MS-DRG 463 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 463 by major payers:
$60,119.11
$68,791.05
$84,408.68
$86,272.86
| 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 463 | ||||||
United | 463 | $111168.78 | 1346291309 - THE PRESBYTERIAN HOSPITAL, NOVANT HEALTH HUNTERSVILLE MEDICAL CENTER | 560554230 - PRESBYTERIAN HOSPITAL | NC | General Acute Care Hospital (282N00000X) |
United | 463 | $107420.49 | 1306938071 - ADVENTIST HEALTH SYSTEM-SUNBELT, INC, ADVENTHEALTH ORLANDO | 590724459 - (FL) ADVENTIST HEALTH SYSTEM-SUNBELT INC | FL | General Acute Care Hospital (282N00000X) |
United | 463 | $115732.63 | 1356901235 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 463 | $67192.07 | 1053354100 - LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH, LONG ISLAND COMMUNITY HOSPITAL | 111704595 - (NY) LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH | NY | General Acute Care Hospital (282N00000X) |
United | 463 | $49030.64 | 1710031836 - MEADVILLE MEDICAL CENTER, INPATIENT DRUG AND ALCOHOL | 251512436 - (PA) MEADVILLE MEDICAL CENTER | PA | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 463 | $38845.50 | 1386823631 - MERCY HOSPITAL JEFFERSON | 430687077 - (MO) MERCY HOSPITAL JEFFERSON | MO | Rehabilitation Hospital Unit (273Y00000X) |
United | 463 | $46875.28 | 1922182831 - SALINE HOSPITAL LLC, SALINE MEMORIAL HOSPITAL | 812816675 | AR | Psychiatric Hospital Unit (273R00000X) |
United | 463 | $134494.20 | 1669673463 - ALAMEDA HEALTH SYSTEM, HIGHLAND GENERAL HOSPITAL | 943302014 | CA | General Acute Care Hospital (282N00000X) |
United | 463 | $72897.29 | 1306889597 - VANDERBILT UNIVERSITY MEDICAL CENTER, VANDERBILT WILSON COUNTY HOSPITAL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 463 | $182186.53 | 1740059948 - EAST COOPER MEDICAL CENTER LLC | 934555562 | SC | Rehabilitation Hospital Unit (273Y00000X) |
United | 463 | $37911.60 | 1376548370 - COFFEY COUNTY HOSPITAL, COFFEY COUNTY HOSPITAL | 480860883 | KS | Critical Access Hospital (282NC0060X) |
United | 463 | $115471.52 | 1386020402 - DECATUR MEMORIAL HOSPITAL | 370661199 - DECATUR MEMORIAL HOSPITAL | IL | Psychiatric Hospital Unit (273R00000X) |
United | 463 | $76942.64 | 1164495255 - CATAWBA VALLEY MEDICAL CENTER | 560789196 | NC | General Acute Care Hospital (282N00000X) |
United | 463 | $182186.53 | 1740059948 - EAST COOPER MEDICAL CENTER LLC | 934555562 | SC | Rehabilitation Hospital Unit (273Y00000X) |
United | 463 | $116823.63 | 1386020402 - DECATUR MEMORIAL HOSPITAL | 370661199 - DECATUR MEMORIAL HOSPITAL | IL | 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 463 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 463 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 463 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 |
|---|---|---|
| 462-APR-DRG | High | NEPHRITIS & NEPHROSIS |
| 462-MS-DRG | High | Bilateral or Multiple Major Joint Procedures of Lower Extremity without MCC |
| 463-MS-DRG | High | Wound Debridement and Skin Graft except Hand for Musculoskeletal and Connective Tissue Disorders with MCC |
| 464-APR-DRG | Moderate | Nonspecific Cva And Precerebral Occlusion Without Infarction |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 463. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 463 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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