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See a sample rate comparisonMS-DRG 189 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.
PULMONARY EDEMA AND RESPIRATORY FAILURE
| 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 189 by major payers:
$15,900.01
$16,771.10
$19,538.66
$19,958.13
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MS-DRG 189
5 of 25 sample ratesHigher to lower in this preview
Texas Health Presbyterian Hospital Plano
$34,806.26Published rateMission Hospital Regional Medical Center, Providence Mission Hospital
Mission Hospital Regional Medical Center
$22,815.91Published rateSt James Hospital And Health Center
Franciscan Health Olympia Fields
$16,317.83Published rateMccurtain Memorial Medical Management, Inc., Mccurtain Memorial Hospital Swing Bed
Mccurtain Memorial Medical Management Inc
$11,272.16Published rateSinging River Health System, Singing River Hospital Comprehensive Rehabilitation Center
$2,703.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 189 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 189 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 189 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 |
|---|---|---|
| 188-MS-DRG | High | PLEURAL EFFUSION WITHOUT CC/MCC |
| 189-MS-DRG | High | PULMONARY EDEMA AND RESPIRATORY FAILURE |
| 190-APR-DRG | High | ACUTE MYOCARDIAL INFARCTION |
| 190-MS-DRG | High | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH 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 189. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 189 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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