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See a sample rate comparisonMS-DRG 969 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.
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
| Key Fact | Detail |
|---|---|
| Service Type | Human Immunodeficiency Virus Infections |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 969 by major payers:
$71,160.66
$81,068.68
$99,057.13
$101,512.19
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MS-DRG 969
5 of 25 sample ratesHigher to lower in this preview
Prisma Health-Midlands
$188,464.14Published rateBbh Cbmc, LLC, Citizens Baptist Medical Center
$120,201.45Published rateFranciscan Health Dyer & Hammond, Franciscan Health Hammond
$85,637.64Published rateSentara Hospitals, Sentara Obici Hospital
Sentara Hospitals
$74,743.75Published rateJane Phillips Nowata Health Center
Jane Phillips Nowata Hospital Inc
$7,128.00Published rate
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See a sample payer proposalMS-DRG 969 vs. Other Human Immunodeficiency Virus Infections Codes
The MS-DRG 969 code is part of the Human Immunodeficiency Virus Infections 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 969 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 |
|---|---|---|
| 969-MS-DRG | High | HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC |
| 970-MS-DRG | High | HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT 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 969. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 969 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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