MS-DRG 476 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 476 by major payers:
$15,722.01
$15,703.97
$18,384.60
$19,043.31
| 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 476 | ||||||
United | 476 | $27083.56 | 1144251216 - PALM BEACH GARDENS COMMUNITY HOSPITAL, INC., PALM BEACH GARDENS MEDICAL CENTER | 591223933 | FL | General Acute Care Hospital (282N00000X) |
United | 476 | $24507.67 | 1730710898 - FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC, FROEDTERT COMMUNITY HOSPITAL | 843381796 | WI | General Acute Care Hospital (282N00000X) |
United | 476 | $27083.56 | 1144251216 - PALM BEACH GARDENS COMMUNITY HOSPITAL, INC., PALM BEACH GARDENS MEDICAL CENTER | 591223933 | FL | General Acute Care Hospital (282N00000X) |
United | 476 | $23026.05 | 1871713495 - SAINT FRANCIS HOSPITAL AND MEDICAL CENTER | 60646813 - (CT) SAINT FRANCIS HOSPITAL AND MEDICAL CENTER | CT | General Acute Care Hospital (282N00000X) |
United | 476 | $34195.14 | 1245201656 - TEXAS INSTITUTE FOR SURGERY, LLP, TEXAS INSTITUTE FOR SURGERY AT TEXAS HEALTH PRESBYTERIAN DALLAS | 770628004 - (TX) TEXAS INSTITUTE FOR SURGERY, LLP | TX | General Acute Care Hospital (282N00000X) |
United | 476 | $13534.34 | 1073765475 - HENRY COUNTY MEDICAL CENTER | 626007078 | TN | Hospitalist Physician (208M00000X) |
United | 476 | $17318.56 | 1316294069 - EMCARE | 871999484 | FL | General Acute Care Hospital (282N00000X) |
United | 476 | $38580.03 | 1003819475 - FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC., FROEDTERT BLUEMOUND REHABILITATION HOSPITAL | 396105970 - (WI) FROEDTERT MEMORIAL LUTHERAN HOSPITAL INC | WI | Rehabilitation Hospital Unit (273Y00000X) |
United | 476 | $13343.75 | 1821098252 - HODGEMAN COUNTY HEALTH CENTER | 480943819 - (KS) HODGEMAN COUNTY HEALTH CENTER | KS | Critical Access Hospital (282NC0060X) |
United | 476 | $10469.59 | 1942255724 - AMORY HMA LLC, MERIT HEALTH GILMORE MEMORIAL | 320583236 - MONROE HEALTH SERVICES INC | MS | General Acute Care Hospital (282N00000X) |
United | 476 | $20835.76 | 1619934627 - ST. CLOUD HOSPITAL | 410695596 - (MN) ST CLOUD HOSPITAL | MN | Rehabilitation Hospital Unit (273Y00000X) |
United | 476 | $15372.66 | 1518178268 - J C BLAIR MEMORIAL HOSPITAL, PENN HIGHLANDS HUNTINGDON | 231352159 - (PA) J C BLAIR MEMORIAL HOSPITAL | PA | Psychiatric Hospital Unit (273R00000X) |
United | 476 | $29960.82 | 1902466840 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 476 | $23262.00 | 1942383781 - THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA, WELLSPAN GOOD SAMARITAN HOSPITAL INPATIENT MEDICAL REHAB UNIT | 230794160 - (PA) THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 476 | $35397.42 | 1073664116 - PRESBYTERIAN HOSPITAL OF PLANO | 752770738 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO | TX | 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 476 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 476 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 476 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 |
|---|---|---|
| 475-APR-DRG | Moderate | Transient Ischemia |
| 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 |
| 477-MS-DRG | High | Biopsies of Musculoskeletal System and Connective Tissue with 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 476. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 476 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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