MS-DRG 866 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 866 by major payers:
$9,867.79
$11,902.28
$14,011.35
$14,362.09
| 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 866 | ||||||
United | 866 | $17040.76 | 1861009672 - NORCAL HEALTHCONNECT LLC, HEALDSBURG HOSPITAL | 852390012 | CA | Critical Access Hospital (282NC0060X) |
United | 866 | $5532.00 | 1205846037 - BAILEY MEDICAL CENTER, LLC | 201547519 - (OK) BAILEY MEDICAL CENTER LLC | OK | General Acute Care Hospital (282N00000X) |
United | 866 | $19460.00 | 1710499462 - HMH HOSPITALS CORPORATION, RIVERVIEW MEDICAL CENTER | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 866 | $5404.00 | 1447672779 - SHARON PENNSYLVANIA HOSPITAL COMPANY LLC | 332621724 | PA | General Acute Care Hospital (282N00000X) |
United | 866 | $21226.34 | 1700037801 - PROVIDENCE HEALTH & SERVICES-WA | 352346161 | WA | General Acute Care Hospital (282N00000X) |
United | 866 | $8621.49 | 1184485989 - HH HEALTH SYSTEM | 934333907 | AL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 866 | $12964.08 | 1295159028 - CATHOLIC HEALTH INITIATIVES COLORADO, ST. ANTHONY SUMMIT HOSPITAL SWING BED UNIT | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 866 | $10575.12 | 1396160396 - PROSPECT CHARTERCARE SJHSRI, LLC, ST. JOSEPH HEALTH CENTER | 464661337 | RI | Psychiatric Hospital Unit (273R00000X) |
United | 866 | $20181.16 | 1124503636 - GENERAL CONFERENCE OF SEVENTH DAY ADVENTIST HACKETTSTOWN COMMUNITY HOS | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 866 | $14597.62 | 1013906239 - ST FRANCIS MEDICAL CENTER, INC, ST FRANCIS ACUTE REHABILITATION CENTER | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 866 | $5226.00 | 1457399198 - MANCHESTER MEMORIAL HOSPITAL | 812216981 | CT | General Acute Care Hospital (282N00000X) |
United | 866 | $13104.76 | 1184655581 - UNIVERSITY OF CALIFORNIA IRVINE, UCI HEALTH LAKEWOOD | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | CA | General Acute Care Hospital (282N00000X) |
United | 866 | $9726.61 | 1427133883 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 866 | $5071.97 | 1063422053 - VALLEY MEDICAL FACILITIES INC, VALLEY MEDICAL FACILITIES INC DBA HERITAGE VALLEY BEAVER | 251801532 - (PA) HERITAGE VALLEY HEALTH SYSTEM | PA | General Acute Care Hospital (282N00000X) |
United | 866 | $6893.02 | 1841258589 - CRIPPLED CHILDREN'S HOSPITAL, CHILDREN'S HOSPITAL | 540506309 - (VA) VCU HEALTH CHILDRENS SERVICES AT BROOK ROAD | VA | Children's Hospital (282NC2000X) |
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 866 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 866 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 866 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 |
|---|---|---|
| 865-MS-DRG | High | Viral Illness with MCC |
| 866-MS-DRG | High | Viral Illness without MCC |
| 867-MS-DRG | High | Other Infectious and Parasitic Diseases Diagnoses 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 866. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 866 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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