MS-DRG 456 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 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 456 by major payers:
$99,890.59
$100,897.45
$119,955.56
$135,114.89
| 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 456 | ||||||
United | 456 | $140351.57 | 1821002007 - UNIVERSITY OF CALIFORNIA IRVINE, UCI HEALTH - FOUNTAIN VALLEY | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | CA | General Acute Care Hospital (282N00000X) |
United | 456 | $97836.20 | 1518065523 - SSM REGIONAL HEALTH SERVICES, SSM HEALTH ST. MARY'S HOSPITAL JEFFERSON CITY | 440546097 | MO | General Acute Care Hospital (282N00000X) |
United | 456 | $116223.07 | 1770673535 - PRINCETON BAPTIST MEDICAL CENTER, PRINCETON BAPTIST MEDICAL CENTER | 474775351 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 456 | $170188.56 | 1902355654 - SWEDISH HEALTH SERVICES, SWEDISH MEDICAL CENTER-BALLARD PSYCH | 910433740 - (WA) SWEDISH HEALTH SERVICES | WA | Psychiatric Hospital Unit (273R00000X) |
United | 456 | $116767.93 | 1205846037 - BAILEY MEDICAL CENTER, LLC | 201547519 - (OK) BAILEY MEDICAL CENTER LLC | OK | General Acute Care Hospital (282N00000X) |
United | 456 | $255896.87 | 1346391323 - SOUTHAMPTON HOSPITAL, SPORTS REHAB EAST HAMPOTN | 113243405 | NY | Rehabilitation Hospital (283X00000X) |
United | 456 | $55244.58 | 1093744187 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 456 | $90843.64 | 1285719328 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 456 | $48941.00 | 1952445959 - UCSF HEALTH COMMUNITY HOSPITALS, ST. MARY'S MEDICAL CENTER | 721561126 | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 456 | $66957.50 | 1043292899 - METRO KNOXVILLE HMA LLC, TENNOVA HEALTHCARE NORTH KNOXVILLE MEDICAL CENTER | 452535623 | TN | General Acute Care Hospital (282N00000X) |
United | 456 | $35308.91 | 1295764553 - PREFERRED HOSPITAL LEASING ELDORADO, INC., SCHLEICHER COUNTY MEDICAL CENTER | 203662596 - (TX) PREFERRED HOSPITAL LEASING ELDORADO INC | TX | Critical Access Hospital (282NC0060X) |
United | 456 | $284912.37 | 1396087672 - DOCTORS MEDICAL CENTER OF MODESTO, INC., EMANUEL MEDICAL CENTER | 752918774 | CA | General Acute Care Hospital (282N00000X) |
United | 456 | $252382.15 | 1063270825 - PRISMA HEALTH-MIDLANDS, PRISMA HEALTH RICHLAND INPATIENT PEDIATRIC REHABILITATION UNIT | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | Children's Rehabilitation Hospital (283XC2000X) |
United | 456 | $248094.09 | 1104856095 - DESERT REGIONAL MEDICAL CENTER, INC., DESERT REGIONAL MEDICAL CENTER | 752694137 | CA | General Acute Care Hospital (282N00000X) |
United | 456 | $131092.81 | 1477583334 - NEW MEDICAL HORIZONS II, LTD., CYPRESS FAIRBANKS MEDICAL CENTER HOSPITAL | 742129954 - (TX) NEW MEDICAL HORIZONS II LTD | TX | 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 456 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 456 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 456 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 |
|---|---|---|
| 451-APR-DRG | Moderate | Cva And Precerebral Occlusion With Infarction |
| 451-MS-DRG | High | Single Level Spinal Fusion except Cervical without MCC |
| 456-MS-DRG | High | Spinal Fusion except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions with MCC |
| 457-APR-DRG | Moderate | Cva And Precerebral Occlusion With Infarction |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 456. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 456 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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