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 | $47451.85 | 1366536963 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE MILWAUKIE HOSPITAL | 930924302 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | General Acute Care Hospital (282N00000X) |
United | 165 | $11595.00 | 1386897148 - JERSEY CITY MEDICAL CENTER, LIBERTY HOSPITALIST SERVICES | 222783298 - (NJ) JERSEY CITY MEDICAL CENTER | NJ | Hospitalist Physician (208M00000X) |
United | 165 | $17942.85 | 1760587182 - GRAND VIEW HOSPITAL | 231352181 - (PA) GRAND VIEW HOSPITAL | PA | Rehabilitation Hospital Unit (273Y00000X) |
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 | $17740.97 | 1386178721 - CLARKSDALE REGIONAL MEDICAL CENTER, INC., NORTHWEST MISSISSIPPI MEDICAL CENTER | 853959101 | MS | 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 | $20452.75 | 1023105566 - INGALLS MEMORIAL HOSPITAL, THE INGALLS MEMORIAL HOSPITAL | 362170866 - (IL) INGALLS MEMORIAL HOSPITAL | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 165 | $23176.98 | 1962504175 - ST MARY MEDICAL CENTER INC, ST MARY WOUND CLINIC | 352007327 - (IN) ST MARY MEDICAL CENTER INC | IN | General Acute Care Hospital (282N00000X) |
United | 165 | $27395.43 | 1619154820 - DAVIESS COUNTY HOSPITAL, DAVIESS COUNTY HOSPITAL PHYSICIANS | 356001322 - (IN) DAVIESS COUNTY HOSPITAL | IN | General Acute Care Hospital (282N00000X) |
United | 165 | $14098.15 | 1700860491 - BLUE RIDGE HEALTHCARE HOSPITALS, INC., UNC HEALTH BLUE RIDGE | 560529976 - (NC) BLUE RIDGE HEALTHCARE HOSPITALS INC | NC | General Acute Care Hospital (282N00000X) |
United | 165 | $14102.00 | 1467483701 - MERCY HEALTH YOUNGSTOWN LLC, MERCY HEALTH ST ELIZABETH YOUNGSTOWN HOSPITAL | 340505560 - HUMILITY OF MARY HEALTH PARTNERS | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 165 | $6055.00 | 1982720249 - MONTCLAIR HOSPITAL LLC, HACKENSACKUMC MOUNTAINSIDE | 208489105 - (NJ) MERIT MOUNTAINSIDE, LLC | NJ | General Acute Care Hospital (282N00000X) |
United | 165 | $34341.87 | 1912527193 - ASCENSION NE WISCONSIN, INC, ASCENSION NE WISCONSIN-MERCY CAMPUS | 390816818 - ASCENSION NE WISCONSIN INC | WI | General Acute Care Hospital (282N00000X) |
United | 165 | $43311.89 | 1316096266 - WINTER HAVEN HOSPITAL INC, MID FLORIDA MEDICAL SERVIES | 590724462 - (FL) WINTER HAVEN HOSPITAL INC | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 165 | $22228.19 | 1831115641 - OZARKS MEDICAL CENTER, OZARKS HEALTHCARE | 446005758 - OZARKS MEDICAL CENTER | MO | 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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