MS-DRG 855 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 | • Infectious & Parasitic Diseases, Systemic or Unspecified Sites |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 855 by major payers:
$22,759.06
$22,202.59
$25,896.49
$26,570.84
| 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 855 | ||||||
United | 855 | $32688.19 | 1801971965 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 855 | $30643.19 | 1336794312 - INSPIRA MEDICAL CENTERS, INC. | 210634484 - (NJ) INSPIRA MEDICAL CENTERS INC | NJ | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 855 | $32688.19 | 1801971965 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 855 | $56578.03 | 1861559007 - NORTH COLORADO MEDICAL CENTER | 841287638 | CO | Rehabilitation Hospital Unit (273Y00000X) |
United | 855 | $24556.31 | 1578875258 - VHS HARPER-HUTZEL HOSPITAL INC, HARPER-HUTZEL HOSPITAL PSYCH UNIT | 272844767 | MI | Psychiatric Hospital Unit (273R00000X) |
United | 855 | $69791.88 | 1700012002 - HARBORVIEW MEDICAL CENTER | 911631806 | WA | General Acute Care Hospital (282N00000X) |
United | 855 | $20469.65 | 1073916896 - , VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 855 | $14395.41 | 1609857432 - SAMPSON REGIONAL MEDICAL CENTER, SAMPSON COUNTY MEMORIAL HOSPITAL | 560562304 - (NC) SAMPSON REGIONAL MEDICAL CNTR | NC | General Acute Care Hospital (282N00000X) |
United | 855 | $7640.31 | 1215005129 - PHC-LOS ALAMOS INC, LOS ALAMOS MEDICAL CENTER - SWING BED UNIT | 30390794 | NM | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 855 | $18590.35 | 1104928548 - FORREST COUNTY GENERAL HOSPITAL | 646001587 - FORREST COUNTY GENERAL HOSPITAL | MS | Rehabilitation Hospital Unit (273Y00000X) |
United | 855 | $29358.33 | 1336478163 - JEWISH HOSPITAL LLC, THE JEWISH HOSPITAL - MERCY HEALTH | 271408630 - (OH) JEWISH HOSPITAL LLC | OH | General Acute Care Hospital (282N00000X) |
United | 855 | $27662.75 | 1467483701 - MERCY HEALTH YOUNGSTOWN LLC, MERCY HEALTH ST ELIZABETH YOUNGSTOWN HOSPITAL | 340505560 - HUMILITY OF MARY HEALTH PARTNERS | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 855 | $22356.35 | 1720053556 - AHS HENRYETTA HOSPITAL LLC, HILLCREST HOSPITAL HENRYETTA | 201026264 - (OK) AHS HENRYETTA HOSPITAL LLC | OK | General Acute Care Hospital (282N00000X) |
United | 855 | $29095.05 | 1275886434 - PHOENIX CHILDREN'S HOSPITAL, INC., PHOENIX CHILDREN'S SURGERY CENTER - EAST VALLEY | 860422559 - (AZ) PHOENIX CHILDRENS HOSPITAL | AZ | Children's Hospital (282NC2000X) |
United | 855 | $32731.46 | 1255317848 - GREENE MEMORIAL HOSPITAL INC, KETTERING HEALTH GREENE MEMORIAL | 310809436 - (OH) GREENE MEMORIAL HOSPITAL INC | OH | 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 855 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 855 code is part of the Infectious & Parasitic Diseases, Systemic or Unspecified Sites 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 855 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 |
|---|---|---|
| 854-MS-DRG | High | Infectious and Parasitic Diseases with O.R. Procedures with CC |
| 855-MS-DRG | High | Infectious and Parasitic Diseases with O.R. Procedures without CC/MCC |
| 856-MS-DRG | High | Postoperative or Post-traumatic Infections with O.R. 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 855. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 855 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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