MS-DRG 191 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 191 by major payers:
$10,636.62
$12,139.66
$14,013.28
$14,185.92
| 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 191 | ||||||
United | 191 | $3615.81 | 1760696546 - ST CHARLES PARISH HOSPITAL | 726014606 | LA | General Acute Care Hospital (282N00000X) |
United | 191 | $38237.39 | 1740215219 - JOHN MUIR HEALTH, JOHN MUIR HEALTH, WALNUT CREEK MEDICAL CENTER | 941461843 - (CA) JOHN MUIR HEALTH | CA | General Acute Care Hospital (282N00000X) |
United | 191 | $3615.81 | 1760696546 - ST CHARLES PARISH HOSPITAL | 726014606 | LA | General Acute Care Hospital (282N00000X) |
United | 191 | $20609.81 | 1649615220 - PROVIDENCE HEALTH & SERVICES-WA, PROVIDENCE REGIONAL MEDICAL CENTER EVERETT | 352346161 | WA | Hospitalist Physician (208M00000X) |
United | 191 | $12259.55 | 1417951468 - MERCY HEALTH-LOURDES HOSPITAL LLC, LOURDES - REHAB | 610600313 | KY | Rehabilitation Hospital Unit (273Y00000X) |
United | 191 | $10405.83 | 1518075795 - FRANCISCAN HEALTH OLYMPIA FIELDS, FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS | 362167869 - FRANCISCAN HEALTH OLYMPIA FIELDS | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 191 | $16298.25 | 1245363662 - POCONO MEDICAL CENTER, LEHIGH VALLEY HOSPITAL POCONO | 240795623 - (PA) POCONO MEDICAL CENTER | PA | Psychiatric Hospital Unit (273R00000X) |
United | 191 | $7481.37 | 1710031836 - MEADVILLE MEDICAL CENTER, INPATIENT DRUG AND ALCOHOL | 251512436 - (PA) MEADVILLE MEDICAL CENTER | PA | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 191 | $9379.16 | 1487218509 - SMSJ TUCSON HOLDINGS, LLC, CARONDELET MARANA HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 191 | $9379.16 | 1487218509 - SMSJ TUCSON HOLDINGS, LLC, CARONDELET MARANA HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 191 | $13121.88 | 1255367611 - KENNEWICK PUBLIC HOSPITAL DISTRICT, KENNEWICK GENERAL HOSPITAL | 823962056 | WA | General Acute Care Hospital (282N00000X) |
United | 191 | $14096.96 | 1578624169 - COVENANT HEALTH SYSTEM, COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 191 | $16545.41 | 1265532915 - FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE, FRANCISCAN HEALTH - INPATIENT REHAB UNIT | 350913537 | IN | Rehabilitation Hospital Unit (273Y00000X) |
United | 191 | $7731.89 | 1902479447 - ANAHEIM COMMUNITY HOSPITAL, LLC | 854314119 - (CA) ANAHEIM COMMUNITY HOSPITAL LLC | CA | General Acute Care Hospital (282N00000X) |
United | 191 | $12048.16 | 1942241799 - SAINT LUKE'S NORTH HOSPITAL, SAINT LUKE'S NORLAND HOSPITAL-SMITHVILLE | 440565393 - (MO) SAINT LUKES NORTH HOSPITAL | MO | 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 191 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 191 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 191 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 |
|---|---|---|
| 190-APR-DRG | High | ACUTE MYOCARDIAL INFARCTION |
| 190-MS-DRG | High | Chronic Obstructive Pulmonary Disease with MCC |
| 191-MS-DRG | High | Chronic Obstructive Pulmonary Disease with CC |
| 192-APR-DRG | High | CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 191. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 191 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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