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See a sample rate comparisonMS-DRG 469 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.
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT
| 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 469 by major payers:
$37,432.71
$39,795.17
$49,274.19
$52,164.94
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MS-DRG 469
5 of 25 sample ratesHigher to lower in this preview
Emanuel Medical Center, Inc.
$109,962.34Published rateLaurens County Health Care System
Prisma Health - Upstate
$55,567.89Published rateChester County Hospital Spu
Chester County Hospital
$43,695.98Published rateProgress West Healthcare Center
$29,291.00Published rateGreenwood County Hospital, Eureka Clinic
Greenwood County Hospital
$5,414.04Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 469 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 469 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 469 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 |
|---|---|---|
| 468-APR-DRG | High | OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS |
| 468-MS-DRG | High | REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC |
| 469-MS-DRG | High | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT |
| 470-APR-DRG | High | CHRONIC KIDNEY DISEASE |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 469. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 469 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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