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MS-DRG 970 Fee Schedule

Last Verified: March 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 FactDetail
Service Type

Human Immunodeficiency Virus Infections

Common Place of Service

21 - Inpatient Hospital

22 - On Campus Outpatient Hospital

Complexity LevelHigh

National average reimbursement for MS-DRG 970 by major payers:

bcbs

$36,629.11

uhc

$35,935.32

aetna

$41,772.00

cigna

$42,948.40

Preview provider-level rates for...
For billing codeMS-DRG 970
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for MS-DRG 970

United
970$84334.931063657963 - BETH ISRAEL MEDICAL CENTER, MILTON AND CARROLL PETRIE DIVISION135564934 - (NY) BETH ISRAEL MEDICAL CENTERNYPsychiatric Hospital Unit (273R00000X)
United
970$31103.271801975107 - EAST TEXAS MEDICAL CENTER CARTHAGE, ETMC CARTHAGE824037220TXGeneral Acute Care Hospital (282N00000X)
United
970$29420.091356308746 - CLAREMORE REGIONAL HOSPITAL LLC, CLAREMORE REGIONAL HOSPITAL452652006OKMedicare Defined Swing Bed Hospital Unit (275N00000X)
United
970$19634.411255496188 - COMMUNITY MEMORIAL HOSPITAL ASSOCIATION460219795 - COMMUNITY MEMORIAL HOSPITAL INCMNMedicare Defined Swing Bed Hospital Unit (275N00000X)
United
970$56833.691558305995 - ST. FRANCIS HOSPITAL, INC., ST. FRANCIS DOWNTOWN582504530 - (SC) ST FRANCIS HOSPITAL INCSCGeneral Acute Care Hospital (282N00000X)
United
970$43185.421144471715 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS364640211WAGeneral Acute Care Hospital (282N00000X)
United
970$24408.091700824398 - MIAMI COUNTY MEDICAL CENTER INC, MIAMI COUNTY MEDICAL CENTER481155548 - (KS) MIAMI COUNTY MEDICAL CENTER INCKSGeneral Acute Care Hospital (282N00000X)
United
970$44173.391144490160 - JORDAN VALLEY MEDICAL CENTER LP820588653UTRehabilitation Hospital Unit (273Y00000X)
United
970$26923.031790706851 - BLACKWELL HMA LLC, ALLIANCEHEALTH BLACKWELL730927647OKGeneral Acute Care Hospital (282N00000X)
United
970$10991.001497702575 - ORANGE COAST MEMORIAL MEDICAL CENTER330687414 - (CA) MEMORIAL HEALTH SERVICESCAGeneral Acute Care Hospital (282N00000X)
United
970$37321.691689738957 - LITTLE COMPANY OF MARY HOSPITAL INC370813229 - (IL) OSF HEALTHCARE SYSTEMILPsychiatric Hospital Unit (273R00000X)
United
970$18093.531023338142 - METDALSPI, LLC, METHODIST HOSPITAL FOR SURGERY263195791TXGeneral Acute Care Hospital (282N00000X)
United
970$48590.191831352087 - NAPLES COMMUNITY HOSPITAL INC, NCH HEALTHCARE SYSTEM592315435 - (FL) MARCO ISLAND HOSPITAL INCFLRehabilitation Hospital (283X00000X)
United
970$50415.351598797094 - SLH VISTA, INC., SAINT LOUIS UNIVERSITY HOSPITAL474196634 - (MO) SSM-SLUH INCMOGeneral Acute Care Hospital (282N00000X)
United
970$20191.601992341473 - MERCY SPECIALTY HOSPITAL SOUTHEAST KANSAS843730625 - (KS) MERCY SPECIALTY HOSPITAL SOUTHEAST KANSASKSSpecial Hospital (284300000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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MS-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.

CodeComplexityDescription
969-MS-DRGHighHIV with Extensive O.R. Procedures with MCC
970-MS-DRGHighHIV with Extensive O.R. Procedures without MCC
974-APR-DRGModerateTonsil And Adenoid Procedures
974-MS-DRGHighHIV 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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