MS-DRG 055 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 055 by major payers:
$13,123.94
$15,070.93
$17,407.66
$17,654.76
| 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 055 | ||||||
United | 055 | $18062.59 | 1306842521 - APPALACHIAN REGIONAL HEALTHCARE, INC., HARLAN ARH HOSPITAL | 520795508 - APPALACHIAN REGIONAL HEALTHCARE INC | KY | General Acute Care Hospital (282N00000X) |
United | 055 | $14004.19 | 1730383084 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 055 | $19393.61 | 1669584983 - ORTHOPAEDIC HOSPITAL OF WISCONSIN, LLC, ORTHOPAEDIC HOSPITAL OF WISCONSIN | 392015655 - (WI) ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC | WI | General Acute Care Hospital (282N00000X) |
United | 055 | $29501.73 | 1881033595 - MCLEOD REGIONAL HEALTH CENTER | 570370242 - MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE INC | SC | General Acute Care Hospital (282N00000X) |
United | 055 | $13566.20 | 1003236878 - ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL INC, ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET | 221487243 - (NJ) ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | NJ | General Acute Care Hospital (282N00000X) |
United | 055 | $13786.04 | 1780684423 - SELECT SPECIALTY HOSPITAL | 251813120 - (TN) SELECT SPECIALTY HOSPITAL | TN | Long Term Care Hospital (282E00000X) |
United | 055 | $18599.36 | 1528006103 - BRYAN MEDICAL CENTER | 470376552 - BRYAN MEDICAL CENTER | NE | General Acute Care Hospital (282N00000X) |
United | 055 | $31846.00 | 1689791295 - CLEVELAND CLINIC FOUNDATION | 340714585 - THE CLEVELAND CLINIC FOUNDATION | OH | General Acute Care Hospital (282N00000X) |
United | 055 | $29352.25 | 1053606905 - MORRISTOWN MEDICAL CENTER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 055 | $9929.16 | 1275566200 - BANNER ESTRELLA MEDICAL CENTER | 900065118 - (AZ) BANNER ESTRELLA MEDICAL CENTER | AZ | General Acute Care Hospital (282N00000X) |
United | 055 | $19703.46 | 1336478163 - JEWISH HOSPITAL LLC, THE JEWISH HOSPITAL - MERCY HEALTH | 271408630 - (OH) JEWISH HOSPITAL LLC | OH | General Acute Care Hospital (282N00000X) |
United | 055 | $28839.49 | 1578620449 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC, BAPTIST MEDICAL CENTER | 590747311 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC | FL | General Acute Care Hospital (282N00000X) |
United | 055 | $9493.13 | 1629024930 - MERCY MEDICAL CENTER, MERCY MEDICAL PSYCH UNIT | 420698295 - (IA) MERCY MEDICAL CENTER | IA | Psychiatric Hospital Unit (273R00000X) |
United | 055 | $7991.18 | 1962662379 - BROADLAWNS MEDICAL CENTER | 426005830 - (IA) BROADLAWNS MEDICAL CENTER | IA | Psychiatric Hospital Unit (273R00000X) |
United | 055 | $18768.47 | 1639320484 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | Psychiatric Hospital Unit (273R00000X) |
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 055 vs. Other Diseases & Disorders of the Nervous System Codes
The MS-DRG 055 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 055 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 |
|---|---|---|
| 054-APR-DRG | High | MIGRAINE & OTHER HEADACHES |
| 054-MS-DRG | High | Nervous System Neoplasms with MCC |
| 055-MS-DRG | High | Nervous System Neoplasms without MCC |
| 056-APR-DRG | High | BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 055 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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