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See a sample rate comparisonMS-DRG 865 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.
VIRAL ILLNESS WITH 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 865 by major payers:
$17,177.02
$19,027.73
$23,370.63
$23,660.02
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MS-DRG 865
5 of 25 sample ratesHigher to lower in this preview
The Mount Vernon Hospital
Montefiore Mount Vernon Hospital
$47,385.25Published rateCommunity Medical Center
$32,911.14Published rateMercy Medical Center
$23,942.05Published rateHca Healthone LLC, North Suburban Medical Center
$13,078.57Published rateMountain States Health Alliance, Unicoi County Hospital
Mountain States Health Alliance
$3,564.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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