MS-DRG 477 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 477 by major payers:
$39,167.89
$45,341.30
$53,857.94
$55,042.13
| 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 477 | ||||||
United | 477 | $59161.12 | 1144471715 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | General Acute Care Hospital (282N00000X) |
United | 477 | $78426.95 | 1740220797 - ST ELIZABETH MEDICAL CENTER, INC, ST ELIZABETH GER PSYCH | 610445850 - ST ELIZABETH MEDICAL CENTER INC | KY | Psychiatric Hospital Unit (273R00000X) |
United | 477 | $76559.02 | 1437234580 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 477 | $76559.02 | 1437234580 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 477 | $66626.82 | 1558333682 - HIGHLINE MEDICAL CENTER | 910712166 - (WA) HIGHLINE MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 477 | $59563.48 | 1811341167 - BBH SBMC, LLC, SHELBY BAPTIST MEDICAL CENTER | 474780023 | AL | General Acute Care Hospital (282N00000X) |
United | 477 | $24668.48 | 1033242987 - PENDER MEMORIAL HOSPITAL INCORPORATED, PENDER MEMORIAL HOSPIAL EKG | 560653348 - PENDER MEMORIAL HOSPITAL INCORPORATED | NC | Critical Access Hospital (282NC0060X) |
United | 477 | $45497.96 | 1467491027 - ROSE CITY HMA LLC, LANCASTER REGIONAL MEDICAL CENTER | 474849671 | PA | General Acute Care Hospital (282N00000X) |
United | 477 | $116575.21 | 1194832477 - THE NEW YORK AND PRESBYTERIAN HOSPITAL, NEWYORK-PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 477 | $39450.83 | 1679628838 - GENESIS MEDICAL CENTER | 421418847 - GENESIS HEALTH SYSTEM | IA | General Acute Care Hospital (282N00000X) |
United | 477 | $36066.21 | 1144209271 - SUMMIT HEALTHCARE ASSOCIATION, SUMMIT HEALTHCARE REGIONAL MEDICAL CENTER | 860320447 - SUMMIT HEALTHCARE ASSOCIATION | AZ | Rural Acute Care Hospital (282NR1301X) |
United | 477 | $59161.12 | 1144471715 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | General Acute Care Hospital (282N00000X) |
United | 477 | $68044.04 | 1821250762 - TARZANA MEDICAL CENTER LLC, PROVIDENCE CEDARS-SINAI TARZANA MEDICAL CENTER | 833972614 - (CA) TARZANA MEDICAL CENTER LLC | CA | General Acute Care Hospital (282N00000X) |
United | 477 | $2536.00 | 1124495239 - PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLC, SUBURBAN COMMUNITY HOSPITAL | 472819044 | PA | General Acute Care Hospital (282N00000X) |
United | 477 | $35524.87 | 1295253920 - CHESTNUT HILL HOSPITAL, LLC, CHESTNUT HILL HOSPITAL | 883577015 | PA | 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 477 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 477 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 477 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 |
|---|---|---|
| 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 |
| 478-MS-DRG | High | Biopsies of Musculoskeletal System and Connective Tissue with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 477. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 477 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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