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  5. /Case rate

APR-DRG 143

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Reported by 7 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$5.7k

Average

$22.3k

Median

$24.2k

High

$42.0k

Hospitals reporting this code

#HospitalLocation
1Sanford Aberdeen Medical CenterAberdeen, SD$36.5k$42.3k$42.0k$49.0k$4.1k
2The Mercy Hospital IncSpringfield, MA$8.2k$26.2k$25.2k$26.2k$3.6k
3Catholic Health Initiatives-Iowa CorpDes Moines, IA$8.6k$13.8k$17.2k$30.3k$8.2k
4Catholic Health Initiatives-Iowa CorpWest Des Moines, IA$16.5k$22.8k$24.2k$30.3k$6.1k
5Mercy Medical Center-Clinton IncClinton, IA$27.7k$30.4k$30.4k$30.4k$338
6Mount Carmel Grove CityGrove City, OH$11.1k$11.4k$11.4k$11.6k$165
7Mount Carmel EastColumbus, OH$4.6k$5.7k$5.7k$6.8k$1.0k

Look up this code directly

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