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See a sample rate comparisonMS-DRG 468 Fee Schedule
Last Verified: September 2026
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.
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
| 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 468 by major payers:
$33,634.86
$33,845.41
$41,465.00
$42,894.74
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MS-DRG 468
5 of 25 sample ratesHigher to lower in this preview
Longmont United Hospital, Behavioral Health Psychiatric Unit
Longmont United Hospital
$75,233.00Published rateCarondelet Health Network, St Mary'S Hospital
$58,399.89Published rateInova Health Care Services, Inova Alexandria Hospital
Inova Health Care Services
$44,798.89Published rateSoutheast Hospital, Mercy Hospital Southeast
Southeast Hospital
$31,514.63Published rateDignity Health, St. Bernardine Medical Center
$21,297.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 468 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 468 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 468 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 |
|---|---|---|
| 467-APR-DRG | Moderate | Nonspecific Cva And Precerebral Occlusion Without Infarction |
| 467-MS-DRG | High | REVISION OF HIP OR KNEE REPLACEMENT WITH CC |
| 468-MS-DRG | High | REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC |
| 469-APR-DRG | High | ACUTE KIDNEY INJURY |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 468. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 468 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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