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See a sample rate comparisonMS-DRG 216 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.
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
| 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
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MS-DRG 216
5 of 25 sample ratesHigher to lower in this preview
Lancaster Hospital Corporation
Medical University Hospital Authority
$271,080.09Published ratePrime Healthcare Services Kansas City, LLC, St. Joseph Medical Center
Prime Healthcare Services - Kansas City LLC
$172,948.45Published rateMissouri Delta Medical Center
$109,576.89Published rateCampbell County Hma, LLC, Tennova Healthcare-Lafollette Medical Center
Campbell County Hma LLC
$82,381.78Published rateWellmont Health System, Lonesome Pine Hospital
Wellmont Health System
$2,805.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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