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See a sample rate comparisonMS-DRG 193 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.
SIMPLE PNEUMONIA AND PLEURISY WITH MCC
| 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 193 by major payers:
$16,039.77
$17,674.16
$21,119.31
$21,195.40
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MS-DRG 193
5 of 25 sample ratesHigher to lower in this preview
New York Presbyterian Hospital
The New York And Presbyterian Hospital
$64,244.46Published rateProvidence Health & Services Oregon, Providence Portland Medical Center
$24,370.85Published rateOsborne County Memorial Hospital
$13,877.91Published rateBaptist Hospitals Of Southeast Texas, Memorial Hermann Baptist Orange Hospital
Baptist Hospitals Of Southeast Texas
$12,209.80Published rateGreenwood Leflore Hospital
$2,060.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 193 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 193 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 193 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 |
|---|---|---|
| 192-APR-DRG | High | CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS |
| 192-MS-DRG | High | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC |
| 193-MS-DRG | High | SIMPLE PNEUMONIA AND PLEURISY WITH MCC |
| 194-APR-DRG | High | HEART FAILURE |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 193. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 193 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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