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See a sample rate comparisonMS-DRG 042 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.
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
| 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
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MS-DRG 042
5 of 25 sample ratesHigher to lower in this preview
Chippenham & Johnston-Willis Hospitals Inc, Cjw Medical Center
$51,334.00Published rateBellevue Medical Center LLC, Bellevue Medical Center - Nebraska Medicine
Bellevue Medical Center LLC
$37,057.23Published rateBanner University Medical Center-Tucson
$30,742.17Published rateRiverview Medical Center Family Health Center
Hackensack Meridian Health Inc
$19,460.00Published rateSmyth County Community Hospital
$4,708.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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