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See a sample rate comparisonMS-DRG 970 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 WITHOUT 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 970 by major payers:
$36,629.11
$35,935.32
$41,772.00
$42,948.40
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MS-DRG 970
5 of 25 sample ratesHigher to lower in this preview
Beth Israel Medical Center, Milton And Carroll Petrie Division
Beth Israel Medical Center
$84,334.93Published rateAllina Health System, Cambridge Medical Center
Allina Health System
$50,780.51Published rateIndiana Orthopaedic Hospital, LLC, Orthoindy Hospital
Indiana Orthopaedic Hospital LLC
$34,617.14Published rateMercy Specialty Hospital Southeast Kansas
$20,191.60Published ratePrime Healthcare Services
$5,526.00Published rate
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See a sample payer proposalMS-DRG 970 vs. Other Human Immunodeficiency Virus Infections Codes
The MS-DRG 970 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 970 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 |
| 974-APR-DRG | Moderate | Tonsil And Adenoid Procedures |
| 974-MS-DRG | High | HIV WITH MAJOR RELATED CONDITION 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 970. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 970 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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