MS-DRG 167 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 167 by major payers:
$23,371.00
$24,009.41
$28,800.85
$29,816.15
| 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 167 | ||||||
United | 167 | $46520.51 | 1396207221 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CENTER FOR PERIOP OPTIMIZATION | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 167 | $51253.66 | 1538193123 - ST. MARY'S MEDICAL CENTER, INC, ST. MARY'S MEDICAL CENTER | 752932830 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 167 | $47441.94 | 1881780302 - CHILDREN'S HOSPITAL OF WISCONSIN, INC., CHILDREN'S HOSPITAL OF WISCONSIN, INC. - FOX VALLEY | 390812532 - CHILDRENS HOSPITAL OF WISCONSIN INC | WI | Children's Hospital (282NC2000X) |
United | 167 | $20632.64 | 1750788667 - CARONDELET HEALTH NETWORK, BRIDGES GEROPSYCHIATRIC PROGRAM AT ST. MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $48453.69 | 1275566200 - BANNER ESTRELLA MEDICAL CENTER | 900065118 - (AZ) BANNER ESTRELLA MEDICAL CENTER | AZ | General Acute Care Hospital (282N00000X) |
United | 167 | $30097.64 | 1558391771 - ASCENSION SACRED HEART EMERALD COAST, ASCENSION SACRED HEART EMERALD COAST | 721529708 | FL | General Acute Care Hospital (282N00000X) |
United | 167 | $32275.66 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $38377.76 | 1528028396 - SENTARA PRINCESS ANNE HOSPITAL, SENTARA HOSPITALS | 273208969 - (VA) SENTARA PRINCESS ANNE HOSPITAL | VA | General Acute Care Hospital (282N00000X) |
United | 167 | $43293.67 | 1427374198 - ST JOSHEPH MEDICAL CENTER, FRANCISCAN HEALTH SYSTEMS | 910564491 - (WA) FRANCISCAN HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 167 | $27517.63 | 1659393932 - DLP FRYE REGIONAL MEDICAL CENTER LLC, FRYE REGIONAL MEDICAL CENTER | 352547114 | NC | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $27207.00 | 1316294069 - EMCARE | 871999484 | FL | General Acute Care Hospital (282N00000X) |
United | 167 | $30713.40 | 1275541104 - SOUTHSIDE HOSPITAL, REHABILITATION UNIT | 111667761 - (NY) SOUTH SHORE UNIVERSITY HOSPITAL | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 167 | $32275.66 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $46884.12 | 1083885917 - ALAMEDA HEALTH SYSTEM, JOHN GEORGE PAVILION | 943302014 | CA | Psychiatric Hospital (283Q00000X) |
United | 167 | $40691.14 | 1285293274 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 821885403 - (CO) UCHEALTH HIGHLANDS RANCH HOSPITAL | CO | 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 167 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 167 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 167 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 |
|---|---|---|
| 166-APR-DRG | High | CORONARY BYPASS W/O AMI OR COMPLEX PDX |
| 166-MS-DRG | High | Other Respiratory System O.R. Procedures with MCC |
| 167-MS-DRG | High | Other Respiratory System O.R. Procedures with CC |
| 168-MS-DRG | High | Other Respiratory System O.R. Procedures 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 167. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 167 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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