MS-DRG 479 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 479 by major payers:
$21,748.22
$23,422.81
$28,000.86
$28,779.44
| 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 479 | ||||||
United | 479 | $31369.50 | 1134178999 - PEACEHEALTH | 916068143 - PEACEHEALTH SOUTHWEST MEDICAL CENTER | WA | General Acute Care Hospital (282N00000X) |
United | 479 | $13576.69 | 1952560914 - BANNER BOSWELL MEDICAL CENTER | 900389314 | AZ | General Acute Care Hospital (282N00000X) |
United | 479 | $26524.72 | 1598781486 - NUMC DEPARTMENT OF NEPHROLOGY, FPP | 113465690 | NY | General Acute Care Hospital (282N00000X) |
United | 479 | $20701.58 | 1841406667 - COX WALNUT LAWN PHARMACY | 440577118 - LESTER E COX MEDICAL CENTER | MO | General Acute Care Hospital (282N00000X) |
United | 479 | $44778.57 | 1356901235 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 479 | $20579.75 | 1467560128 - ADVOCATE HEALTH AND HOSPITALS CORPORATION, ADVOCATE SOUTH SUBURBAN HOSPITAL | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | General Acute Care Hospital (282N00000X) |
United | 479 | $29984.30 | 1235239211 - MERCY HEALTH, MERCY HOSPITAL ANDERSON | 310537085 | OH | General Acute Care Hospital (282N00000X) |
United | 479 | $12633.04 | 1609917202 - HARDIN COUNTY GENERAL HOSPITAL, HARDIN MEDICAL CENTER | 626002428 - (TN) HARDIN COUNTY GENERAL HOSPITAL | TN | General Acute Care Hospital (282N00000X) |
United | 479 | $58492.32 | 1770502635 - THE NEW YORK AND PRESBYTERIAN HOSPITAL, NEW YORK-PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | Psychiatric Hospital (283Q00000X) |
United | 479 | $30465.22 | 1851388961 - DAKOTA SPECIALTY INSTITUTE, INNOVIS HEALTH | 261175213 - INNOVIS HEALTH LLC | ND | General Acute Care Hospital (282N00000X) |
United | 479 | $14082.08 | 1003996000 - THE HEALTH CARE AUTHORITY OF THE CITY OF ANNISTON, NORTHEAST ALABAMA REGIONAL MEDICAL CENTER | 636000090 - THE HEALTH CARE AUTHORITY OF THE CITY OF ANNISTON | AL | General Acute Care Hospital (282N00000X) |
United | 479 | $17591.69 | 1235344409 - DARDANELLE COMMUNITY HOSPITAL LLC, RIVER VALLEY MEDICAL CENTER | 834538290 - (AR) DARDANELLE REGIONAL LLC | AR | Critical Access Hospital (282NC0060X) |
United | 479 | $54018.05 | 1053347955 - DELRAY MEDICAL CENTER, INC., DELRAY MEDICAL CENTER | 752922687 | FL | Psychiatric Hospital Unit (273R00000X) |
United | 479 | $35684.69 | 1902355654 - SWEDISH HEALTH SERVICES, SWEDISH MEDICAL CENTER-BALLARD PSYCH | 910433740 - (WA) SWEDISH HEALTH SERVICES | WA | Psychiatric Hospital Unit (273R00000X) |
United | 479 | $27960.00 | 1033214416 - COMMUNITY FIRST HEALTHCARE OF ILLINOIS, INC, COMMUNITY FIRST MEDICAL CENTER | 472313900 - (IL) COMMUNITY FIRST HEALTHCARE OF IL | IL | 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 479 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 479 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 479 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 |
|---|---|---|
| 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 |
| 480-APR-DRG | High | MAJOR MALE PELVIC PROCEDURES |
| 480-MS-DRG | High | Hip and Femur Procedures except Major Joint 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 479. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 479 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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