MS-DRG 462 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 462 by major payers:
$38,507.39
$37,889.59
$45,600.95
$47,197.75
| 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 462 | ||||||
United | 462 | $22469.36 | 1831226273 - ADIRONDACK MEDICAL CENTER | 141731786 - (NY) ADIRONDACK MEDICAL CENTER | NY | Psychiatric Hospital Unit (273R00000X) |
United | 462 | $54022.71 | 1760498588 - PIEDMONT NEWTON HOSPITAL, INC., NEWTON MEDICAL CENTER | 582155150 - (GA) PIEDMONT NEWTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | 462 | $31018.98 | 1518065523 - SSM REGIONAL HEALTH SERVICES, SSM HEALTH ST. MARY'S HOSPITAL JEFFERSON CITY | 440546097 | MO | General Acute Care Hospital (282N00000X) |
United | 462 | $40502.85 | 1801857172 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIVERSITY MEDICAL CENTER | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 462 | $39409.92 | 1023472842 - THEDACARE REGIONAL MEDICAL CENTER, THEDA CLARK MEDICAL CENTER, INC. | 390830664 - (WI) THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC | WI | General Acute Care Hospital (282N00000X) |
United | 462 | $8815.41 | 1346544616 - COMANCHE COUNTY MEDICAL CENTER COMPANY | 273993262 - (TX) COMANCHE COUNTY MEDICAL CENTER COMPANY | TX | Critical Access Hospital (282NC0060X) |
United | 462 | $3526.00 | 1891808499 - HOUSTON HOSPITALS INC, PERRY HOSPITAL | 711045290 - (GA) HOUSTON HOSPITALS INC | GA | General Acute Care Hospital (282N00000X) |
United | 462 | $39299.44 | 1821030842 - VANDERBILT UNIVERSITY MEDICAL CENTER, VANDERBILT WILSON COUNTY HOSPITAL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Psychiatric Hospital Unit (273R00000X) |
United | 462 | $46190.23 | 1740805423 - FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC, FROEDTERT COMMUNITY HOSPITAL | 843381796 | WI | General Acute Care Hospital (282N00000X) |
United | 462 | $52092.98 | 1093205163 - ASCENSION NE WISCONSIN, INC, ASCENSION NE WISCONSIN-MERCY CAMPUS | 390816818 - ASCENSION NE WISCONSIN INC | WI | Psychiatric Hospital Unit (273R00000X) |
United | 462 | $64757.66 | 1104913367 - CLEVELAND CLINIC FOUNDATION | 340714585 - THE CLEVELAND CLINIC FOUNDATION | OH | Chronic Disease Hospital (281P00000X) |
United | 462 | $49098.19 | 1467537886 - MERCY HEALTH SERVICES-IOWA CORP, MERCY MEDICAL CENTER-NORTH IOWA | 311373080 - MERCY HEALTH SERVICES IOWA CORP | IA | Rural Acute Care Hospital (282NR1301X) |
United | 462 | $62276.62 | 1790767812 - SAINT LUKES SOUTH HOSPITAL, INC. | 481203262 - SAINT LUKES SOUTH HOSPITAL INC | KS | Rehabilitation Hospital Unit (273Y00000X) |
United | 462 | $31808.23 | 1295755353 - HSHS HOLY FAMILY HOSPITAL INC | 370792770 - (IL) HSHS HOLY FAMILY HOSPITAL INC | IL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 462 | $63753.92 | 1154406254 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | 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 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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