MS-DRG 478 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 478 by major payers:
$28,051.66
$31,000.11
$36,728.73
$37,658.50
| 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 478 | ||||||
United | 478 | $52581.07 | 1265818488 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 478 | $34686.21 | 1366492977 - LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIE, SIBLEY MEMORIAL HOSPITAL | 530196602 - (DC) LUCY WEBB HAYNES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSION | DC | General Acute Care Hospital (282N00000X) |
United | 478 | $34672.10 | 1164481529 - ST. CHARLES HOSPITAL | 111871039 - (NY) ST CHARLES HOSPITAL CORP | NY | General Acute Care Hospital (282N00000X) |
United | 478 | $27780.43 | 1316279003 - METROSOUTH MEDICAL CENTER, HOSPITAL | 510382045 | IL | General Acute Care Hospital (282N00000X) |
United | 478 | $31464.83 | 1720434806 - THEDACARE REGIONAL MEDICAL CENTER, THEDA CLARK MEDICAL CENTER, INC. | 390830664 - (WI) THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC | WI | General Acute Care Hospital (282N00000X) |
United | 478 | $52061.91 | 1710353339 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 478 | $33723.16 | 1912205311 - ST. TAMMANY PARISH HOSPITAL DISTRIC #1, CANCER SERVICES | 720478620 | LA | General Acute Care Hospital (282N00000X) |
United | 478 | $25326.81 | 1871805150 - VHS REHABILITATION INSTITUTE OF MICHIGAN INC, REHABILITATION INSTITUTE OF MICHIGAN | 272844407 | MI | Rehabilitation Hospital (283X00000X) |
United | 478 | $38975.30 | 1720037799 - NORTH VISTA HOSPITAL LLC, NORTH VISTA HOSPITAL | 200470861 | NV | General Acute Care Hospital (282N00000X) |
United | 478 | $52061.91 | 1710353339 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 478 | $14717.40 | 1417991159 - GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION, PERSHING MEMORIAL HOSPITAL | 430715842 - (MO) GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION | MO | Critical Access Hospital (282NC0060X) |
United | 478 | $2626.00 | 1174553598 - WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC, HAWKINS COUNTY MEMORIAL HOSPITAL | 621816368 - (TN) WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC | TN | General Acute Care Hospital (282N00000X) |
United | 478 | $25326.81 | 1871805150 - VHS REHABILITATION INSTITUTE OF MICHIGAN INC, REHABILITATION INSTITUTE OF MICHIGAN | 272844407 | MI | Rehabilitation Hospital (283X00000X) |
United | 478 | $12214.28 | 1326134255 - DIMMIT REGIONAL HOSPITAL | 263091251 - (TX) DIMMIT REGIONAL HOSPITAL | TX | Critical Access Hospital (282NC0060X) |
United | 478 | $38303.92 | 1770988917 - MERCY HEALTH-LOURDES HOSPITAL LLC, LOURDES HOSPITAL PSYCHIATRIC UNIT | 610600313 | KY | 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 478 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 478 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 478 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 |
|---|---|---|
| 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 |
| 479-MS-DRG | High | Biopsies of Musculoskeletal System and Connective Tissue 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 478. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 478 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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