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See a sample rate comparisonMS-DRG 199 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.
PNEUMOTHORAX WITH 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 199 by major payers:
$20,360.72
$22,603.43
$27,763.42
$28,202.60
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MS-DRG 199
5 of 25 sample ratesHigher to lower in this preview
Sierra Vista Hospital, Inc., Sierra Vista Regional Medical Center
$97,894.22Published rateWentworth Douglass Hospital
Mass General Brigham Incorporated
$36,171.00Published rateBrooks
Brooks-Tlc Hospital System Inc
$20,639.89Published rateMercy Hospital Lincoln
$16,622.28Published rateSan Dimas Community Hospital, Inc., San Dimas Community Hospital
$6,034.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 199 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 199 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 199 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 |
|---|---|---|
| 198-APR-DRG | High | ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS |
| 198-MS-DRG | High | INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC |
| 199-MS-DRG | High | PNEUMOTHORAX WITH MCC |
| 200-APR-DRG | High | CARDIAC STRUCTURAL & VALVULAR DISORDERS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 199. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 199 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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