MS-DRG 205 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 205 by major payers:
$19,241.09
$23,737.38
$29,405.14
$29,978.60
| 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 205 | ||||||
United | 205 | $33818.05 | 1811150618 - ST CLOUD HOSPITAL, CENTRACARE ST CLOUD HOSPITAL ADOLESCENT ADDICTION SERVICES | 410695596 - (MN) ST CLOUD HOSPITAL | MN | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 205 | $26814.31 | 1831170232 - GOTTLIEB MEMORIAL HOSPITAL | 362379649 - (IL) GOTTLIEB MEMORIAL HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 205 | $61602.69 | 1700801909 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE MEMORIAL CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 205 | $16609.59 | 1801892740 - NORTON COUNTY HOSPITAL | 486013207 - (KS) NORTON COUNTY HOSPITAL | KS | Critical Access Hospital (282NC0060X) |
United | 205 | $12277.95 | 1770147118 - KPC PROMISE HOSPITAL OF PHOENIX LLC | 834169286 | AZ | Long Term Care Hospital (282E00000X) |
United | 205 | $22238.27 | 1316279003 - METROSOUTH MEDICAL CENTER, HOSPITAL | 510382045 | IL | General Acute Care Hospital (282N00000X) |
United | 205 | $7536.00 | 1225275639 - JACKSON MEMORIAL HOSPITAL | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | General Acute Care Hospital (282N00000X) |
United | 205 | $3665.00 | 1528195724 - THE SHRINERS' HOSPITAL FOR CHILDREN | 362193608 - SHRINERS HOSPITALS FOR CHILDREN | MA | Children's Hospital (282NC2000X) |
United | 205 | $29721.51 | 1487604179 - UPMC ALTOONA, ALTOONA FAMILY PHYSICIANS | 231352155 - UPMC | PA | General Acute Care Hospital (282N00000X) |
United | 205 | $24346.96 | 1033100052 - HOLY REDEEMER HEALTH SYSTEM, SENIOR BEHAVORIAL HEALTH | 231534300 - HOLY REDEEMER HEALTH SYSTEM | PA | Psychiatric Hospital Unit (273R00000X) |
United | 205 | $1875.00 | 1396037230 - THE DCH HEALTH CARE AUTHORITY, DCH HEALTH CARE AUTHORITY - REHAB | 636000271 - (AL) THE DCH HEALTH CARE AUTHORITY | AL | Rehabilitation Hospital Unit (273Y00000X) |
United | 205 | $31099.61 | 1548217763 - FLUSHING HOSPITAL & MEDICAL CENTER | 111631781 - FLUSHING HOSPITAL & MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 205 | $20765.80 | 1184639122 - FARMERS UNION HOSPITAL ASSOCIATION, GREAT PLAINS REGIONAL MEDICAL CENTER | 730579295 - (OK) FARMERS UNION HOSPITAL ASSOCIATION | OK | General Acute Care Hospital (282N00000X) |
United | 205 | $42753.01 | 1255387726 - BAYCARE AURORA, LLC, AURORA BAYCARE MEDICAL CENTER | 391947472 | WI | General Acute Care Hospital (282N00000X) |
United | 205 | $17924.66 | 1619270089 - NORTHWEST COMMUNITY HOSPITAL | 362340313 - NORTHWEST COMMUNITY HOSPITAL | IL | 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 205 vs. Other Diseases & Disorders of the Respiratory System Codes
The MS-DRG 205 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 205 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 |
|---|---|---|
| 204-APR-DRG | High | SYNCOPE & COLLAPSE |
| 204-MS-DRG | High | Respiratory Signs and Symptoms |
| 205-MS-DRG | High | Other Respiratory System Diagnoses with MCC |
| 206-APR-DRG | High | MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 205 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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