MS-DRG 168 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 168 by major payers:
$16,852.69
$17,908.99
$21,377.07
$22,198.57
| 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 168 | ||||||
United | 168 | $27815.88 | 1538572748 - THE PRESBYTERIAN HOSPITAL, NOVANT HEALTH HUNTERSVILLE MEDICAL CENTER | 560554230 - PRESBYTERIAN HOSPITAL | NC | General Acute Care Hospital (282N00000X) |
United | 168 | $6034.00 | 1487697215 - ST.FRANCIS MEDICAL CENTER | 850737566 | CA | General Acute Care Hospital (282N00000X) |
United | 168 | $11146.57 | 1386802023 - SOUTHEAST HEALTH CENTER OF STODDARD COUNTY, LLC, MERCY HOSPITAL STODDARD | 461481133 - (MO) SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC | MO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 168 | $35269.10 | 1548399736 - DOCTORS MEDICAL CENTER OF MODESTO, INC., DOCTORS BEHAVIORAL HEALTH CENTER | 752918774 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 168 | $16792.41 | 1912978685 - MERCY HOSPITAL WALDRON | 710557895 - MERCY HOSPITAL WALDRON | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 168 | $1200.00 | 1568626273 - ALLEGIANCE HOSPITAL OF MANY,LLC, SABINE MEDICAL CENTER | 262074318 | LA | General Acute Care Hospital (282N00000X) |
United | 168 | $20229.97 | 1720003312 - NASSAU HEALTHCARE CORPORATION, NUMC DEPARTMENT OF PATHOLOGY, FPP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 168 | $19663.07 | 1922018092 - MARYVIEW HOSPITAL LLC | 540506463 | VA | Rehabilitation Hospital Unit (273Y00000X) |
United | 168 | $18652.67 | 1487724712 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 168 | $34600.78 | 1063071033 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 168 | $14978.36 | 1578648614 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 168 | $4796.00 | 1598196206 - EBD BEMC BURLESON, LLC, BAYLOR EMERGENCY MEDICAL CENTER AT MANSFIELD | 364755936 | TX | General Acute Care Hospital (282N00000X) |
United | 168 | $31198.53 | 1245207521 - PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S, UPHS PRESBYTERIAN MEDICAL CENTER | 311538725 - (PA) PENNSYLVANIA HOSPITAL OF THE UNIV OF PENNSYLVANIA HEALTH SYSTEM | PA | General Acute Care Hospital (282N00000X) |
United | 168 | $18560.89 | 1184655953 - BROOKWOOD HEALTH SERVICES, INC., BROOKWOOD MEDICAL CENTER | 474757851 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 168 | $15911.03 | 1104949965 - MURRAY-CALLOWAY COUNTY PUBLIC HOSPITAL CORPORATION | 610620567 | KY | 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 168 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 168 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 168 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 |
|---|---|---|
| 167-APR-DRG | High | OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES |
| 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 |
| 173-APR-DRG | Moderate | Ap-Drg: Digestive Malignancy W/O Cc |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 168. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 168 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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