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 | $130590.32 | 1073524690 - LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1, ODESSA MEMORIAL HEALTHCARE CENTER | 916001722 - (WA) LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1 | WA | Critical Access Hospital (282NC0060X) |
United | 056 | $32288.59 | 1730132234 - MEMORIAL HERMANN HEALTH SYSTEM | 741152597 - (TX) MEMORIAL HERMANN HEALTH SYSTEM | TX | General Acute Care Hospital (282N00000X) |
United | 056 | $26042.64 | 1639459282 - CUYUNA REGIONAL MEDICAL CENTER | 411724637 - (MN) CUYUNA REGIONAL MEDICAL CENTER | MN | Critical Access Hospital Clinic/Center (261QC0050X) |
United | 056 | $26994.74 | 1285664177 - MERCY HOSPITALS EAST COMMUNITIES, MERCY HOSPITAL WASHINGTON | 431066883 - (MO) MERCY HOSPITALS EAST COMMUNITIES | MO | General Acute Care Hospital (282N00000X) |
United | 056 | $23523.51 | 1497028302 - UT MEDICAL CENTER KNOXVILLE | 311626179 - (TN) UNIVERSITY HEALTH SYSTEMS INC | TN | General Acute Care Hospital (282N00000X) |
United | 056 | $25366.52 | 1740273994 - ECTOR COUNTY HOSPITAL DISTRICT, MEDICAL CENTER HOSPITAL | 752302928 | TX | General Acute Care Hospital (282N00000X) |
United | 056 | $25867.34 | 1639869233 - CHH COMMUNITY HEALTH | 883577015 | PA | Psychiatric Hospital Unit (273R00000X) |
United | 056 | $69168.25 | 1780748871 - LAWRENCE AND MEMORIAL HOSPITAL, INC. | 60646704 - (CT) LAWRENCE AND MEMORIAL HOSPITAL INC | CT | Rehabilitation Hospital Unit (273Y00000X) |
United | 056 | $20215.50 | 1033710116 - MCLAREN MACOMB | 381218516 - (MI) MCLAREN MACOMB | MI | Rehabilitation Hospital Unit (273Y00000X) |
United | 056 | $3308.00 | 1083616221 - OKMULGEE MEMORIAL HOSPITAL, INC, OKMULGEE MEMORIAL HOSPITAL | 731357965 - MUSCOGEE (CREEK) NATION DEPARTMENT OF HEALTH | OK | General Acute Care Hospital (282N00000X) |
United | 056 | $10369.00 | 1902901333 - CLARA MAASS MEDICAL CENTER | 221500556 | NJ | General Acute Care Hospital (282N00000X) |
United | 056 | $22747.47 | 1891980124 - SEMINOLE HMA, LLC, ALLIANCEHEALTH SEMINOLE | 455055149 - (OK) ST ANTHONY SHAWNEE HOSPITAL INC | OK | General Acute Care Hospital (282N00000X) |
United | 056 | $40701.05 | 1639263189 - LASALLE PARISH HOSPITAL SERVICE DIST NO1, HARDTNER MEDICAL CENTER | 720652984 - (LA) HARDTNER MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | 056 | $55090.19 | 1710139688 - GRADY HOSPITAL | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | 056 | $69265.90 | 1174576896 - PHYSICIAN MANAGEMENT, LTD. | 210634484 - (NJ) INSPIRA MEDICAL CENTERS INC | NJ | 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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