MS-DRG 461 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 461 by major payers:
$66,829.24
$72,682.79
$90,819.31
$97,545.70
| 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 461 | ||||||
United | 461 | $12887.00 | 1689655912 - NOCONA HOSPITAL DISTRICT, NOCONA GENERAL HOSPITAL | 751368648 | TX | General Acute Care Hospital (282N00000X) |
United | 461 | $172542.14 | 1346269982 - WILLAMETTE VALLEY MEDICAL CENTER LLC, WILLAMETTE VALLEY MEDICAL CENTER | 621762552 - (OR) WILLAMETTE VALLEY MEDICAL CENTER LLC | OR | General Acute Care Hospital (282N00000X) |
United | 461 | $109507.46 | 1598744856 - VHS SAN ANTONIO PARTNERS LLC, BAPTIST MEDICAL CENTER | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 461 | $66117.00 | 1225128432 - UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER, THE MEMORIAL HOSPITAL OF GENEVA | 340714461 - (OH) UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | Critical Access Hospital (282NC0060X) |
United | 461 | $103207.02 | 1649220724 - PARK NICOLLET METHODIST HOSPITAL | 410132080 - (MN) PARK NICOLLET HEALTH SERVICES | MN | General Acute Care Hospital (282N00000X) |
United | 461 | $127376.39 | 1477531580 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 461 | $74255.93 | 1619923919 - METROPOLITAN HOSPITAL, METRO HEALTH HOSPITAL | 380593405 - METROPOLITAN HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 461 | $78322.70 | 1568538387 - PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK, PRESENCE ST. JOSEPH HOSPITAL - ELGIN PSYCHIATRIC UNIT | 992115457 | IL | Psychiatric Hospital Unit (273R00000X) |
United | 461 | $123593.14 | 1245330281 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 461 | $83826.42 | 1881676104 - MONADNOCK COMMUNITY HOSPITAL | 20222157 - (NH) MONADNOCK COMMUNITY HOSPITAL | NH | Critical Access Hospital (282NC0060X) |
United | 461 | $61977.25 | 1962758375 - OSS ORTHOPAEDIC HOSPITAL, LLC, OSS HEALTH | 800458999 - (PA) OSS HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 461 | $138565.56 | 1801457510 - ADVENTHEALTH POLK NORTH INC, ADVENTHEALTH HEART OF FLORIDA | 841793121 | FL | General Acute Care Hospital (282N00000X) |
United | 461 | $42820.10 | 1386694487 - GROVE HILL MEMORIAL HOSPITAL, INC | 630436871 | AL | General Acute Care Hospital (282N00000X) |
United | 461 | $90762.25 | 1588699599 - BLADEN COUNTY HOSPITAL | 800164702 | NC | Critical Access Hospital (282NC0060X) |
United | 461 | $140929.31 | 1972637619 - TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | 756001743 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | TX | Chronic Disease Hospital (281P00000X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
MS-DRG 461 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 461 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 461 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 |
|---|---|---|
| 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 |
| 461-MS-DRG | High | Bilateral or Multiple Major Joint Procedures of Lower Extremity with MCC |
| 462-APR-DRG | High | NEPHRITIS & NEPHROSIS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 461. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 461 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 461) and we'll show you how you compare in 15 minutes or less.