MS-DRG 196 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 196 by major payers:
$20,752.06
$24,238.92
$29,515.49
$29,992.59
| 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 196 | ||||||
United | 196 | $34957.58 | 1528332970 - LINCOLN MEDICAL AND MENTAL HEALTH CENTER | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | 196 | $15378.26 | 1134125016 - VIRTUA, VIRTUA MOUNT HOLLY HOSPITAL | 210634562 - (NJ) VIRTUA-MEMORIAL HOSPITAL BURLINGTON COUNTY INC | NJ | General Acute Care Hospital (282N00000X) |
United | 196 | $25990.09 | 1083790893 - ANTELOPE MEMORIAL HOSPITAL | 470393176 - (NE) ANTELOPE MEMORIAL HOSPITAL | NE | Critical Access Hospital (282NC0060X) |
United | 196 | $6520.00 | 1053456111 - JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC | 730606129 - JANE PHILLIPS MEMORIAL MEDICAL CENTER INC | OK | Rehabilitation Hospital Unit (273Y00000X) |
United | 196 | $22141.76 | 1801897038 - DLP CONEMAUGH MEMORIAL MEDICAL CENTER LLC, MEMORIAL MEDICAL CENTER | 611739000 | PA | General Acute Care Hospital (282N00000X) |
United | 196 | $17595.94 | 1386697688 - ORO VALLEY HOSPITAL LLC, ORO VALLEY HOSPITAL | 522379881 | AZ | General Acute Care Hospital (282N00000X) |
United | 196 | $22958.49 | 1528039039 - PHOENIXVILLE HOSPITAL COMPANY LLC, PHOENIXVILLE HOSPITAL | 822062413 | PA | General Acute Care Hospital (282N00000X) |
United | 196 | $32896.55 | 1508315516 - ADVOCATE HEALTH & HOSPITALS CORPORATION | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Children's Hospital (282NC2000X) |
United | 196 | $55392.53 | 1952453987 - TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | 751047527 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | TX | Psychiatric Hospital Unit (273R00000X) |
United | 196 | $31270.41 | 1710097936 - OCHSNER MEDICAL CENTER | 205432782 | LA | General Acute Care Hospital (282N00000X) |
United | 196 | $22958.49 | 1528039039 - PHOENIXVILLE HOSPITAL COMPANY LLC, PHOENIXVILLE HOSPITAL | 822062413 | PA | General Acute Care Hospital (282N00000X) |
United | 196 | $7718.00 | 1710238639 - SAINT CLARE'S HOSPITAL INC | 463483967 | NJ | General Acute Care Hospital (282N00000X) |
United | 196 | $30522.41 | 1366420531 - PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC. | 390794174 - (WI) PROHEALTH MEDICAL GROUP INC | WI | General Acute Care Hospital (282N00000X) |
United | 196 | $34846.42 | 1902818883 - GRANT COUNTY PUBLIC HOSPITAL DISTRICT 1, SAMARITAN HEALTHCARE | 930386906 | WA | General Acute Care Hospital (282N00000X) |
United | 196 | $41054.35 | 1184691610 - CAPE CANAVERAL HOSPITAL, INC. | 592477479 - (FL) CAPE CANAVERAL HOSPITAL INC | FL | 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 196 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 196 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 196 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 |
|---|---|---|
| 195-MS-DRG | High | Simple Pneumonia and Pleurisy without CC/MCC |
| 196-MS-DRG | High | Interstitial Lung Disease with MCC |
| 197-APR-DRG | High | PERIPHERAL & OTHER VASCULAR DISORDERS |
| 197-MS-DRG | High | Interstitial Lung Disease with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 196. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 196 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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