MS-DRG 159 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 159 by major payers:
$8,110.14
$9,420.58
$10,523.06
$10,835.49
| 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 159 | ||||||
United | 159 | $4908.00 | 1144627050 - ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | 221487243 - (NJ) ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | NJ | Children's Hospital (282NC2000X) |
United | 159 | $7192.00 | 1639170699 - LAKESIDE WOMEN'S HOSPITAL, LLC | 731493662 | OK | General Acute Care Hospital (282N00000X) |
United | 159 | $4708.00 | 1285685727 - DICKENSON COMMUNITY HOSPITAL, INC. | 770599553 - DICKENSON COMMUNITY HOSPITAL INC | VA | Critical Access Hospital (282NC0060X) |
United | 159 | $11891.26 | 1568668754 - MEMORIAL HEALTH SYSTEM, MEMORIAL HOSPITAL PHYS GROUP | 460796114 - (CO) UCH-MHS | CO | General Acute Care Hospital (282N00000X) |
United | 159 | $5936.39 | 1962506568 - ANSON HOSPITAL DISTRICT | 811008596 | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 159 | $7129.62 | 1427041516 - INDIANA REGIONAL MEDICAL CENTER | 250965404 - (PA) INDIANA REGIONAL MEDICAL CENTER | PA | Rural Acute Care Hospital (282NR1301X) |
United | 159 | $8255.54 | 1316175417 - URGENT CARE CENTERS OF ST. ANTHONY'S MEDICAL CENTER, LC | 430980256 - (MO) MERCY HOSPITAL SOUTH | MO | General Acute Care Hospital (282N00000X) |
United | 159 | $12106.95 | 1891810206 - SHANDS HOSPITAL | 591943502 - (FL) SHANDS TEACHING HOSPITAL AND CLINICS INC | FL | General Acute Care Hospital (282N00000X) |
United | 159 | $9890.00 | 1881827301 - NORTH SHORE LIJ | 111562701 - (NY) NORTH SHORE UNIVERSITY HOSPITAL | NY | Long Term Care Hospital (282E00000X) |
United | 159 | $8454.08 | 1912423260 - TOPEKA HOSPITAL, LLC, THE UNIVERSITY OF KANSAS HEALTH SYSTEM, ST. FRANCIS CAMPUS | 822034009 | KS | General Acute Care Hospital (282N00000X) |
United | 159 | $10601.40 | 1760446009 - SIERRA VISTA HOSPITAL 69 | 850422820 | NM | Critical Access Hospital (282NC0060X) |
United | 159 | $15544.12 | 1447212592 - BON SECOURS ST FRANCIS MEDICAL CENTER LLC, BON SECOURS ST. FRANCIS MEDICAL CENTER | 311716973 | VA | General Acute Care Hospital (282N00000X) |
United | 159 | $11498.15 | 1215135785 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVERSITTY MEDICAL CENTER - | 113465690 | NY | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 159 | $7221.95 | 1316279003 - METROSOUTH MEDICAL CENTER, HOSPITAL | 510382045 | IL | General Acute Care Hospital (282N00000X) |
United | 159 | $9234.40 | 1144914532 - UCHICAGO MEDICINE NORTHWEST INDIANA INC | 922355855 - (IN) UCHICAGO MEDICINE NORTHWEST INDIANA INC | IN | 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 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.
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