MS-DRG 869 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 869 by major payers:
$9,650.11
$10,597.69
$11,469.90
$11,862.97
| 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 869 | ||||||
United | 869 | $23284.82 | 1013080084 - ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC, PROVIDENCE QUEEN OF THE VALLEY MEDICAL CENTER | 814791043 - (CA) ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC | CA | General Acute Care Hospital (282N00000X) |
United | 869 | $13192.65 | 1346275328 - RAWLINS COUNTY HEALTH CENTER | 480545181 - (KS) RAWLINS COUNTY HEALTH CENTER | KS | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 869 | $5325.04 | 1255496188 - COMMUNITY MEMORIAL HOSPITAL ASSOCIATION | 460219795 - COMMUNITY MEMORIAL HOSPITAL INC | MN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 869 | $12322.57 | 1851477913 - ST CLARE MEMORIAL HOSPITAL, INC | 390848401 - ST CLARE MEMORIAL HOSPITAL INC | WI | Critical Access Hospital (282NC0060X) |
United | 869 | $9250.79 | 1548681091 - RCHP OTTUMWA LLC, SENIOR BEHAVIORAL CARE CENTER | 272200283 | IA | Psychiatric Hospital Unit (273R00000X) |
United | 869 | $35084.10 | 1972828564 - NEW YORK PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 869 | $9972.17 | 1720039605 - CEDAR COUNTY MEMORIAL HOSPITAL | 440645325 - (MO) CEDAR COUNTY MEMORIAL HOSPITAL | MO | Critical Access Hospital (282NC0060X) |
United | 869 | $3783.00 | 1558391045 - WELLMONT HEALTH SYSTEM, BRISTOL REGIONAL MEDICAL CENTER PSYCHIATRIC UNIT | 621636465 - WELLMONT HEALTH SYSTEM | TN | Psychiatric Hospital Unit (273R00000X) |
United | 869 | $8600.66 | 1831450865 - ST JOSEPH HEALTH SERVICES OF RI, HOSPITALIST GROUP | 464661337 | RI | Hospitalist Physician (208M00000X) |
United | 869 | $8636.50 | 1447898622 - VHS OF ARROWHEAD, INC., ABRAZO SURPRISE HOSPITAL | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 869 | $7791.83 | 1215139233 - ASCENSION MACOMB OAKLAND HOSPITAL, ST JOHN MACOMB OAKLAND - OAKLAND CENTER | 383322109 - ASCENSION MACOMB OAKLAND HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 869 | $8636.50 | 1447898622 - VHS OF ARROWHEAD, INC., ABRAZO SURPRISE HOSPITAL | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 869 | $32832.26 | 1568676880 - NEW YORK PRESBYTERIAN HOSPITAL, HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 869 | $17457.68 | 1346213469 - GOOD SAMARITAN HOSPITAL OF SUFFERN | 131740104 - (NY) BON SECOURS CHARITY HEALTH SYSTEM INC | NY | General Acute Care Hospital (282N00000X) |
United | 869 | $5404.00 | 1790219616 - STEWARD SHARON REGIONAL HEALTH SYSTEM, INC. | 815457135 | PA | 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 869 vs. Other Infectious & Parasitic Diseases, Systemic or Unspecified Sites Codes
The MS-DRG 869 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 869 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 |
|---|---|---|
| 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 |
| 870-MS-DRG | High | Septicemia or Severe Septis with MV >96 Hours |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 869. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 869 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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