MS-DRG 969 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 | • 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
| 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 969 | ||||||
United | 969 | $95885.75 | 1598744856 - VHS SAN ANTONIO PARTNERS LLC, BAPTIST MEDICAL CENTER | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 969 | $69523.03 | 1285719328 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 969 | $111718.75 | 1134178999 - PEACEHEALTH | 916068143 - PEACEHEALTH SOUTHWEST MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 969 | $71553.13 | 1568577724 - ARMSTRONG COUNTY MEMORIAL HOSPITAL, ACMH HOSPITAL | 250965237 - ARMSTRONG COUNTY MEMORIAL HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 969 | $76099.79 | 1477549756 - UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES, THE UNIVERSITY HOSPITAL OF ARKANSAS | 716046242 | AR | General Acute Care Hospital (282N00000X) |
United | 969 | $121679.96 | 1437105624 - | 390987025 - (WI) COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC | WI | Psychiatric Hospital Unit (273R00000X) |
United | 969 | $125555.53 | 1568427383 - ALLINA HEALTH SYSTEM, CAMBRIDGE MEDICAL CENTER | 363261413 - ALLINA HEALTH SYSTEM | MN | General Acute Care Hospital (282N00000X) |
United | 969 | $7128.00 | 1548247489 - JANE PHILLIPS NOWATA HEALTH CENTER | 731440267 - (OK) JANE PHILLIPS NOWATA HOSPITAL INC | OK | General Acute Care Hospital (282N00000X) |
United | 969 | $105164.53 | 1225289895 - PROVIDENCE HEALTH & SERVICES, PROVIDENCE HOLY FAMILY HOSPITAL | 352345508 | WA | General Acute Care Hospital (282N00000X) |
United | 969 | $80717.03 | 1386453165 - SAINT JOSEPH MEDICAL CENTER | 992141118 | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 969 | $97797.10 | 1477579464 - NASSAU HEALTH CARE CORPORATION, NUMC DEPARTMENT OF RADIOLOGY, FFP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 969 | $148468.00 | 1114189636 - PHELPS MEMORIAL HOSPITAL ASSOCIATION, REHABILITATION SUB PROVIDER HOSPITAL | 131725076 - (NY) PHELPS MEMORIAL HOSPITAL ASSOCIATION | NY | Rehabilitation Hospital (283X00000X) |
United | 969 | $76099.79 | 1477549756 - UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES, THE UNIVERSITY HOSPITAL OF ARKANSAS | 716046242 | AR | General Acute Care Hospital (282N00000X) |
United | 969 | $85637.64 | 1215012828 - FRANCISCAN HEALTH DYER & HAMMOND, FRANCISCAN HEALTH HAMMOND | 351835133 | IN | Psychiatric Hospital Unit (273R00000X) |
United | 969 | $100016.88 | 1700883717 - RIVERVIEW HOSPITAL | 351128943 - RIVERVIEW HOSPITAL | IN | 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 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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