MS-DRG 916 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 | • Injuries, Poisonings & Toxic Effects of Drugs |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 916 by major payers:
$7,405.69
$8,984.81
$10,639.03
$10,972.68
| 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 916 | ||||||
United | 916 | $2000.00 | 1568657583 - DOCTORS HOSPITAL AT RENAISSANCE, LTD, HOSPITAL - PSYCHIATRIC UNIT | 742802643 - (TX) DOCTORS HOSPITAL AT RENAISSANCE | TX | Psychiatric Hospital Unit (273R00000X) |
United | 916 | $7601.77 | 1518021310 - CLIFTON SPRINGS SANITARIUM CO, CLIFTON SPRINGS HOSPITAL AND CLINIC | 160743966 - (NY) CLIFTON SPRINGS SANITARIUM CO | NY | Psychiatric Hospital Unit (273R00000X) |
United | 916 | $5435.14 | 1386793115 - GRAHAM REGIONAL MEDICAL CENTER | 463113489 | TX | General Acute Care Hospital (282N00000X) |
United | 916 | $3446.51 | 1558364760 - CLOUD COUNTY HEALTH CENTER INC, NORTH CENTRAL KANSAS MEDICAL CENTER | 480545923 - CLOUD COUNTY HEALTH CENTER INC | KS | Critical Access Hospital (282NC0060X) |
United | 916 | $2223.26 | 1033166442 - SHENANDOAH MEMORIAL HOSPITAL, INC., SHENANDOAH MEMORIAL HOSPITAL, INC. | 540490687 - VALLEY HEALTH SYSTEM | VA | Critical Access Hospital (282NC0060X) |
United | 916 | $7863.60 | 1689741985 - BASSETT HOSPITAL OF SCHOHARIE COUNTY | 141772971 - (NY) BASSETT HOSPITAL OF SCHOHARIE COUNTY | NY | Critical Access Hospital (282NC0060X) |
United | 916 | $15435.03 | 1396781795 - MERCY HEALTH | 344428250 - MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC | OH | General Acute Care Hospital (282N00000X) |
United | 916 | $6182.58 | 1104859131 - HOLY NAME MEDICAL CENTER INC., HOLY NAME HOSPITAL | 221487322 - (NJ) HOLY NAME MEDICAL CENTER INC | NJ | General Acute Care Hospital (282N00000X) |
United | 916 | $6998.43 | 1497397053 - UOFL HEALTH-SHELBYVILLE INC | 843178470 - UOFL HEALTH-LOUISVILLE INC | KY | General Acute Care Hospital (282N00000X) |
United | 916 | $11446.16 | 1487740957 - HOWARD UNIVERSITY HOSPITAL CORP | 530196961 - (DC) HOWARD UNIVERSITY HOSPITAL | DC | General Acute Care Hospital (282N00000X) |
United | 916 | $11400.59 | 1417946377 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | 720423635 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | LA | Rehabilitation Hospital (283X00000X) |
United | 916 | $19106.16 | 1245299726 - GARNET HEALTH MEDICAL CENTER, ORANGE REGIONAL MEDICAL CENTER | 141364536 - (NY) GARNET HEALTH MEDICAL CENTER | NY | Psychiatric Hospital (283Q00000X) |
United | 916 | $10593.99 | 1275505372 - MARTIN HEALTH, WEST TENNESSEE HEALTHCARE VOLUNTEER HOSPITAL | 825187448 - (TN) MARTIN HEALTH | TN | General Acute Care Hospital (282N00000X) |
United | 916 | $7032.14 | 1356307656 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 916 | $6804.72 | 1700036696 - ROANE COUNTY MEDICAL CENTER, ROANE MEDICAL CENTER | 680673354 - (TN) ROANE COUNTY MEDICAL CENTER | TN | 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 916 vs. Other Injuries, Poisonings & Toxic Effects of Drugs Codes
The MS-DRG 916 code is part of the Injuries, Poisonings & Toxic Effects of Drugs 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 916 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 |
|---|---|---|
| 915-MS-DRG | High | Allergic Reactions with MCC |
| 916-MS-DRG | High | Allergic Reactions without MCC |
| 917-APR-DRG | Moderate | Other Major Head And Neck Procedures |
| 917-MS-DRG | High | Poisoning and Toxic Effects of Drugs 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 916. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 916 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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