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See a sample rate comparisonMS-DRG 166 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.
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC
| 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 166 by major payers:
$43,606.37
$50,140.67
$60,504.48
$62,124.77
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MS-DRG 166
5 of 25 sample ratesHigher to lower in this preview
Banner Boswell Medical Center
$90,675.60Published rateUniversity Healthcare System, L.C., East Jefferson General Hospital
$58,224.23Published rateWhite County Medical Center, White County Medical Center Rehab Unit
White County Medical Center
$38,510.69Published rateJersey City Medical Center, Liberty Hospitalist Services
Jersey City Medical Center
$11,595.00Published rateSabine Medical Center Inc, Sabine Medical Center
$1,200.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 166 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 166 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 166 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 |
|---|---|---|
| 165-APR-DRG | High | CORONARY BYPASS W AMI OR COMPLEX PDX |
| 165-MS-DRG | High | MAJOR CHEST PROCEDURES WITHOUT CC/MCC |
| 166-MS-DRG | High | OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC |
| 167-APR-DRG | High | OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 166. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 166 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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