MS-DRG 042 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 | • Diseases & Disorders of the Nervous System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 042 by major payers:
$21,130.14
$23,661.01
$29,299.46
$29,818.72
| 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 042 | ||||||
United | 042 | $47325.14 | 1063541266 - GEORGETOWN UNIVERSITY HOSPITAL | 522218584 - (DC) MEDSTAR-GEORGETOWN MEDICAL CENTER INC | DC | General Acute Care Hospital (282N00000X) |
United | 042 | $18628.33 | 1912060526 - EAST TEXAS MEDICAL CENTER TRINITY, COMMUNITY HEALTH CLINIC | 824037220 | TX | General Acute Care Hospital (282N00000X) |
United | 042 | $18628.33 | 1912060526 - EAST TEXAS MEDICAL CENTER TRINITY, COMMUNITY HEALTH CLINIC | 824037220 | TX | General Acute Care Hospital (282N00000X) |
United | 042 | $19529.00 | 1073504528 - SOUTHERN OCEAN COUNTY HOSPITAL | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 042 | $19927.66 | 1528398534 - ADVANCED SURGICAL HOSPITAL LLC | 264093335 - (PA) ADVANCED SURGICAL HOSPITAL LLC | PA | General Acute Care Hospital (282N00000X) |
United | 042 | $24105.48 | 1356560858 - J C BLAIR MEMORIAL HOSPITAL, PENN HIGHLANDS HUNTINGDON | 231352159 - (PA) J C BLAIR MEMORIAL HOSPITAL | PA | Psychiatric Hospital Unit (273R00000X) |
United | 042 | $24182.82 | 1437111713 - HOT SPRING COUNTY MEDICAL CENTER | 710236856 - (AR) BAPTIST HEALTH | AR | Psychiatric Hospital Unit (273R00000X) |
United | 042 | $36790.07 | 1407020118 - BOARD OF TRUSTEE OF HOWARD COMMUNITY HOSPITAL, HOWARD REGIONAL HEALTH SYSTEM | 351865344 - (IN) COMMUNITY HOWARD REGIONAL HEALTH INC | IN | General Acute Care Hospital (282N00000X) |
United | 042 | $29081.25 | 1942685920 - SSM-SLUH INC, SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL | 474196634 - (MO) SSM-SLUH INC | MO | General Acute Care Hospital (282N00000X) |
United | 042 | $26573.71 | 1073653523 - MONROE CLINIC, SSM HEALTH MONROE HOSPITAL | 390808509 - THE MONROE CLINIC INC | WI | General Acute Care Hospital (282N00000X) |
United | 042 | $22939.98 | 1649383035 - INTEGRIS BASS BAPTIST HEALTH CENTER | 730612674 | OK | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 042 | $26247.24 | 1073500419 - SOUTHWESTERN REGIONAL MEDICAL CENTER, LLC | 362510771 - MIDWESTERN REGIONAL MEDICAL CENTER INC | OK | Special Hospital (284300000X) |
United | 042 | $32867.32 | 1942756051 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH INT MED/SUBSPEC CLINIC | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 042 | $20281.96 | 1114181062 - UNIVERSITY OF KENTUCKY | 616001218 | KY | General Acute Care Hospital (282N00000X) |
United | 042 | $20281.96 | 1114181062 - UNIVERSITY OF KENTUCKY | 616001218 | KY | 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 042 vs. Other Diseases & Disorders of the Nervous System Codes
The MS-DRG 042 code is part of the Diseases & Disorders of the Nervous System 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 042 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 |
|---|---|---|
| 041-APR-DRG | High | NERVOUS SYSTEM MALIGNANCY |
| 041-MS-DRG | High | Peripheral, Cranial Nerve and Other Nervous System Procedures with CC or Peripheral Neurostimulator |
| 042-MS-DRG | High | Peripheral, Cranial Nerve and Other Nervous System Procedures without CC/MCC |
| 052-APR-DRG | High | ALTERATION IN CONSCIOUSNESS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 042 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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