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See a sample rate comparisonMS-DRG 916 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.
ALLERGIC REACTIONS WITHOUT MCC
| 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
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MS-DRG 916
5 of 25 sample ratesHigher to lower in this preview
Robert Wood Johnson University Hospital Inc, Robert Wood Johnson University Hospital Somerset
Robert Wood Johnson University Hospital
$19,827.00Published rateNovant Health Matthews Medical Center LLC, Novant Health Matthews Medical Center
Novant Health Matthews Medical Center LLC
$11,603.57Published rateBassett Hospital Of Schoharie County
$7,863.60Published rateCovenant Medical Center
$6,042.56Published rateDoctors Hospital At Renaissance, Ltd, Hospital - Psychiatric Unit
Doctors Hospital At Renaissance
$2,000.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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