MS-DRG 616 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 | • Endocrine, Nutritional & Metabolic Diseases & Disorders |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 616 by major payers:
$45,144.40
$50,648.76
$60,794.98
$62,266.86
| 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 616 | ||||||
United | 616 | $53620.55 | 1588648315 - POINTE COUPEE PARISH HEALTH SERVICES DISTRICT NUMBER ONE, POINTE COUPEE GENERAL HOSPITAL | 721054801 | LA | Critical Access Hospital (282NC0060X) |
United | 616 | $41131.32 | 1548376700 - TISHOMINGO HEALTH SERVICES, INC., TISHOMINGO CO HOSPITAL | 640741047 - TISHOMINGO HEALTH SERVICES INC | MS | General Acute Care Hospital (282N00000X) |
United | 616 | $32636.06 | 1770581894 - T J SAMSON COMMUNITY HOSPITAL | 610461767 - T J SAMSON COMMUNITY HOSPITAL | KY | General Acute Care Hospital (282N00000X) |
United | 616 | $86042.63 | 1285719328 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 616 | $8899.00 | 1609847870 - ST JOSEPH'S HOSPITAL AND MEDICAL CENTER, ST JOSEPH'S WAYNE MEDICAL CENTER | 221487602 - ST JOSEPHS HEALTH INC | NJ | Rehabilitation Hospital Unit (273Y00000X) |
United | 616 | $62614.92 | 1497859649 - NORTHWESTERN MEMORIAL HEALTHCARE | 370960170 - (IL) NORTHWESTERN MEMORIAL HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 616 | $41243.42 | 1316413313 - RESILIENCE HEALTHCARE, LOUIS A. WEISS MEMORIAL HOSPITAL | 352637418 | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 616 | $58451.39 | 1285295899 - AHN EMERUS WESTMORELAND LLC, AHN MCCANDLESS NEIGHBORHOOD HOSPITAL | 823697883 - (PA) AHN EMERUS WESTMORELAND LLC | PA | General Acute Care Hospital (282N00000X) |
United | 616 | $56480.33 | 1093749848 - ASCENSION BORGESS HOSPITAL, BORGESS INPATIENT SERVICES | 381360526 - (MI) ASCENSION BORGESS HOSPITAL | MI | Hospitalist Physician (208M00000X) |
United | 616 | $150159.09 | 1851787295 - HDMC HOLDINGS, LLC, HI-DESERT MEDICAL CENTER | 473550779 | CA | General Acute Care Hospital (282N00000X) |
United | 616 | $77300.00 | 1780819102 - EPHRATA COMMUNITY HOSPITAL | 231370484 - EPHRATA COMMUNITY HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 616 | $37892.16 | 1033118716 - CASTRO COUNTY HOSPITAL DISTRICT, PLAINS MEMORIAL HOSPITAL | 756003939 | TX | Critical Access Hospital (282NC0060X) |
United | 616 | $95620.10 | 1619938016 - DANBURY HOSPITAL, DANBURY HOSPITAL DBA NEW MILFORD HOSPITAL | 60646597 - DANBURY HOSPITAL | CT | General Acute Care Hospital (282N00000X) |
United | 616 | $111806.71 | 1003991845 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE PORTLAND MEDICAL CENTER | 930386906 | OR | General Acute Care Hospital (282N00000X) |
United | 616 | $44044.64 | 1578630182 - AUBURN MEMORIAL HOSPITAL | 150532054 - AUBURN COMMUNITY HOSPITAL | NY | 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 616 vs. Other Endocrine, Nutritional & Metabolic Diseases & Disorders Codes
The MS-DRG 616 code is part of the Endocrine, Nutritional & Metabolic Diseases & Disorders 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 616 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 |
|---|---|---|
| 615-MS-DRG | High | Adrenal and Pituitary Procedures without CC/MCC |
| 616-MS-DRG | High | Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with MCC |
| 617-MS-DRG | High | Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 616 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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