horizon City, LLC, The Hospitals Of Providence Northeast Campus
Hcn Ep Horizon City LLC
$16,358.08Published rateShands Hospital
Shands Teaching Hospital And Clinics Inc
$12,106.95Published rateUchicago Medicine Northwest Indiana Inc
$9,234.40Published rateIndiana Regional Medical Center
$7,129.62Published ratePublic Health Trust Of Miami Dade County Florida, Jackson North Medical Center
Public Health Trust Of Miami-Dade County Florida
$3,120.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalMS-DRG 159 vs. Other Diseases & Disorders of the Ear, Nose, Mouth & Throat Codes
The MS-DRG 159 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 159 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 |
|---|---|---|
| 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 159. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 159 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 159) and we'll show you how you compare in 15 minutes or less.