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See a sample rate comparisonMS-DRG 462 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 WITHOUT 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 462 by major payers:
$38,507.39
$37,889.59
$45,600.95
$47,197.75
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MS-DRG 462
5 of 25 sample ratesHigher to lower in this preview
St. Joseph Health Northern California, LLC, Providence St. Joseph Hospital
St Joseph Health Northern California LLC
$82,050.72Published ratePasco-Pinellas Hillsborough Community Health System Inc, Adventhealth Wesley Chapel
Pasco-Pinellas Hillsborough Community Health System Inc
$57,004.05Published rateFroedtert Health Neighborhood Hospital, LLC, Froedtert Community Hospital
$46,190.23Published rateHshs Holy Family Hospital Inc
$31,808.23Published rateHouston Hospitals Inc, Perry Hospital
Houston Hospitals Inc
$3,526.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 462 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 462 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 462 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 |
|---|---|---|
| 461-APR-DRG | High | KIDNEY & URINARY TRACT MALIGNANCY |
| 461-MS-DRG | High | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC |
| 462-MS-DRG | High | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC |
| 463-APR-DRG | High | KIDNEY & URINARY TRACT INFECTIONS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 462. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 462 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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