MS-DRG 165 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 Respiratory System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 165 by major payers:
$23,741.64
$24,519.58
$30,062.82
$30,851.97
| 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 165 | ||||||
United | 165 | $17740.97 | 1386178721 - CLARKSDALE REGIONAL MEDICAL CENTER, INC., NORTHWEST MISSISSIPPI MEDICAL CENTER | 853959101 | MS | General Acute Care Hospital (282N00000X) |
United | 165 | $49135.94 | 1942772546 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | Rehabilitation Hospital Unit (273Y00000X) |
United | 165 | $27016.82 | 1538260849 - VALLEY BAPTIST MEDICAL CENTER | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 165 | $44098.51 | 1285619254 - ST JOSEPH HOSPITAL OF ORANGE, PROVIDENCE ST. JOSEPH HOSPITAL | 951643359 - (CA) ST JOSEPH HOSPITAL OF ORANGE | CA | Psychiatric Hospital Unit (273R00000X) |
United | 165 | $13672.08 | 1811971302 - MEDICAL UNIVERSITY OF OHIO AT TOLEDO, UNIVERSITY OF TOLEDO MEDICAL CENTER | 340967014 | OH | General Acute Care Hospital (282N00000X) |
United | 165 | $34239.08 | 1578044053 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH BAPTIST EASLEY HOSPTIAL O/P THERAPY SERVICES | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 165 | $27283.36 | 1942651401 - THEDACARE MEDICAL CENTER-BERLIN, INC. | 390806359 - (WI) THEDACARE MEDICAL CENTER-BERLIN INC | WI | Rural Acute Care Hospital (282NR1301X) |
United | 165 | $12108.54 | 1861870024 - KAPLAN GENERAL HOSPITAL, INC. | 472540179 - (LA) KAPLAN GENERAL HOSPITAL INC | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 165 | $25680.33 | 1487724712 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 165 | $42054.58 | 1609954395 - CARONDELET HEALTH NETWORK, CARONDELET OREILLY CARE CENTER | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 165 | $49429.55 | 1558521070 - BANNER BOSWELL MEDICAL CENTER | 900389314 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 165 | $34672.26 | 1285732933 - ST MARYS HEALTH, INC., ASCENSION ST. VINCENT EVANSVILLE | 350869065 - (IN) UNITED STATES CATHOLIC CONFERENCE | IN | Psychiatric Hospital Unit (273R00000X) |
United | 165 | $51884.33 | 1811237985 - PRISMA HEALTH-MIDLANDS, PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | General Acute Care Hospital (282N00000X) |
United | 165 | $9689.07 | 1730692641 - THE HEALTH CARE AUTHORITY OF THE CITY OF EUFAULA, MEDICAL CENTER BARBOUR | 208104245 | AL | Critical Access Hospital (282NC0060X) |
United | 165 | $32895.87 | 1013998426 - WSNCHS NORTH, INC., ST. JOSEPH HOSPITAL | 113438973 - ST JOSEPH HOSPITAL | NY | 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 165 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 165 code is part of the Diseases & Disorders of the Respiratory System 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 165 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 |
|---|---|---|
| 164-MS-DRG | High | Major Chest Procedures with CC |
| 165-MS-DRG | High | Major Chest Procedures without CC/MCC |
| 166-APR-DRG | High | CORONARY BYPASS W/O AMI OR COMPLEX PDX |
| 166-MS-DRG | High | Other Respiratory System O.R. Procedures with 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 165. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 165 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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