MS-DRG 862 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 862 by major payers:
$21,002.63
$23,466.13
$29,096.53
$29,322.47
| 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 862 | ||||||
United | 862 | $22792.41 | 1225083074 - OLEAN GENERAL HOSPITAL | 160743102 - OLEAN GENERAL HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 862 | $29786.93 | 1366420531 - PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC. | 390794174 - (WI) PROHEALTH MEDICAL GROUP INC | WI | General Acute Care Hospital (282N00000X) |
United | 862 | $30564.31 | 1053718361 - PRIME HEALTHCARE SERVICES NORTH VISTA LLC | 200470861 | NV | General Acute Care Hospital (282N00000X) |
United | 862 | $16787.00 | 1144627050 - ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | 221487243 - (NJ) ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | NJ | Children's Hospital (282NC2000X) |
United | 862 | $30844.28 | 1023305034 - LEGACY MERIDIAN PARK HOSPITAL | 930618975 - LEGACY MERIDIAN PARK HOSPITAL | OR | Hospitalist Physician (208M00000X) |
United | 862 | $8402.86 | 1316537228 - DUBOIS REGIONAL MEDICAL CENTER, PENN HIGHLANDS CLEARFIELD-A CAMPUS OF PENN HIGHLANDS DUBOIS | 251490707 - DUBOIS REGIONAL MEDICAL CENTER | PA | General Acute Care Hospital (282N00000X) |
United | 862 | $23204.39 | 1093087157 - PRIME HEALTHCARE SERVICES ROXBOROUGH LLC, ROXBOROUGH MEMORIAL HOSPITAL | 454246163 - (PA) PRIME HEALTHCARE SERVICES ROXBOROUGH, LLC | PA | Psychiatric Hospital Unit (273R00000X) |
United | 862 | $43564.32 | 1124194063 - THE FAUQUIER HOSPITAL INC, BLACKWELL ROAD LOCATION | 463107896 | VA | General Acute Care Hospital (282N00000X) |
United | 862 | $14808.38 | 1417209685 - H H HEALTH SYSTEM-MORGAN LLC, DECATUR MORGAN HOSPITAL WEST | 460928982 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 862 | $21879.27 | 1962572396 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. MARY'S HOSPITAL - ST. LOUIS | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 862 | $15975.79 | 1275107344 - HMH HOSPITALS CORPORATION | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | Rehabilitation Hospital (283X00000X) |
United | 862 | $31127.34 | 1861435042 - SAINT VINCENT HEALTH CENTER | 250965547 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 862 | $28406.08 | 1073606737 - DELAWARE COUNTY MEMORIAL HOSPITAL | 811520273 | PA | General Acute Care Hospital (282N00000X) |
United | 862 | $59839.21 | 1386940823 - HOLMES REGIONAL MEDICAL CENTER, INC, PALM BAY HOSPITAL | 590624371 - (FL) HOLMES REGIONAL MEDICAL CENTER | FL | General Acute Care Hospital (282N00000X) |
United | 862 | $28681.77 | 1285293274 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 821885403 - (CO) UCHEALTH HIGHLANDS RANCH HOSPITAL | CO | 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 862 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 862 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 862 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 |
|---|---|---|
| 858-MS-DRG | High | Postoperative or Post-traumatic Infections with O.R. Procedures without CC/MCC |
| 862-MS-DRG | High | Postoperative and Post-traumatic Infections with MCC |
| 863-APR-DRG | High | NEONATAL AFTERCARE |
| 863-MS-DRG | High | Postoperative and Post-traumatic Infections without 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 862. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 862 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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