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 | $2893.00 | 1477882033 - SAVOY MEDICAL MANAGEMENT GROUP, INC., SAVOY MEDICAL CENTER HOSPITAL BASED PHYSICIANS | 800202027 - (LA) SAVOY MEDICAL MANAGEMENT GROUP INC | LA | General Acute Care Hospital (282N00000X) |
United | 205 | $20752.58 | 1518042605 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 205 | $31099.61 | 1548217763 - FLUSHING HOSPITAL & MEDICAL CENTER | 111631781 - FLUSHING HOSPITAL & MEDICAL CENTER | NY | 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 | $42753.01 | 1255387726 - BAYCARE AURORA, LLC, AURORA BAYCARE MEDICAL CENTER | 391947472 | WI | General Acute Care Hospital (282N00000X) |
United | 205 | $22238.27 | 1316279003 - METROSOUTH MEDICAL CENTER, HOSPITAL | 510382045 | IL | General Acute Care Hospital (282N00000X) |
United | 205 | $6034.00 | 1245227180 - ST FRANCIS MEDICAL CENTER | 850737566 | CA | General Acute Care Hospital (282N00000X) |
United | 205 | $6034.00 | 1245227180 - ST FRANCIS MEDICAL CENTER | 850737566 | CA | General Acute Care Hospital (282N00000X) |
United | 205 | $42492.48 | 1689693434 - FRANCISCAN HEALTH SYSTEM, ST. JOSEPH MEDICAL CENTER | 910564491 - (WA) FRANCISCAN HEALTH SYSTEM | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 205 | $32700.47 | 1770673535 - PRINCETON BAPTIST MEDICAL CENTER, PRINCETON BAPTIST MEDICAL CENTER | 474775351 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 205 | $43974.67 | 1811973100 - OCHSNER CLINIC FOUNDATION, OCHSNER MEDICAL CENTER ACUTE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | General Acute Care Hospital (282N00000X) |
United | 205 | $8799.00 | 1154399749 - OHI WEST, INC, BAYFRONT HEALTH ST PETERSBURG | 845074208 - (FL) OHI WEST INC | FL | General Acute Care Hospital (282N00000X) |
United | 205 | $40585.80 | 1902261860 - VANDERBILT UNIVERSITY MEDICAL CENTER | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Children's Hospital (282NC2000X) |
United | 205 | $38870.32 | 1053496026 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 205 | $10654.00 | 1215398813 - CHILDREN'S HOSPITAL COLORADO, CHILDREN'S HOSPITAL COLORADO OUTPATIENT SPECIALTY CARE UPTOWN | 840166760 - CHILDRENS HOSPITAL COLORADO | CO | Children's Hospital (282NC2000X) |
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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