MS-DRG 197 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 197 by major payers:
$12,851.61
$13,573.55
$15,713.01
$16,072.16
| 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 197 | ||||||
United | 197 | $10577.16 | 1326546797 - HENDERSON HOSPITAL, LLC, UTHEALTH EAST TEXAS HENDERSON HOSPITAL | 824019349 | TX | General Acute Care Hospital (282N00000X) |
United | 197 | $10076.98 | 1700870672 - METHODIST MEDICAL CENTER | 620636239 - METHODIST MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 197 | $10577.16 | 1326546797 - HENDERSON HOSPITAL, LLC, UTHEALTH EAST TEXAS HENDERSON HOSPITAL | 824019349 | TX | General Acute Care Hospital (282N00000X) |
United | 197 | $8969.75 | 1437177664 - TALLAHASSEE MEMORIAL HEALTHCARE INC | 591917016 - TALLAHASSEE MEMORIAL HEALTHCARE INC | FL | General Acute Care Hospital (282N00000X) |
United | 197 | $32504.66 | 1073576740 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 197 | $10883.07 | 1053496026 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 197 | $20882.07 | 1861009672 - NORCAL HEALTHCONNECT LLC, HEALDSBURG HOSPITAL | 852390012 | CA | Critical Access Hospital (282NC0060X) |
United | 197 | $16762.67 | 1750365375 - DEANCO HEALTHCARE LLC, MISSION COMMUNITY HOSPITAL | 272099923 - (CA) DEANCO HEALTHCARE, LLC DBA MISSION COMMUNITY HOSPITAL | CA | General Acute Care Hospital (282N00000X) |
United | 197 | $22617.53 | 1306938071 - ADVENTIST HEALTH SYSTEM-SUNBELT, INC, ADVENTHEALTH ORLANDO | 590724459 - (FL) ADVENTIST HEALTH SYSTEM-SUNBELT INC | FL | General Acute Care Hospital (282N00000X) |
United | 197 | $43589.69 | 1194832477 - THE NEW YORK AND PRESBYTERIAN HOSPITAL, NEWYORK-PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 197 | $13016.37 | 1487724712 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 197 | $11832.48 | 1285779116 - ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND, SOUTHERN NEW ENGLAND REHABILITION | 464661337 | RI | Rehabilitation Hospital Unit (273Y00000X) |
United | 197 | $19460.00 | 1699851758 - RIVERVIEW MEDICAL CENTER FAMILY HEALTH CENTER | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 197 | $28743.66 | 1235218785 - ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC, PROVIDENCE QUEEN OF THE VALLEY MEDICAL CENTER | 814791043 - (CA) ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC | CA | General Acute Care Hospital (282N00000X) |
United | 197 | $11280.05 | 1679927529 - UNIVERSITY OF LOUISVILLE | 611293786 - (KY) UNIVERSITY MEDICAL CENTER INC | KY | 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 197 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 197 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 197 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 |
|---|---|---|
| 196-APR-DRG | High | CARDIAC ARREST & SHOCK |
| 196-MS-DRG | High | Interstitial Lung Disease with MCC |
| 197-MS-DRG | High | Interstitial Lung Disease with CC |
| 198-APR-DRG | High | ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 197 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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