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See a sample rate comparisonMS-DRG 863 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.
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
| 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 863 by major payers:
$12,131.38
$13,686.11
$15,839.84
$16,198.21
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MS-DRG 863
5 of 25 sample ratesHigher to lower in this preview
Carondelet Health Network, St Mary'S Hospital
$21,523.24Published rateOur Lady Of The Lake Hospital, Inc., Our Lady Of The Lake Regional Medical Center
Our Lady Of The Lake Hospital Inc
$17,348.26Published rateCumberland Medical Center, Inc., Cumberland Medical Center
Cumberland Medical Center Inc
$14,264.66Published rateGlobalrehab-Scottsdale, LLC, Honorhealth Rehabilitation Hospital
Globalrehabscottsdale LLC
$9,250.67Published rateWellmont Health System, Hancock County Hospital
Wellmont Health System
$2,626.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 863 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 863 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 863 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 |
|---|---|---|
| 862-APR-DRG | High | OTHER AFTERCARE & CONVALESCENCE |
| 862-MS-DRG | High | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC |
| 863-MS-DRG | High | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC |
| 864-MS-DRG | High | FEVER AND INFLAMMATORY CONDITIONS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 863. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 863 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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