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 | $12414.79 | 1619975331 - UNION HOSPITAL INC. | 350876396 - UNION HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 194 | $27738.35 | 1174615330 - EMANUEL MEDICAL CENTER, INC. | 752918774 | CA | 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 | $22512.27 | 1952546616 - UNIVERSITY OF SOUTHERN CALIFORNIA, KECK HOSPITAL OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | 194 | $10797.75 | 1669470712 - NEMAHA VALLEY COMMUNITY HOSPITAL | 480764456 - (KS) NEMAHA VALLEY COMMUNITY HOSPITAL | KS | Critical Access Hospital (282NC0060X) |
United | 194 | $10572.25 | 1427616002 - NYU LANGONE HOSPITALS, NYU LANGONE HOSPITAL LONG ISLAND | 133971298 - NYU LANGONE HOSPITALS | NY | 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 | $21040.38 | 1083815872 - ALAMEDA HEALTH SYSTEM, HIGHLAND GENERAL HOSPITAL | 943302014 | CA | General Acute Care Hospital (282N00000X) |
United | 194 | $3336.00 | 1285717298 - NIAGARA FALLS MEMORIAL MEDICAL CENTER | 160743094 - (NY) NIAGARA FALLS MEMORIAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 194 | $1200.00 | 1619057155 - SABINE MEDICAL CENTER | 262074318 | LA | General Acute Care Hospital (282N00000X) |
United | 194 | $11337.32 | 1295159028 - CATHOLIC HEALTH INITIATIVES COLORADO, ST. ANTHONY SUMMIT HOSPITAL SWING BED UNIT | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 194 | $7523.12 | 1558391706 - RUSH OAK PARK HOSPITAL INC | 362183812 - (IL) RUSH OAK PARK HOSPITAL INC | IL | General Acute Care Hospital (282N00000X) |
United | 194 | $16251.61 | 1770593956 - CHENANGO MEMORIAL HOSPITAL INC | 150532180 - (NY) CHENANGO MEMORIAL HOSPITAL INC | NY | General Acute Care Hospital (282N00000X) |
United | 194 | $12284.41 | 1043457583 - MEMORIAL HERMANN REHABILITATION HOSPITAL KATY, LLC, MEMORIAL HERMANN REHABILITATION HOSPITAL KATY | 263896170 | TX | Rehabilitation Hospital (283X00000X) |
United | 194 | $15142.94 | 1295735330 - BAY PARK COMMUNITY HOSPITAL | 341883132 - (OH) BAY PARK COMMUNITY HOSPITAL | OH | Rehabilitation Hospital Unit (273Y00000X) |
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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