MS-DRG 474 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 474 by major payers:
$48,092.57
$59,300.02
$69,712.51
$71,573.07
| 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 474 | ||||||
United | 474 | $49542.48 | 1144247982 - HENDERSON COUNTY HOSPITAL CORPORATION, MARGARET R. PARDEE MEMORIAL HOSPITAL | 562084959 | NC | General Acute Care Hospital (282N00000X) |
United | 474 | $77275.86 | 1215913470 - PRESBYTERIAN HEALTHCARE SERVICES, PRESBYTERIAN HOSPITAL | 850105601 - PRESBYTERIAN HEALTHCARE SERVICES | NM | General Acute Care Hospital (282N00000X) |
United | 474 | $53681.85 | 1063414233 - MEMORIAL HOSPITAL, MEMORIAL HEALTHCARE | 381358208 - MEMORIAL HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 474 | $232074.26 | 1164458196 - COASTAL CAROLINA MEDICAL CENTER, INC., COASTAL CAROLINA HOSPITAL-SWING BED UNIT | 934580630 | SC | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 474 | $28788.30 | 1124136593 - SINGING RIVER HEALTH SYSTEM | 646000515 - SINGING RIVER HEALTH SYSTEM | MS | General Acute Care Hospital (282N00000X) |
United | 474 | $67696.54 | 1215921077 - OUR LADY OF THE LAKE ASCENSION COMMUNITY HOSPITAL, INC., ST. ELIZABETH HOSPITAL | 720423651 - (LA) OUR LADY OF THE LAKE HOSPITAL INC | LA | General Acute Care Hospital (282N00000X) |
United | 474 | $101115.79 | 1003991845 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE PORTLAND MEDICAL CENTER | 930386906 | OR | General Acute Care Hospital (282N00000X) |
United | 474 | $101053.75 | 1326078288 - DELRAY MEDICAL CENTER, INC., DELRAY MEDICAL CENTER | 752922687 | FL | General Acute Care Hospital (282N00000X) |
United | 474 | $78217.64 | 1609817220 - ENDEAVOR HEALTH CLINICAL OPERATIONS, HIGHLAND PARK HOSPITAL | 362167060 - (IL) NORTHSHORE UNIVERSITY HEALTHSYSTEM | IL | General Acute Care Hospital (282N00000X) |
United | 474 | $47914.53 | 1720037559 - EAST TEXAS MEDICAL CENTER PITTSBURG, ETMC PITTSBURG | 823953636 | TX | Critical Access Hospital (282NC0060X) |
United | 474 | $118548.56 | 1457526154 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC, BAPTIST MEDICAL CENTER | 590747311 - SOUTHERN BAPTIST HOSPITAL OF FLORIDA INC | FL | Psychiatric Hospital (283Q00000X) |
United | 474 | $139397.00 | 1881827301 - NORTH SHORE LIJ | 111562701 - (NY) NORTH SHORE UNIVERSITY HOSPITAL | NY | Long Term Care Hospital (282E00000X) |
United | 474 | $51973.19 | 1912014564 - ADVOCATE NORTH SIDE HEALTH NETWORK, ADVOCATE ILLINOIS MASONIC MEDICAL CENTER | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 474 | $105112.39 | 1255327201 - MULTICARE HEALTH SYSTEM, MULTICARE AUBURN MEDICAL CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 474 | $72970.54 | 1942475074 - FLAGLER HOSPITAL | 590675143 - (FL) FLAGLER HOSPITAL INC | FL | 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 474 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 474 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 474 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 |
|---|---|---|
| 473-APR-DRG | Moderate | Transient Ischemia |
| 473-MS-DRG | High | Cervical Spinal Fusion without CC/MCC |
| 474-MS-DRG | High | Amputation for Musculoskeletal System and Connective Tissue Disorders with MCC |
| 475-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 474. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 474 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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