MS-DRG 465 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 465 by major payers:
$24,184.99
$23,711.14
$27,663.47
$28,596.26
| 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 465 | ||||||
United | 465 | $14296.00 | 1942432471 - ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | 221487243 - (NJ) ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | NJ | General Acute Care Hospital (282N00000X) |
United | 465 | $33904.30 | 1700978558 - SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, ADVENTHEALTH FISH MEMORIAL | 593149293 - SOUTHWEST VOLUSIA HEALTHCARE CORPORATION | FL | General Acute Care Hospital (282N00000X) |
United | 465 | $4350.00 | 1720152945 - SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC, LAKE CHARLES MEMORIAL HOSPITAL | 720551963 - (LA) SOUTHWEST LOUISIANA HOSPITAL ASSOCIATION INC | LA | General Acute Care Hospital (282N00000X) |
United | 465 | $13141.23 | 1972517365 - COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 465 | $32375.40 | 1518995505 - FOUNTAIN VALLEY REGIONAL HOSPITAL & MEDICAL CENTER, FOUNTAIN VALLEY REGIONAL HOSPITAL | 952768729 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 465 | $11052.00 | 1679934277 - CHILDREN'S HOSPITAL COLORADO, CHILDREN'S HOSPITAL COLORADO THERAPY CARE BROOMFIELD | 840166760 - CHILDRENS HOSPITAL COLORADO | CO | Children's Hospital (282NC2000X) |
United | 465 | $19218.63 | 1467537506 - CARONDELET HEALTH NETWORK, ST. MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 465 | $44004.96 | 1013130145 - BANNER HEALTH | 900412842 | AZ | General Acute Care Hospital (282N00000X) |
United | 465 | $22827.98 | 1942361308 - HUGH CHATHAM MEMORIAL HOSPITAL INC | 560642846 - HUGH CHATHAM MEMORIAL HOSPITAL INC | NC | General Acute Care Hospital (282N00000X) |
United | 465 | $15277.67 | 1992971923 - CALHOUN HEALTH SERVICES | 813257997 - (MS) BAPTIST MEMORIAL HOSPITAL - CALHOUN INC | MS | General Acute Care Hospital (282N00000X) |
United | 465 | $25951.22 | 1780930412 - UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER | 264827222 - (OH) UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | General Acute Care Hospital (282N00000X) |
United | 465 | $2954.00 | 1447285432 - WELLMONT HEALTH SYSTEM, LONESOME PINE SWING BED | 621636465 - WELLMONT HEALTH SYSTEM | VA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 465 | $12857.28 | 1891740585 - BELLIN MEMORIAL HOSPITAL INC. | 390884478 - BELLIN MEMORIAL HOSPITAL INC | WI | General Acute Care Hospital (282N00000X) |
United | 465 | $4880.81 | 1336109768 - HOSPITAL SERVICE DISTRICT NO 1-A OF THE PARISH OF RICHLAND STATE OF LA, RICHLAND PARISH HOSPITAL | 721179027 - (LA) RICHLAND PARISH HOSPITAL | LA | Critical Access Hospital (282NC0060X) |
United | 465 | $17597.10 | 1033228168 - ST FRANCIS HEALTH LLC, ST FRANCIS HOSPITAL | 475259919 - (GA) ST FRANCIS HEALTH LLC | GA | General Acute Care Hospital (282N00000X) |
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 465 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 465 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 465 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 |
|---|---|---|
| 464-APR-DRG | Moderate | Nonspecific Cva And Precerebral Occlusion Without Infarction |
| 464-MS-DRG | High | Wound Debridement and Skin Graft except Hand for Musculoskeletal and Connective Tissue Disorders with CC |
| 465-MS-DRG | High | Wound Debridement and Skin Graft except Hand for Musculoskeletal and Connective Tissue Disorders without CC/MCC |
| 466-APR-DRG | High | MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 465. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 465 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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