MS-DRG 186 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 186 by major payers:
$18,320.62
$20,946.81
$24,830.78
$25,276.81
| 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 186 | ||||||
United | 186 | $3183.00 | 1376591941 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER | 726015227 | LA | General Acute Care Hospital (282N00000X) |
United | 186 | $9454.71 | 1285718478 - IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME | 370673512 - IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME | IL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 186 | $14069.00 | 1912992215 - NORTHERN WESTCHESTER HOSPITAL ASSOCIATION, NORTHERN WESTCHESTER HOSPITAL | 131740118 - (NY) NORTHERN WESTCHESTER HOSPITAL ASSOCIATION | NY | General Acute Care Hospital (282N00000X) |
United | 186 | $34169.07 | 1194751313 - RICE COUNTY DISTRICT ONE HOSPITAL, DISTRICT ONE HOSPITAL | 363261413 - ALLINA HEALTH SYSTEM | MN | General Acute Care Hospital (282N00000X) |
United | 186 | $45311.23 | 1447393152 - DIGNITY HEALTH, ST. ROSE DOMINICAN HOSPITAL, ROSE DE LIMA CAMPUS | 880059427 - (NV) DIGNITY HEALTH | NV | General Acute Care Hospital (282N00000X) |
United | 186 | $20874.96 | 1386162014 - PHOENIXVILLE HOSPITAL, LLC, REHABILITATION AT PHOENIXVILLE HOSPITAL | 822062413 | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 186 | $20874.96 | 1386162014 - PHOENIXVILLE HOSPITAL, LLC, REHABILITATION AT PHOENIXVILLE HOSPITAL | 822062413 | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 186 | $41765.71 | 1578620449 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC, BAPTIST MEDICAL CENTER | 590747311 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC | FL | General Acute Care Hospital (282N00000X) |
United | 186 | $27018.00 | 1013906239 - ST FRANCIS MEDICAL CENTER, INC, ST FRANCIS ACUTE REHABILITATION CENTER | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 186 | $7268.00 | 1972689172 - LAKE HOSPITAL SYSTEM INC, LAKE HEALTH | 341425870 - (OH) UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | General Acute Care Hospital (282N00000X) |
United | 186 | $1800.00 | 1912081290 - EAST TEXAS MEDICAL CENTER CROCKETT | 823280177 - (TX) CROCKETT MEDICAL CENTER LLC | TX | Long Term Care Hospital (282E00000X) |
United | 186 | $6098.00 | 1497910012 - HUMC OPCO LLC, HOBOKEN UNIVERSITY MEDICAL CENTER | 452147328 - (NJ) HUMC OPCO LLC (D/B/A CAREPOINT HEALTH - HOBOKEN UNIVERSITY MED CENTER) | NJ | Rehabilitation Hospital Unit (273Y00000X) |
United | 186 | $9326.00 | 1225062193 - STATEN ISLAND UNIVERSITY HOSPITAL | 112868878 - (NY) STATEN ISLAND UNIVERSITY HOSPITAL | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 186 | $46993.94 | 1851787295 - HDMC HOLDINGS, LLC, HI-DESERT MEDICAL CENTER | 473550779 | CA | General Acute Care Hospital (282N00000X) |
United | 186 | $20656.91 | 1114473329 - EMERUS BHS SA THOUSAND OAKS LLC, BAPTIST NEIGHBORHOOD HOSPITAL SHAVANO PARK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | 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 186 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 186 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 186 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 |
|---|---|---|
| 185-MS-DRG | High | Major Chest Trauma without CC/MCC |
| 186-MS-DRG | High | Pleural Effusion with MCC |
| 187-MS-DRG | High | Pleural Effusion with 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 186. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 186 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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