MS-DRG 194 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 194 by major payers:
$10,879.26
$11,714.72
$13,758.85
$13,444.65
| 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 194 | ||||||
United | 194 | $7549.74 | 1275217606 - NORTHWEST MISS REGIONAL MEDICAL CENTER, NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER | 646001574 | MS | General Acute Care Hospital (282N00000X) |
United | 194 | $7549.74 | 1275217606 - NORTHWEST MISS REGIONAL MEDICAL CENTER, NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER | 646001574 | MS | General Acute Care Hospital (282N00000X) |
United | 194 | $14238.17 | 1689727208 - GREAT PLAINS OF OTTAWA CO INC, OTTAWA COUNTY HEALTH CENTER | 481226856 - (KS) GREAT PLAINS OF OTTAWA CO INC | KS | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 194 | $18045.22 | 1336252717 - INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION, INTEGRIS JIM THORPE INPATIENT REHABILITATION | 731089149 - (OK) INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION | OK | Rehabilitation Hospital Unit (273Y00000X) |
United | 194 | $6965.00 | 1548380900 - HUNTERDON MEDICAL CENTER | 221537688 - HUNTERDON MEDICAL CENTER | NJ | General Acute Care Hospital (282N00000X) |
United | 194 | $12063.58 | 1538201488 - JOHNSTON MEMORIAL HOSPITAL | 463176429 - (NC) JOHNSTON HEALTH SERVICES CORPORATION | NC | General Acute Care Hospital (282N00000X) |
United | 194 | $20068.25 | 1396001780 - UNIVERSITY OF COLORADO HOSPITAL | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 194 | $10339.53 | 1063168243 - CLEARSKY REHABILITATION HOSPITAL OF WEST VALLEY, LLC, CLEARSKY REHABILITATION HOSPITAL OF AVONDALE | 873207355 - (AZ) CLEARSKY REHABILITATION HOSPITAL OF WEST VALLEY LLC | AZ | Rehabilitation Hospital (283X00000X) |
United | 194 | $12414.79 | 1619975331 - UNION HOSPITAL INC. | 350876396 - UNION HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 194 | $11929.16 | 1619066594 - HENRY FORD MACOMB HOSPITAL CORPORATION, HENRY FORD MACOMB HOSPITAL | 381357020 - HENRY FORD HEALTH SYSTEM | MI | Psychiatric Hospital Unit (273R00000X) |
United | 194 | $8428.88 | 1356334510 - INDIANA REGIONAL MEDICAL CENTER | 250965404 - (PA) INDIANA REGIONAL MEDICAL CENTER | PA | Rural Acute Care Hospital (282NR1301X) |
United | 194 | $10797.75 | 1669470712 - NEMAHA VALLEY COMMUNITY HOSPITAL | 480764456 - (KS) NEMAHA VALLEY COMMUNITY HOSPITAL | KS | Critical Access Hospital (282NC0060X) |
United | 194 | $11913.20 | 1184911877 - VHS BROWNSVILLE HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER - BROWNSVILLE | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 194 | $5196.00 | 1285052845 - SHARON PENNSYLVANIA HOSPITAL COMPANY LLC, SRHS INPATIENT PSYCH BILLING | 815457135 | PA | Psychiatric Hospital Unit (273R00000X) |
United | 194 | $3336.00 | 1285717298 - NIAGARA FALLS MEMORIAL MEDICAL CENTER | 160743094 - (NY) NIAGARA FALLS MEMORIAL MEDICAL CENTER | NY | 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 194 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 194 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 194 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 |
|---|---|---|
| 193-APR-DRG | High | ACUTE & SUBACUTE ENDOCARDITIS |
| 193-MS-DRG | High | Simple Pneumonia and Pleurisy with MCC |
| 194-MS-DRG | High | Simple Pneumonia and Pleurisy with CC |
| 195-MS-DRG | High | Simple Pneumonia and Pleurisy without CC/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 194. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 194 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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