MS-DRG 265 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 265 by major payers:
$38,844.73
$45,458.57
$55,173.17
$56,954.63
| 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 265 | ||||||
United | 265 | $2954.00 | 1811915838 - TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC., TAKOMA ADVENTIST HOSPITAL | 510603966 - TAKOMA REGIONAL HOSPITAL INC | TN | Psychiatric Hospital Unit (273R00000X) |
United | 265 | $55109.67 | 1457715146 - PROSPECT CCMC, LLC, CROZER CHESTER MEDICAL CENTER | 811507712 | PA | General Acute Care Hospital (282N00000X) |
United | 265 | $58655.46 | 1720078041 - BAY COUNTY HEALTH SYSTEM, LLC, ASCENSION SACRED HEART BAY | 900799724 | FL | General Acute Care Hospital (282N00000X) |
United | 265 | $40159.05 | 1174601397 - PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA, JACKSON SOUTH COMMUNITY HOSPITAL | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | General Acute Care Hospital (282N00000X) |
United | 265 | $60128.71 | 1730508250 - PRIME HEALTHCARE SERVICES, ST. MARY'S HOSPITAL | 463499370 | NJ | General Acute Care Hospital (282N00000X) |
United | 265 | $85662.74 | 1043551708 - MT SINAI SERVICES AT QHC | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Psychiatric Hospital (283Q00000X) |
United | 265 | $42255.96 | 1144266115 - OLATHE MEDICAL CENTER INC | 480577664 - (KS) OLATHE MEDICAL CENTER INC | KS | General Acute Care Hospital (282N00000X) |
United | 265 | $65585.00 | 1053588640 - UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 265 | $41075.60 | 1598842643 - BOONEVILLE COMMUNITY HOSPITAL, INC | 463851119 - MERCY HOSPITAL BOONEVILLE | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 265 | $39239.19 | 1124285366 - REEDSBURG AREA MEDICAL CENTER | 391091432 - (WI) REEDSBURG AREA MEDICAL CENTER INC | WI | Critical Access Hospital (282NC0060X) |
United | 265 | $3150.00 | 1902468085 - THOMASVILLE REGIONAL MEDICAL CENTER, LLC, THOMASVILLE REGIONAL MEDICAL CENTER | 453144371 - (AL) THOMASVILLE REGIONAL MEDICAL CENTER, LLC | AL | General Acute Care Hospital (282N00000X) |
United | 265 | $2772.00 | 1518580893 - CLEVELAND TENNESSEE HOSPITAL COMPANY LLC, TENNOVA HEALTHCARE-CLEVELAND | 992892769 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 265 | $71344.00 | 1124076039 - EVANGELICAL COMMUNITY HOSPITAL | 240795411 - (PA) EVANGELICAL COMMUNITY HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 265 | $74386.82 | 1285200105 - MEDICAL UNIVERSITY HOSPITAL AUTHORITY, MUSC HEALTH COLUMBIA MEDICAL CENTER NORTHEAST | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 265 | $104875.67 | 1417980202 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | 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 265 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 265 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 265 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 |
|---|---|---|
| 264-APR-DRG | High | OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES |
| 264-MS-DRG | High | Other Circulatory System O.R. Procedures |
| 265-MS-DRG | High | AICD Lead Procedures |
| 266-MS-DRG | High | Endovascular Cardiac Valve Replacement and Supplement Procedures with MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 265 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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