MS-DRG 467 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 467 by major payers:
$41,843.75
$42,641.70
$52,401.82
$54,821.74
| 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 467 | ||||||
United | 467 | $59317.60 | 1982650206 - LAKEVIEW MEDICAL CENTER, LLC, LAKEVIEW REGIONAL MEDICAL CENTER | 621596506 | LA | Psychiatric Hospital Unit (273R00000X) |
United | 467 | $91312.40 | 1144384876 - UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS, UT SOUTHWESTERN UNIVERSITY HOSPITAL - ZALE LIPSHY | 753175630 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 467 | $116141.67 | 1659381895 - BON SECOURS-RICHMOND COMMUNITY HOSPITAL LLC, BON SECOURS RICHMOND COMMUNITY HOSPITAL PRO FEE SERVICE | 540647482 | VA | General Acute Care Hospital (282N00000X) |
United | 467 | $3288.00 | 1457347239 - UHS-CORONA INC, CORONA REGIONAL MEDICAL CENTER | 432035443 | CA | General Acute Care Hospital (282N00000X) |
United | 467 | $92862.00 | 1740400290 - AVISTA ADVENTIST HOSPITAL | 840438224 - PORTERCARE ADVENTIST HEALTH SYSTEM | CO | General Acute Care Hospital (282N00000X) |
United | 467 | $48840.87 | 1932284411 - FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC, FOUNDATION SURGICAL HOSPITAL OF SAN ANTONIO | 203793927 - (TX) FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 467 | $21965.00 | 1487694857 - DIGNITY HEALTH, MERCY GENERAL HOSPITAL | 942761692 | CA | General Acute Care Hospital (282N00000X) |
United | 467 | $45506.00 | 1710041694 - GOOD SAMARITAN HOSPITAL | 621763090 | CA | General Acute Care Hospital (282N00000X) |
United | 467 | $111368.00 | 1396813523 - SUTTER BAY HOSPITALS, SUTTER WEST BAY HOSPITALS | 940562680 - (CA) SUTTER BAY HOSPITALS | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 467 | $21965.00 | 1487694857 - DIGNITY HEALTH, MERCY GENERAL HOSPITAL | 942761692 | CA | General Acute Care Hospital (282N00000X) |
United | 467 | $2500.00 | 1134166036 - CLHG-WINN, LLC, WINN PARISH MEDICAL CENTER | 813465517 | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 467 | $77180.03 | 1326078288 - DELRAY MEDICAL CENTER, INC., DELRAY MEDICAL CENTER | 752922687 | FL | General Acute Care Hospital (282N00000X) |
United | 467 | $62294.10 | 1831352087 - NAPLES COMMUNITY HOSPITAL INC, NCH HEALTHCARE SYSTEM | 590694358 - (FL) NAPLES COMMUNITY HOSPITAL INC | FL | Rehabilitation Hospital (283X00000X) |
United | 467 | $80279.84 | 1366556227 - MULTICARE HEALTH SYSTEM, TACOMA GENERAL ALLENMORE | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 467 | $13783.00 | 1265780811 - BARNABAS HEALTH SYSTEM | 223452311 | NJ | 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 467 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 467 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 467 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 |
|---|---|---|
| 466-APR-DRG | High | MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC |
| 466-MS-DRG | High | Revision of Hip or Knee Replacement with MCC |
| 467-MS-DRG | High | Revision of Hip or Knee Replacement with CC |
| 468-APR-DRG | High | OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 467. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 467 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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