MS-DRG 457 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 457 by major payers:
$73,009.47
$70,187.03
$86,470.73
$93,195.86
| 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 457 | ||||||
United | 457 | $121134.42 | 1417134156 - GEORGETOWN UNIVERSITY HOSPITAL | 522218584 - (DC) MEDSTAR-GEORGETOWN MEDICAL CENTER INC | DC | General Acute Care Hospital (282N00000X) |
United | 457 | $111011.46 | 1164463493 - SAINT FRANCIS MEDICAL CENTER, OUTPATIENT SERVICES | 370662569 - (IL) SAINT FRANCIS MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | 457 | $161833.85 | 1033681630 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | Psychiatric Hospital Unit (273R00000X) |
United | 457 | $86344.35 | 1043915523 - CATHOLIC HEALTH INITIATIVES COLORADO, HOLY CROSS HOSPITAL - SALT LAKE | 621795214 | UT | General Acute Care Hospital (282N00000X) |
United | 457 | $109227.82 | 1427147883 - NEBRASKA METHODIST HOSPITAL, METHODIST HOSPITAL | 470376604 - NEBRASKA METHODIST HOSPITAL | NE | General Acute Care Hospital (282N00000X) |
United | 457 | $119310.64 | 1801457510 - ADVENTHEALTH POLK NORTH INC, ADVENTHEALTH HEART OF FLORIDA | 841793121 | FL | General Acute Care Hospital (282N00000X) |
United | 457 | $70875.85 | 1700036696 - ROANE COUNTY MEDICAL CENTER, ROANE MEDICAL CENTER | 680673354 - (TN) ROANE COUNTY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 457 | $97569.79 | 1356328199 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566256 - (GA) EMORY UNIVERSITY | GA | Rehabilitation Hospital (283X00000X) |
United | 457 | $5526.00 | 1285064907 - PRIME HEALTHCARE PARADISE VALLEY LLC, PARADISE VALLEY HOSPITAL | 205837239 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 457 | $133360.70 | 1437135811 - MORTON PLANT HOSPITAL ASSOCIATION INC, MORTON PLANT NORTH BAY HOSPITAL | 590624462 - (FL) MORTON PLANT HOSPITAL ASSOCIATION INC | FL | General Acute Care Hospital (282N00000X) |
United | 457 | $67822.49 | 1497798847 - BAPTIST HEALTHCARE SYSTEM, INC., BAPTIST HEALTH FLOYD | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | IN | General Acute Care Hospital (282N00000X) |
United | 457 | $197149.81 | 1356350391 - BON SECOURS ST. FRANCIS MEDICAL CENTER LLC, BON SECOURS ST FRANCIS PROFESSIONAL FEE SERVICES | 311716973 | VA | General Acute Care Hospital (282N00000X) |
United | 457 | $124143.21 | 1679559553 - MEMORIAL MEDICAL CENTER | 370661220 - (IL) MEMORIAL HEALTH SYSTEM | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 457 | $191592.65 | 1972863249 - NYU LANGONE MEDICAL CENTER | 133971298 - NYU LANGONE HOSPITALS | NY | Special Hospital (284300000X) |
United | 457 | $65620.02 | 1780763284 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. MARY'S HOSPITAL - ST. LOUIS | 431343281 - SSM HEALTH CARE ST LOUIS | MO | Psychiatric Hospital Unit (273R00000X) |
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 457 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 457 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 457 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 |
|---|---|---|
| 456-MS-DRG | High | Spinal Fusion except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions with MCC |
| 457-MS-DRG | High | Spinal Fusion except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions with CC |
| 458-APR-DRG | Moderate | Cva And Precerebral Occlusion With Infarction |
| 458-MS-DRG | High | Spinal Fusion except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions without CC/MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 457. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 457 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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