MS-DRG 865 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 865 by major payers:
$17,177.02
$19,027.73
$23,370.63
$23,660.02
| 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 865 | ||||||
United | 865 | $28400.80 | 1609957141 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 865 | $7246.66 | 1134126659 - CALDWELL MEMORIAL HOSPITAL INC | 720878037 - (LA) CALDWELL MEMORIAL HOSPITAL, INC. | LA | General Acute Care Hospital (282N00000X) |
United | 865 | $22480.91 | 1134607005 - ADVOCATE NORTH SIDE HEALTH NETWORK, ADVOCATE ILLINOIS MASONIC MEDICAL CENTER REHAB UNIT | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 865 | $12173.21 | 1801943725 - PORTER | 351088541 | IN | General Acute Care Hospital (282N00000X) |
United | 865 | $10339.53 | 1265512917 - HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT, HARRISON COUNTY COMMUNITY HOSPITAL | 431530883 | MO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 865 | $39244.17 | 1992736599 - DOCTORS HOSPITAL OF MANTECA, INC., DOCTORS HOSPITAL OF MANTECA | 752918966 - (CA) DOCTORS HOSPITAL OF MANTECA INC | CA | General Acute Care Hospital (282N00000X) |
United | 865 | $14392.76 | 1720623853 - BON SECOURS MERCY HEALTH PETERSBURG LLC, BON SECOURS - SOUTHSIDE MEDICAL CENTER | 843050337 | VA | General Acute Care Hospital (282N00000X) |
United | 865 | $4958.00 | 1487832200 - SMYTH COUNTY COMMUNITY HOSPITAL, SMYTH COUNTY COMMUNITY HOSPITAL SWING BED UNIT | 540794913 - (VA) SMYTH COUNTY COMMUNITY HOSPITAL | VA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 865 | $25237.89 | 1124109061 - ST. FRANCIS MEDICAL CENTER, INC, ST. FRANCIS NORTH HOSPITAL PSYCH UNIT | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | Psychiatric Hospital Unit (273R00000X) |
United | 865 | $11205.03 | 1366506826 - AMERICAN LEGION HOSPITAL | 464958152 - (LA) ACADIA GENERAL HOSPITAL INC | LA | General Acute Care Hospital (282N00000X) |
United | 865 | $35284.33 | 1699334680 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 865 | $13078.57 | 1821042979 - HCA HEALTHONE LLC, NORTH SUBURBAN MEDICAL CENTER | 841321373 | CO | General Acute Care Hospital (282N00000X) |
United | 865 | $39707.60 | 1053384776 - AHS HOSPITAL CORP., MORRISTOWN MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 865 | $25690.99 | 1790739977 - SAINT ANTHONY MEDICAL CENTER, OSF SAINT ANTHONY MEDICAL CENTER | 362167864 | IL | General Acute Care Hospital (282N00000X) |
United | 865 | $21897.92 | 1982733655 - DIGNITY HEALTH, ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER | 721561134 - (AZ) ST JOSEPHS HOSPITAL AND MEDICAL CENTER | AZ | 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 865 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 865 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 865 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 |
|---|---|---|
| 864-MS-DRG | High | Fever and Inflammatory Conditions |
| 865-MS-DRG | High | Viral Illness with MCC |
| 866-MS-DRG | High | Viral Illness 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 865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 865 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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