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See a sample rate comparisonMS-DRG 461 Fee Schedule
Last Verified: September 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.
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
| 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
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MS-DRG 461
5 of 25 sample ratesHigher to lower in this preview
Doctors Medical Center Of Modesto, Inc., Doctors Medical Center Of Modesto
$207,813.20Published rateUniversity Of Washington, University Of Washington Medical Center
$123,593.14Published rateBladen County Hospital
$90,762.25Published rateLubbock County Hospital District, Umc Medical Professional Services
Lubbock County Hospital District
$57,930.44Published rateNocona Hospital District, Nocona General Hospital
$12,887.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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.
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