MS-DRG 475 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 475 by major payers:
$26,547.36
$29,358.65
$33,954.92
$34,961.39
| 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 475 | ||||||
United | 475 | $27120.84 | 1477537363 - VHS OF PHOENIX INC, ABRAZO CENTRAL CAMPUS | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 475 | $24419.55 | 1801975156 - O'CONNOR HOSPITAL | 161540394 - (NY) OCONNOR HOSPITAL | NY | Critical Access Hospital (282NC0060X) |
United | 475 | $64699.57 | 1104856095 - DESERT REGIONAL MEDICAL CENTER, INC., DESERT REGIONAL MEDICAL CENTER | 752694137 | CA | General Acute Care Hospital (282N00000X) |
United | 475 | $22594.41 | 1326349135 - ST CLARE MEMORIAL HOSPITAL, INC, ST CLARE MEMORIAL HOSPITAL SWING BED | 390848401 - ST CLARE MEMORIAL HOSPITAL INC | WI | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 475 | $27533.61 | 1578372363 - SAINT MARY OF NAZARETH HOSPITAL | 992171028 | IL | Psychiatric Hospital Unit (273R00000X) |
United | 475 | $4796.00 | 1982609558 - TROPHY CLUB MEDICAL CENTER LP, BAYLOR SCOTT & WHITE MEDICAL CENTER - TROPHY CLUB | 481260190 - (TX) TROPHY CLUB MEDICAL CENTER LP | TX | General Acute Care Hospital (282N00000X) |
United | 475 | $33802.21 | 1861435042 - SAINT VINCENT HEALTH CENTER | 250965547 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 475 | $72014.99 | 1275632895 - NYU LANGONE HOSPITALS | 133971298 - NYU LANGONE HOSPITALS | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 475 | $54924.85 | 1548689672 - GREENVILLE HEALTH SYSTEM, GHS CARDIOVASCULAR SVCS GRNV | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 475 | $43318.57 | 1336638915 - VALLEY WEST COMMUNITY HOSPITAL, NORTHWESTERN MEDICINE VALLEY WEST HOSPITAL | 364244337 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 475 | $8276.00 | 1114179025 - CLARA MAASS MEDICAL CENTER | 221500556 | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 475 | $27533.61 | 1578372363 - SAINT MARY OF NAZARETH HOSPITAL | 992171028 | IL | Psychiatric Hospital Unit (273R00000X) |
United | 475 | $42677.87 | 1417037045 - MOUNT CARMEL HEALTH SYSTEM | 311439334 - MOUNT CARMEL HEALTH SYSTEM | OH | General Acute Care Hospital (282N00000X) |
United | 475 | $35932.30 | 1154748416 - AGH LAVEEN LLC, DIGNITY HEALTH ARIZONA GENERAL HOSPITAL | 471587223 - (AZ) AGH LAVEEN LLC | AZ | General Acute Care Hospital (282N00000X) |
United | 475 | $38169.10 | 1033224704 - UNIVERSITY HOSPITAL AT STONY BROOK, STONY BROOK SOUTHAMPTON HOSPITAL | 113243405 | NY | General Acute Care Hospital (282N00000X) |
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 475 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 475 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 475 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 |
|---|---|---|
| 474-APR-DRG | Moderate | Transient Ischemia |
| 474-MS-DRG | High | Amputation for Musculoskeletal System and Connective Tissue Disorders with MCC |
| 475-MS-DRG | High | Amputation for Musculoskeletal System and Connective Tissue Disorders with CC |
| 476-MS-DRG | High | Amputation for Musculoskeletal System and Connective Tissue Disorders without CC/MCC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 475. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 475 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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