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See a sample rate comparisonMS-DRG 426 Fee Schedule
Last Verified: October 2026
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.
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
| Key Fact | Detail |
|---|---|
| Service Type | Diseases & Disorders of the Musculoskeletal System & Connective Tissue |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 426 by major payers:
$116,611.82
$145,696.91
$143,700.64
$167,446.16
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MS-DRG 426
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Alliance
$260,104.18Published rateCarondelet Health Network, St Mary'S Hospital
$185,037.46Published rateSmsj Tucson Holdings LLC, Bridges Geropsychiatric Program At St. Marys Hospital
$115,962.67Published rateMemorial Hospital Of Polk County, Chi St. Luke'S Heath Memorial Livingston
Memorial Medical Center Livingston
$71,232.71Published rateCr Emergency Room, LLC, Baylor Scott & White Emergency Hospital Keller
$5,185.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 426 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 426 code is part of the Diseases & Disorders of the Musculoskeletal System & Connective Tissue 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 426 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 |
|---|---|---|
| 425-APR-DRG | High | OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS |
| 425-MS-DRG | High | OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC |
| 426-MS-DRG | High | MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE |
| 427-APR-DRG | High | THYROID DISORDERS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 426 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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