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 | $10197.00 | 1093714073 - SIOUXLAND SURGERY CENTER LIMITED LIABILITY PARTNERSHIP, DUNES SURGICAL HOSPITAL | 460423353 - (SD) SIOUXLAND SURGERY CENTER, LP | SD | Special Hospital (284300000X) |
United | 197 | $18256.25 | 1912527193 - ASCENSION NE WISCONSIN, INC, ASCENSION NE WISCONSIN-MERCY CAMPUS | 390816818 - ASCENSION NE WISCONSIN INC | WI | 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 | $12635.37 | 1487715645 - PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK, PRESENCE ST. JOSEPH MEDICAL CENTER | 992141118 | IL | General Acute Care Hospital (282N00000X) |
United | 197 | $12635.37 | 1487715645 - PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK, PRESENCE ST. JOSEPH MEDICAL CENTER | 992141118 | IL | General Acute Care Hospital (282N00000X) |
United | 197 | $14553.00 | 1154991487 - CONWAY HOSPITAL, INC. | 570314381 - (SC) CONWAY HOSPITAL INC | SC | Rehabilitation Hospital Unit (273Y00000X) |
United | 197 | $3537.00 | 1962435792 - HOUSTON HOSPITALS INC, HOUSTON MEDICAL CENTER | 711045290 - (GA) HOUSTON HOSPITALS INC | GA | General Acute Care Hospital (282N00000X) |
United | 197 | $5947.83 | 1659472447 - TYRONE HOSPITAL | 231440116 - (PA) TYRONE HOSPITAL | PA | Critical Access Hospital (282NC0060X) |
United | 197 | $32504.66 | 1073576740 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | 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 | $14711.40 | 1942509427 - MIDTOWN | 356005697 | IN | General Acute Care Hospital (282N00000X) |
United | 197 | $15480.50 | 1841497153 - GPCH, LLC, GOLDEN PLAINS COMMUNITY HOSPITAL | 260328929 - (TX) GPCH,LLC DBA GOLDEN PLAINS COMMUNITY HOSPITAL | TX | Critical Access Hospital (282NC0060X) |
United | 197 | $8867.42 | 1013122571 - MIDWEST SURGICAL HOSPITAL, L.L.C. | 383712521 - (NE) MIDWEST SURGICAL HOSPITAL, LLC | NE | Special Hospital (284300000X) |
United | 197 | $7352.04 | 1891795415 - SELECT SPECIALTY HOSPITAL | 251813117 - (AZ) SELECT SPECIALTY HOSPITAL | AZ | Long Term Care Hospital (282E00000X) |
United | 197 | $4653.00 | 1215005129 - PHC-LOS ALAMOS INC, LOS ALAMOS MEDICAL CENTER - SWING BED UNIT | 30390794 | NM | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
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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