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 | $51253.66 | 1538193123 - ST. MARY'S MEDICAL CENTER, INC, ST. MARY'S MEDICAL CENTER | 752932830 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 167 | $51253.66 | 1538193123 - ST. MARY'S MEDICAL CENTER, INC, ST. MARY'S MEDICAL CENTER | 752932830 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 167 | $17384.55 | 1881792547 - MERCY HOSPITALS EAST COMMUNITIES, MERCY HOSPITAL ST LOUIS | 430653493 - MERCY HOSPITALS EAST COMMUNITIES | MO | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $3229.00 | 1245221050 - UNIVERSAL HEALTH SERVICES OF RANCHO SPRINGS INC, SOUTHWEST HEALTHCARE - INLAND VALLEY HOSPITAL | 233059262 | CA | 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 | $35341.69 | 1700910189 - DIGNITY COMMUNITY CARE, CHANDLER REGIONAL MEDICAL CENTER | 721561132 | AZ | General Acute Care Hospital (282N00000X) |
United | 167 | $18374.13 | 1821087164 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 167 | $26638.21 | 1710097936 - OCHSNER MEDICAL CENTER | 205432782 | LA | General Acute Care Hospital (282N00000X) |
United | 167 | $22377.84 | 1578630026 - ARIA HEALTH, ARIA HEALTH BUCKS COUNTY PYSCHE UNIT | 230596940 - (PA) JEFFERSON HEALTH-NORTHEAST | PA | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $29518.38 | 1720056138 - JEFFERSON REGIONAL MEDICAL CENTER, JEFFERSON HOSPITAL COUNSELING SERVICES | 251260215 - (PA) HIGHMARK HEALTH | PA | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $41280.10 | 1386712925 - NEBRASKA MEDICAL CENTER, THE NEBRASKA MEDICAL CENTER - NEBRASKA MEDICINE | 911858433 - (NE) THE NEBRASKA MEDICAL CENTER | NE | Psychiatric Hospital Unit (273R00000X) |
United | 167 | $15279.92 | 1710683354 - MEDICAL UNIVERSITY HOSPITAL AUTHORITY | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 167 | $28849.18 | 1578526695 - ST. JOHN'S RIVERSIDE HOSPITAL | 131740126 - (NY) ST JOHNS RIVERSIDE HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 167 | $39240.35 | 1508859323 - PIH HEALTH GOOD SAMARITAN HOSPITAL, GOOD SAMARITAN HOSPITAL | 951656366 - (CA) PIH HEALTH GOOD SAMARITAN HOSPITAL | CA | General Acute Care Hospital (282N00000X) |
United | 167 | $18659.30 | 1942205166 - CLAIBORNE MEDICAL CENTER | 464420358 - (TN) CLAIBORNE MEDICAL CENTER | TN | 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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