MS-DRG 868 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 868 by major payers:
$13,470.52
$14,735.81
$16,669.92
$17,051.52
| 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 868 | ||||||
United | 868 | $9174.30 | 1275506115 - SPRINGHILL MEDICAL SERVICES, INC., SPRINGHILL MEDICAL CENTER | 721479692 - SPRINGHILL MEDICAL SERVICES INC | LA | General Acute Care Hospital (282N00000X) |
United | 868 | $11377.28 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 868 | $1787.00 | 1306889597 - VANDERBILT UNIVERSITY MEDICAL CENTER, VANDERBILT WILSON COUNTY HOSPITAL | 200248060 | TN | General Acute Care Hospital (282N00000X) |
United | 868 | $13023.33 | 1144236571 - INTEGRIS BASS BAPTIST HEALTH CENTER, INTEGRIS BASS BAPTIST HEALTH CENTER | 730612674 | OK | General Acute Care Hospital (282N00000X) |
United | 868 | $24115.55 | 1033120423 - TEXAS HEALTH HUGULEY, INC., TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH | 452694620 - (TX) TEXAS HEALTH HUGULEY INC | TX | General Acute Care Hospital (282N00000X) |
United | 868 | $12968.74 | 1679652192 - AHS HILLCREST MEDICAL CENTER LLC, HILLCREST MEDICAL CENTER | 770633896 - (OK) AHS HILLCREST MEDICAL CENTER LLC | OK | Rehabilitation Hospital Unit (273Y00000X) |
United | 868 | $16087.80 | 1831798719 - VANDERBILT COFFEE HOSPITAL, LLC, VANDERBILT TULLAHOMA-HARTON HOSPITAL | 853420386 | TN | General Acute Care Hospital (282N00000X) |
United | 868 | $9246.07 | 1811942238 - KPH-CONSOLIDATION, INC., HCA HOUSTON HEALTHCARE NORTH CYPRESS A CAMPUS OF HCA HOUSTON HEALTHCAR | 621619857 | TX | General Acute Care Hospital (282N00000X) |
United | 868 | $12462.58 | 1396837951 - CENTRAL IOWA HOSPITAL CORPORATION, IOWA METHODIST MEDICAL CENTER | 420680452 - CENTRAL IOWA HOSPITAL CORPORATION | IA | General Acute Care Hospital (282N00000X) |
United | 868 | $1200.00 | 1235387044 - HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES, INC., ASCENSION SAINT THOMAS THREE RIVERS | 261861676 - (TN) HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES INC | TN | Critical Access Hospital (282NC0060X) |
United | 868 | $24115.55 | 1710011382 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | Chronic Disease Hospital (281P00000X) |
United | 868 | $4008.00 | 1801826912 - WELLMONT HEALTH SYSTEM, LONESOME PINE HOSPITAL | 621636465 - WELLMONT HEALTH SYSTEM | VA | General Acute Care Hospital (282N00000X) |
United | 868 | $18362.84 | 1538193123 - ST. MARY'S MEDICAL CENTER, INC, ST. MARY'S MEDICAL CENTER | 752932830 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 868 | $18579.41 | 1457517013 - SUNY STONYBROOK UNIVERSITY HOSPITAL | 113243405 | NY | General Acute Care Hospital (282N00000X) |
United | 868 | $19166.23 | 1134223878 - PROVIDENCE EVERETT MEDICAL CENTER, INPATIENT REHABILITATION FACILITY | 352346161 | WA | Rehabilitation Hospital Unit (273Y00000X) |
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 868 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 868 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 868 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 |
|---|---|---|
| 867-MS-DRG | High | Other Infectious and Parasitic Diseases Diagnoses with MCC |
| 868-MS-DRG | High | Other Infectious and Parasitic Diseases Diagnoses with CC |
| 869-MS-DRG | High | Other Infectious and Parasitic Diseases Diagnoses without CC/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 868. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 868 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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