MS-DRG 464 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 464 by major payers:
$35,704.84
$39,055.98
$46,231.23
$47,664.34
| 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 464 | ||||||
United | 464 | $5069.00 | 1255327920 - UHS CORONA INC, CORONA REGIONAL MEDICAL CENTER | 432035443 | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 464 | $72261.34 | 1487875498 - NEW ENGLAND MEDICAL CENTER | 43400617 - TUFTS MEDICAL CENTER PARENT INC | MA | Critical Access Hospital (282NC0060X) |
United | 464 | $30066.86 | 1467476556 - MARSHALL COUNTY HMA, LLC, ALLIANCEHEALTH MADILL | 383862800 | OK | Critical Access Hospital (282NC0060X) |
United | 464 | $66496.82 | 1700998697 - HOLY FAMILY MEMORIAL INC, FROEDTERT HOLY FAMILY MEMORIAL HOSPITAL | 390806395 - HOLY FAMILY MEMORIAL INC | WI | General Acute Care Hospital (282N00000X) |
United | 464 | $20679.06 | 1043904949 - REUNION REHABILITATION HOSPITAL JACKSONVILLE, LLC | 880596358 - (FL) REUNION REHABILITATION HOSPITAL JACKSONVILLE LLC | FL | Rehabilitation Hospital (283X00000X) |
United | 464 | $50906.75 | 1699752915 - FAIRVIEW HEALTH SERVICES, FAIRVIEW SOUTHDALE HOSPITAL | 410991680 - FAIRVIEW HEALTH SERVICES | MN | General Acute Care Hospital (282N00000X) |
United | 464 | $21721.00 | 1184933434 - WESLEY MEDICAL CENTER | 621762545 - (KS) WESLEY MEDICAL CENTER LLC | KS | General Acute Care Hospital (282N00000X) |
United | 464 | $67280.71 | 1508877689 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE ST. PETER HOSPITAL | 910567732 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 464 | $89091.95 | 1225507114 - UNIVERSITY HOSPITAL AT STONY BROOK | 113243405 | NY | General Acute Care Hospital (282N00000X) |
United | 464 | $26325.44 | 1174555692 - MAJOR HOSPITAL, W.S. MAJOR HOSPITAL | 351118234 - (IN) MAJOR HOSPITAL | IN | General Acute Care Hospital (282N00000X) |
United | 464 | $42929.01 | 1043915523 - CATHOLIC HEALTH INITIATIVES COLORADO, HOLY CROSS HOSPITAL - SALT LAKE | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | UT | General Acute Care Hospital (282N00000X) |
United | 464 | $67280.71 | 1508877689 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE ST. PETER HOSPITAL | 910567732 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 464 | $20355.38 | 1770147118 - KPC PROMISE HOSPITAL OF PHOENIX LLC | 834169286 | AZ | Long Term Care Hospital (282E00000X) |
United | 464 | $38173.00 | 1588618367 - FAWCETT MEMORIAL HOSPITAL, INC., HCA FLORIDA FAWCETT HOSPITAL | 650252846 - (FL) FAWCETT MEMORIAL HOSPITAL INC | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 464 | $18529.98 | 1639185457 - SAINT LUKE'S HOSPITAL OF ALLEN COUNTY, INC, ALLEN COUNTY REGIONAL HOSPITAL | 843362602 - SAINT LUKES HOSPITAL OF ALLEN COUNTY INC | KS | Critical Access Hospital (282NC0060X) |
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 464 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 464 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 464 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 |
|---|---|---|
| 463-APR-DRG | High | KIDNEY & URINARY TRACT INFECTIONS |
| 463-MS-DRG | High | Wound Debridement and Skin Graft except Hand for Musculoskeletal and Connective Tissue Disorders with MCC |
| 464-MS-DRG | High | Wound Debridement and Skin Graft except Hand for Musculoskeletal and Connective Tissue Disorders with CC |
| 465-APR-DRG | High | URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 464. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 464 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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