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See a sample rate comparisonMS-DRG 864 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.
FEVER AND INFLAMMATORY CONDITIONS
| 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 864 by major payers:
$10,360.36
$12,050.45
$14,202.27
$14,583.38
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MS-DRG 864
5 of 25 sample ratesHigher to lower in this preview
Dlp Central Carolina Medical Center LLC, Central Carolina Hospital
$24,006.23Published rateGreene Memorial Hospital
Greene Memorial Hospital Inc
$18,081.23Published rateSt. Charles Hospital
St Charles Hospital Corp
$16,738.72Published rateIngalls Memorial Hospital, The Ingalls Memorial Hospital
Ingalls Memorial Hospital
$10,344.05Published rateJohnston Memorial Hospital, Inc, Johnston Memorial Hospital Rehabilitation
Johnston Memorial Hospital Inc
$4,158.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 864 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 864 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 864 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 |
|---|---|---|
| 863-APR-DRG | High | NEONATAL AFTERCARE |
| 863-MS-DRG | High | POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC |
| 864-MS-DRG | High | FEVER AND INFLAMMATORY CONDITIONS |
| 865-MS-DRG | High | VIRAL ILLNESS 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 864. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 864 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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