MS-DRG 056 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 056 by major payers:
$25,050.70
$34,594.97
$38,924.62
$39,543.64
| 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 056 | ||||||
United | 056 | $29929.00 | 1396160396 - PROSPECT CHARTERCARE SJHSRI, LLC, ST. JOSEPH HEALTH CENTER | 464661337 | RI | Psychiatric Hospital Unit (273R00000X) |
United | 056 | $22744.74 | 1285062968 - CHILDRESS REGIONAL MEDICAL CENTER | 751228349 | TX | General Acute Care Hospital (282N00000X) |
United | 056 | $29453.38 | 1023069028 - SOUTHCREST LLC, SOUTHCREST HOSPITAL | 452711804 | OK | General Acute Care Hospital (282N00000X) |
United | 056 | $40924.51 | 1639422504 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL SCHERTZ | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 056 | $18694.51 | 1811987084 - RHEA MEDICAL CENTER, RHEA COUNTY HOSPITAL | 626014528 - (TN) RHEA COUNTY MEDICAL CENTER | TN | Critical Access Hospital (282NC0060X) |
United | 056 | $18393.07 | 1629256532 - SELECT SPECIALTY HOSPITAL, SELECT SPECIALTY HOSPITAL - ARIZONA (PHOENIX DOWNTOWN) | 251821705 - (AZ) SELECT SPECIALTY HOSPITAL | AZ | Long Term Care Hospital (282E00000X) |
United | 056 | $19281.57 | 1164447850 - PUBLIC HOSPITAL DISTRICT NO 2 SKAGIT COUNTY WASHINGTON, ISLAND HOSPITAL | 910729255 - (WA) PUBLIC HOSPITAL DISTRICT NO 2 | WA | General Acute Care Hospital (282N00000X) |
United | 056 | $18409.85 | 1710396932 - OSF HEALTHCARE SYSTEM, OSF SAINT ANTHONY'S HEALTH CENTER | 370813229 - (IL) OSF HEALTHCARE SYSTEM | IL | General Acute Care Hospital (282N00000X) |
United | 056 | $25859.83 | 1154795581 - PRIME HEALTHCARE FOUNDATION, SOUTHERN REGIONAL MEDICAL CENTER | 300885567 | GA | General Acute Care Hospital (282N00000X) |
United | 056 | $10369.00 | 1902901333 - CLARA MAASS MEDICAL CENTER | 221500556 | NJ | General Acute Care Hospital (282N00000X) |
United | 056 | $4590.00 | 1811968308 - THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE | 822445000 - (AL) THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE | AL | Psychiatric Hospital Unit (273R00000X) |
United | 056 | $18055.51 | 1821098286 - TOURO INFIRMARY | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | 056 | $2000.00 | 1902469653 - CLHG-DEQUINCY, LLC | 364911029 - (LA) CLHGDEQUINCY LLC | LA | Critical Access Hospital (282NC0060X) |
United | 056 | $48808.87 | 1275506636 - TAYLORVILLE MEMORIAL HOSPITAL | 370661250 - (IL) MEMORIAL HEALTH SYSTEM | IL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 056 | $15198.63 | 1417950650 - KANSAS SPINE & SPECIALTY HOSPITAL, L.L.C. | 481251730 - (KS) KANSAS SPINE & SPECIALTY HOSPITAL, L.L.C. | KS | 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 056 vs. Other Diseases & Disorders of the Nervous System Codes
The MS-DRG 056 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 056 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 |
|---|---|---|
| 055-APR-DRG | High | HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE |
| 055-MS-DRG | High | Nervous System Neoplasms without MCC |
| 056-MS-DRG | High | Degenerative Nervous System Disorders with MCC |
| 057-APR-DRG | High | CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, 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 056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 056 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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