MS-DRG 216 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 Circulatory System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 216 by major payers:
$110,250.96
$115,891.39
$138,720.57
$147,671.12
| 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 216 | ||||||
United | 216 | $2805.00 | 1801826912 - WELLMONT HEALTH SYSTEM, LONESOME PINE HOSPITAL | 621636465 - WELLMONT HEALTH SYSTEM | VA | General Acute Care Hospital (282N00000X) |
United | 216 | $82653.00 | 1437254562 - UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 216 | $214852.79 | 1720454341 - SMSJ TUCSON HOLDINGS LLC, BRIDGES GEROPSYCHIATRIC PROGRAM AT ST. MARYS HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 216 | $82381.78 | 1548241953 - CAMPBELL COUNTY HMA, LLC, TENNOVA HEALTHCARE-LAFOLLETTE MEDICAL CENTER | 452528273 - CAMPBELL COUNTY HMA LLC | TN | Psychiatric Hospital Unit (273R00000X) |
United | 216 | $109576.89 | 1942370648 - MISSOURI DELTA MEDICAL CENTER | 430633449 - MISSOURI DELTA MEDICAL CENTER | MO | Rehabilitation Hospital Unit (273Y00000X) |
United | 216 | $243130.51 | 1841224870 - BANNER | 270036499 | AZ | General Acute Care Hospital (282N00000X) |
United | 216 | $125126.50 | 1811927544 - MAURY REGIONAL HOSPITAL, WAYNE MEDICAL CENTER | 621605071 - (TN) MAURY REGIONAL HOSPITAL | TN | General Acute Care Hospital (282N00000X) |
United | 216 | $86712.00 | 1528122371 - NORTHEASTERN HEALTH SYSTEM, TAHLEQUAH HOSPITAL AUTHORITY | 736045246 - (OK) NORTHEASTERN HEALTH SYSTEM | OK | Rehabilitation Hospital Unit (273Y00000X) |
United | 216 | $131759.15 | 1467489682 - THE METROHEALTH SYSTEM, METROHEALTH MEDICAL CENTER | 346004382 | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 216 | $69214.00 | 1871911016 - NORTH TEXAS, MEDICAL CITY ALLIANCE | 464027347 - (TX) NORTH TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 216 | $237010.68 | 1619938149 - SENTARA HOSPITALS, SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 216 | $106654.32 | 1982835708 - OCONNOR HOSPITAL | 161540394 - (NY) OCONNOR HOSPITAL | NY | Critical Access Hospital (282NC0060X) |
United | 216 | $142874.87 | 1700870672 - METHODIST MEDICAL CENTER | 620636239 - METHODIST MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 216 | $14970.00 | 1962504340 - TEXAS HEART HOSPITAL OF THE SOUTHWEST LLP, BAYLOR SCOTT & WHITE THE HEART HOSPITAL - PLANO | 412101361 - (TX) TEXAS HEART HOSPITAL OF THE SOUTHWEST, L.L.P | TX | General Acute Care Hospital (282N00000X) |
United | 216 | $11595.00 | 1659703254 - JERSEY CITY MEDICAL CENTER | 222783298 - (NJ) JERSEY CITY MEDICAL CENTER | NJ | 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 216 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 216 code is part of the Diseases & Disorders of the Circulatory 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 216 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 |
|---|---|---|
| 215-APR-DRG | Moderate | Open Craniotomy Except Trauma |
| 215-MS-DRG | High | Other Heart Assist System Implant |
| 216-MS-DRG | High | Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC |
| 217-APR-DRG | Moderate | Open Craniotomy Except Trauma |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 216. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 216 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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