MS-DRG 469 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 469 by major payers:
$37,432.71
$39,795.17
$49,274.19
$52,164.94
| 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 469 | ||||||
United | 469 | $55567.89 | 1093716979 - DEKALB MEDICAL CENTER, INC., EMORY DECATUR HOSPITAL | 581966795 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | 469 | $109962.34 | 1174615330 - EMANUEL MEDICAL CENTER, INC. | 752918774 | CA | General Acute Care Hospital (282N00000X) |
United | 469 | $60072.92 | 1417944224 - IREDELL MEMORIAL HOSPITAL, INCORPORATED | 560591303 - (NC) IREDELL MEMORIAL HOSPITAL INCORPORATED | NC | General Acute Care Hospital (282N00000X) |
United | 469 | $48865.23 | 1033611454 - UNIVERSITY HEALTHCARE SYSTEM, L.C., LAKEVIEW CAMPUS NICU | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 469 | $26276.00 | 1548393127 - UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA, UNIVERSITY MEDICAL CENTER | 886000436 | NV | General Acute Care Hospital (282N00000X) |
United | 469 | $37616.19 | 1780690180 - HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH, IBERIA MEDICAL CENTER | 726014963 | LA | General Acute Care Hospital (282N00000X) |
United | 469 | $29291.00 | 1508938044 - PROGRESS WEST HEALTHCARE CENTER | 412140764 - (MO) PROGRESS WEST HEALTHCARE CENTER | MO | General Acute Care Hospital (282N00000X) |
United | 469 | $26276.00 | 1548393127 - UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA, UNIVERSITY MEDICAL CENTER | 886000436 | NV | General Acute Care Hospital (282N00000X) |
United | 469 | $30306.91 | 1326088139 - THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, CAROLINAS HEALTHCARE SYSTEM LINCOLN | 560529945 | NC | General Acute Care Hospital (282N00000X) |
United | 469 | $55567.89 | 1588703714 - LAURENS COUNTY HEALTH CARE SYSTEM | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 469 | $56144.00 | 1578519815 - GOOD SAMARITAN HOSPITAL, L.P., GOOD SAMARITAN HOSPITAL | 621763090 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 469 | $46467.83 | 1407962046 - DLP HARRIS REGIONAL HOSPITAL LLC, HARRIS REGIONAL HOSPITAL | 383932775 | NC | General Acute Care Hospital (282N00000X) |
United | 469 | $43695.98 | 1003951195 - CHESTER COUNTY HOSPITAL SPU | 230469150 - (PA) CHESTER COUNTY HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 469 | $59253.78 | 1982150009 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH GREER MEMORIAL HOSPITAL | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 469 | $5414.04 | 1629044961 - GREENWOOD COUNTY HOSPITAL, EUREKA CLINIC | 480616260 - (KS) GREENWOOD COUNTY HOSPITAL | 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 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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