MS-DRG 255 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 Circulatory System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 255 by major payers:
$31,229.64
$35,169.03
$41,172.39
$42,422.72
| 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 255 | ||||||
United | 255 | $34158.41 | 1073512000 - UHS OF TEXOMA, INC, REBA MCENTIRE CENTER FOR REHABILITATION | 205908627 - UHS OF TEXOMA INC | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 255 | $45799.21 | 1992100127 - MERCY HEALTH YOUNGSTOWN LLC, MERCY HEALTH ST ELIZABETH YOUNGSTOWN HOSPITAL | 340505560 - HUMILITY OF MARY HEALTH PARTNERS | OH | Psychiatric Hospital Unit (273R00000X) |
United | 255 | $26165.00 | 1013379528 - BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION, THE MEDICAL CENTER AT ALBANY | 610920842 - (KY) BOWLING GREEN-WARREN COUNTY COMMUNITY HOSPITAL CORPORATION | KY | Critical Access Hospital (282NC0060X) |
United | 255 | $47410.98 | 1669639712 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | General Acute Care Hospital (282N00000X) |
United | 255 | $41546.17 | 1033611454 - UNIVERSITY HEALTHCARE SYSTEM, L.C., LAKEVIEW CAMPUS NICU | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 255 | $47410.98 | 1245330281 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 255 | $41546.17 | 1033611454 - UNIVERSITY HEALTHCARE SYSTEM, L.C., LAKEVIEW CAMPUS NICU | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 255 | $20229.39 | 1194758284 - BANNER BAYWOOD MEDICAL CENTER | 363386394 - (AZ) BANNER BAYWOOD MEDICAL CENTER | AZ | General Acute Care Hospital (282N00000X) |
United | 255 | $40595.00 | 1154411338 - KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2, EVERGREENHEALTH MEDICAL CENTER | 910844563 | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 255 | $25586.73 | 1356723027 - PRIME HEALTHCARE SERVICES-PORT HURON LLC | 472361878 | MI | Rehabilitation Hospital Unit (273Y00000X) |
United | 255 | $33535.67 | 1669991675 - TOPEKA HOSPITAL, LLC, THE UNIVERSITY OF KANSAS HEALTH SYSTEM, ST. FRANCIS CAMPUS | 822034009 | KS | Rehabilitation Hospital Unit (273Y00000X) |
United | 255 | $26615.40 | 1356723027 - PRIME HEALTHCARE SERVICES-PORT HURON LLC | 472361878 | MI | Rehabilitation Hospital Unit (273Y00000X) |
United | 255 | $49444.00 | 1649615220 - PROVIDENCE HEALTH & SERVICES-WA, PROVIDENCE REGIONAL MEDICAL CENTER EVERETT | 352346161 | WA | Hospitalist Physician (208M00000X) |
United | 255 | $70601.02 | 1912982216 - ST JOSEPH HOSPITAL OF ORANGE, PROVIDENCE ST. JOSEPH HOSPITAL | 951643359 - (CA) ST JOSEPH HOSPITAL OF ORANGE | CA | General Acute Care Hospital (282N00000X) |
United | 255 | $32463.27 | 1427493246 - FRANCISCAN HEALTH MUNSTER, FRANCISCAN HEALTHCARE - MUNSTER | 352472136 - (IN) FRANCISCAN HEALTHCARE MUNSTER | IN | 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 255 vs. Other Diseases & Disorders of the Circulatory System Codes
The MS-DRG 255 code is part of the Diseases & Disorders of the Circulatory 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 255 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 |
|---|---|---|
| 254-APR-DRG | High | OTHER DIGESTIVE SYSTEM DIAGNOSES |
| 254-MS-DRG | High | Other Vascular Procedures without CC/MCC |
| 255-MS-DRG | High | Upper Limb and Toe Amputation for Circulatory System Disorders with MCC |
| 256-MS-DRG | High | Upper Limb and Toe Amputation for Circulatory System Disorders with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 255. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 255 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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