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MS-DRG 054 Fee Schedule

Last Verified: December 2025

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.

Nervous System Neoplasms with MCC
Key FactDetail
Service Type

Diseases & Disorders of the Nervous System

Common Place of Service

21 - Inpatient Hospital

22 - On Campus Outpatient Hospital

Complexity LevelHigh

National average reimbursement for MS-DRG 054 by major payers:

bcbs

$17,053.28

uhc

$19,559.26

aetna

$23,767.00

cigna

$24,025.78

Preview provider-level rates for...
For billing codeMS-DRG 054
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for MS-DRG 054

United
054$18738.751528348489 - SHERMAN GRAYSON HOSPITAL LLC, WILSON N. JONES REGIONAL MEDICAL CENTER - BHS272025690TXPsychiatric Hospital Unit (273R00000X)
United
054$32480.351265818488 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL474131755AZGeneral Acute Care Hospital (282N00000X)
United
054$48771.371174689665 - BETH ISRAEL MEDICAL CENTER133371536 - (NY) SLR DIAGNOSTIC RADIOLOGY, P.C.NYGeneral Acute Care Hospital (282N00000X)
United
054$32480.351265818488 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL474131755AZGeneral Acute Care Hospital (282N00000X)
United
054$6023.001326075193 - MADISON HMA LLC, MERIT HEALTH MADISON646008520MSMedicare Defined Swing Bed Hospital Unit (275N00000X)
United
054$25574.071922542604 - ADVOCATE HEALTH AND HOSPITALS CORPORATION362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATIONILRehabilitation Hospital Unit (273Y00000X)
United
054$18626.011881048221 - BBH CBMC, LLC, CITIZENS BAPTIST MEDICAL CENTER474802869ALPsychiatric Hospital Unit (273R00000X)
United
054$20173.681811341290 - BBH BMC, LLC, BROOKWOOD MEDICAL CENTER474757851ALPsychiatric Hospital Unit (273R00000X)
United
054$21886.851619154820 - DAVIESS COUNTY HOSPITAL, DAVIESS COUNTY HOSPITAL PHYSICIANS356001322 - (IN) DAVIESS COUNTY HOSPITALINGeneral Acute Care Hospital (282N00000X)
United
054$13293.151073510277 - PEACEHEALTH, ST. JOHN MEDICAL CENTER910564987WAGeneral Acute Care Hospital (282N00000X)
United
054$11285.961942288527 - MARY WASHINGTON HOSPITAL INC.540519577 - (VA) MARY WASHINGTON HOSPITAL INCVAGeneral Acute Care Hospital (282N00000X)
United
054$15806.001275541104 - SOUTHSIDE HOSPITAL, REHABILITATION UNIT111667761 - (NY) SOUTH SHORE UNIVERSITY HOSPITALNYRehabilitation Hospital Unit (273Y00000X)
United
054$6023.001326075193 - MADISON HMA LLC, MERIT HEALTH MADISON646008520MSMedicare Defined Swing Bed Hospital Unit (275N00000X)
United
054$33372.961790860856 - CARONDELET HEALTH NETWORK, ST JOSEPH'S HOSPITAL474131755AZGeneral Acute Care Hospital (282N00000X)
United
054$41420.121437102605 - HCA HEALTH SERVICES OF GEORGIA, INC., HUGHSTON ORTHOPEDIC HOSPITAL331216751 - (GA) HUGHSTON HOSPITAL INCGAGeneral Acute Care Hospital (282N00000X)
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 054 vs. Other Diseases & Disorders of the Nervous System Codes

The MS-DRG 054 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 054 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
053-APR-DRGHighSEIZURE
053-MS-DRGHighSpinal Disorders and Injuries without CC/MCC
054-MS-DRGHighNervous System Neoplasms with MCC
055-APR-DRGHighHEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 054. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 054 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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