MS-DRG 472 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 472 by major payers:
$35,120.71
$36,322.04
$43,628.23
$46,940.91
| 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 472 | ||||||
United | 472 | $68178.11 | 1225295512 - MOUNT SINAI HOSPITAL PHARMACY | 131624096 - MOUNT SINAI HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 472 | $52733.00 | 1992751879 - NOTAMI HOSPITALS OF FLORIDA INC, HCA FLORIDA LAKE CITY HOSPITAL | 954176924 | FL | General Acute Care Hospital (282N00000X) |
United | 472 | $17232.00 | 1962455816 - CHCA CONROE LP, CONROE REGIONAL MEDICAL CENTER | 621801361 - (TX) CHCA CONROE LP | TX | General Acute Care Hospital (282N00000X) |
United | 472 | $7213.16 | 1174599468 - WAYNE COUNTY HOSPITAL | 426038180 | IA | Critical Access Hospital (282NC0060X) |
United | 472 | $97968.82 | 1538522412 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE TRANSMOUNTAIN CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 472 | $6167.12 | 1851921571 - BHSM REHABILITATION, LLC | 823481322 | AZ | Rehabilitation Hospital (283X00000X) |
United | 472 | $3385.00 | 1710099742 - MOUNTAIN STATES HEALTH ALLIANCE, SYCAMORE SHOALS HOSPITAL PSYCHIATRIC UNIT | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | TN | Psychiatric Hospital Unit (273R00000X) |
United | 472 | $27860.56 | 1902865389 - BAPTIST HEALTHCARE SYSTEM, INC, BAPTIST HEALTH CORBIN | 610444707 - BAPTIST HEALTHCARE SYSTEM INC | KY | General Acute Care Hospital (282N00000X) |
United | 472 | $4158.00 | 1780680215 - RUSSELL COUNTY MEDICAL CENTER, INC, RUSSELL COUNTY MEDICAL CENTER | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | VA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 472 | $62020.35 | 1366536963 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE MILWAUKIE HOSPITAL | 930924302 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | General Acute Care Hospital (282N00000X) |
United | 472 | $56500.00 | 1770680217 - UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, UCSF MEDICAL CENTER | 943281657 | CA | General Acute Care Hospital (282N00000X) |
United | 472 | $31965.60 | 1396109500 - GOTTLIEB MEMORIAL HOSPITAL | 362379649 - (IL) GOTTLIEB MEMORIAL HOSPITAL | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 472 | $53183.57 | 1417032541 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 472 | $52665.23 | 1396747960 - ST. JOSEPH MEDICAL CENTER | 471669781 - (MO) PRIME HEALTHCARE SERVICES - KANSAS CITY LLC | MO | General Acute Care Hospital (282N00000X) |
United | 472 | $51176.14 | 1609954395 - CARONDELET HEALTH NETWORK, CARONDELET OREILLY CARE CENTER | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
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 472 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 472 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 472 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 |
|---|---|---|
| 471-APR-DRG | Moderate | Transient Ischemia |
| 471-MS-DRG | High | Cervical Spinal Fusion with MCC |
| 472-MS-DRG | High | Cervical Spinal Fusion with CC |
| 473-APR-DRG | Moderate | Transient Ischemia |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 472. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 472 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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