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See a sample rate comparisonMS-DRG 195 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 WITHOUT CC/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 195 by major payers:
$8,497.37
$9,064.90
$11,007.06
$10,339.25
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MS-DRG 195
5 of 25 sample ratesHigher to lower in this preview
Bon Secours St Francis Medical Center LLC, Bon Secours St. Francis Medical Center
$20,430.83Published rateThhbp Management Company LLC, Baylor Scott & White The Heart Hospital - Denton
Thhbp Management Company LLC
$13,861.00Published rateMemorial Health System, Memorial Hospital Phys Group
Uch-Mhs
$10,630.82Published rateWalker County Hospital Corporation, Huntsville Memorial Hospital
Huntsville Community Hospital Inc
$8,057.74Published rateMeridian Hospitals Corporation, Jersey Shore University Medical Center- Audiology
Hackensack Meridian Health Inc
$2,000.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 195 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 195 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 195 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 |
|---|---|---|
| 194-APR-DRG | High | HEART FAILURE |
| 194-MS-DRG | High | SIMPLE PNEUMONIA AND PLEURISY WITH CC |
| 195-MS-DRG | High | SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC |
| 196-APR-DRG | High | CARDIAC ARREST & SHOCK |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 195. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 195 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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