MS-DRG 195 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 195 by major payers:
$8,497.37
$9,064.90
$11,007.06
$10,339.25
| 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 195 | ||||||
United | 195 | $10688.54 | 1073967329 - BBH SBMC, LLC, SHELBY BAPTIST MEDICAL CENTER | 474780023 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 195 | $2926.68 | 1285701623 - PHC-LOS ALAMOS INC, LOS ALAMOS MEDICAL CENTER | 30390794 | NM | Rural Acute Care Hospital (282NR1301X) |
United | 195 | $7123.66 | 1609275585 - CHCA PEARLAND, L.P., HCA HOUSTON HEALTHCARE PEARLAND | 50631189 | TX | General Acute Care Hospital (282N00000X) |
United | 195 | $10688.54 | 1073967329 - BBH SBMC, LLC, SHELBY BAPTIST MEDICAL CENTER | 474780023 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 195 | $4887.31 | 1528079027 - SAINT ANTHONYS HEALTH CENTER | 370813229 - (IL) OSF HEALTHCARE SYSTEM | IL | General Acute Care Hospital (282N00000X) |
United | 195 | $15146.54 | 1912280298 - DR FATHIMA SYED MD PLLC | 591113901 - (FL) UNIVERSITY COMMUNITY HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 195 | $14564.58 | 1053384776 - AHS HOSPITAL CORP., MORRISTOWN MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 195 | $10617.29 | 1649209230 - PUBLIC HOSPITAL DISTRICT 1 OF KING COUNTY, VALLEY MEDICAL CENTER | 916000986 - (WA) PUBLIC HOSPITAL DISTRICT 1 OF KING COUNTY | WA | General Acute Care Hospital (282N00000X) |
United | 195 | $13861.00 | 1194753590 - THHBP MANAGEMENT COMPANY LLC, BAYLOR SCOTT & WHITE THE HEART HOSPITAL - DENTON | 263603862 - (TX) THHBP MANAGEMENT COMPANY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 195 | $11021.79 | 1689679581 - ALLE-KISKI MEDICAL CENTER, ALLEGHENY VALLEY HOSPITAL | 251875178 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 195 | $7424.00 | 1396786307 - SARTORI MEMORIAL HOSPITAL INC, MERCYONE CEDAR FALLS MEDICAL CENTER | 420758901 - (IA) SARTORI MEMORIAL HOSPITAL INC | IA | Psychiatric Hospital Unit (273R00000X) |
United | 195 | $2428.53 | 1578960647 - MEMORIAL MEDICAL CLINIC | 746003411 | TX | Critical Access Hospital (282NC0060X) |
United | 195 | $8385.75 | 1215043112 - INTEGRIS MIAMI HOSPITAL, INTEGRIS MIAMI HOSPITAL GENERATIONS PSYCH UNIT | 730584411 | OK | Psychiatric Hospital Unit (273R00000X) |
United | 195 | $11040.37 | 1003260480 - BBH BMC, LLC, BROOKWOOD MEDICAL CENTER | 474757851 | AL | General Acute Care Hospital (282N00000X) |
United | 195 | $11040.37 | 1003260480 - BBH BMC, LLC, BROOKWOOD MEDICAL CENTER | 474757851 | AL | 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 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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