MS-DRG 480 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 480 by major payers:
$35,153.87
$38,325.63
$46,083.50
$47,722.81
| 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 480 | ||||||
United | 480 | $47447.14 | 1881412740 - HSA PGH LLC | 862724926 | FL | General Acute Care Hospital (282N00000X) |
United | 480 | $63445.71 | 1033475959 - ORLANDO HEALTH CENTRAL, INC., HEALTH CENTRAL | 800764192 - (FL) ORLANDO HEALTH CENTRAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 480 | $17781.00 | 1356828172 - HMH HOSPITALS CORPORATION, RARITAN BAY MEDICAL CENTER-OLD BRIDGE | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 480 | $37930.07 | 1750371522 - HOLY REDEEMER HEALTH SYSTEM, HOLY REDEEMER HOSPITAL & MEDICAL CENTER | 231534300 - HOLY REDEEMER HEALTH SYSTEM | PA | General Acute Care Hospital (282N00000X) |
United | 480 | $42338.64 | 1396998183 - LANSDALE HOSPITAL CORPORATION, LANSDALE HOSPITAL | 263359979 - (PA) LANSDALE HOSPITAL CORPORATION | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 480 | $25685.74 | 1194969618 - HASAN AMIR | 161768258 | OH | Hospitalist Physician (208M00000X) |
United | 480 | $39041.46 | 1215979190 - VANDERBILT UNIVERSITY MEDICAL CENTER, VANDERBILT WILSON COUNTY HOSPITAL | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 480 | $49591.14 | 1902891682 - STATE OF CONNECTICUT, JOHN DEMPSEY HOSPITAL- SUBPROVIDER | 66000798 | CT | Psychiatric Hospital Unit (273R00000X) |
United | 480 | $39959.37 | 1124719935 - SOUTH ARKANSAS REGIONAL HOSPITAL LLC | 923616260 | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 480 | $49441.26 | 1154531630 - AVERA MCKENNAN, AVERA MCKENNAN HOSPITAL AND UNIVERSITY HEALTH CENTER - DIABETIC ED | 460224743 - AVERA MCKENNAN | SD | General Acute Care Hospital (282N00000X) |
United | 480 | $53290.92 | 1881820462 - UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | General Acute Care Hospital (282N00000X) |
United | 480 | $35230.14 | 1043450828 - SSM SELECT REHAB ST LOUIS LLC, SSM PHYSICAL THERAPY | 263694972 | MO | Rehabilitation Hospital (283X00000X) |
United | 480 | $49591.14 | 1902891682 - STATE OF CONNECTICUT, JOHN DEMPSEY HOSPITAL- SUBPROVIDER | 66000798 | CT | Psychiatric Hospital Unit (273R00000X) |
United | 480 | $53437.96 | 1952333205 - ST. MARY'S MEDICAL CENTER, INC, ST. MARY'S MEDICAL CENTER | 752932830 | FL | General Acute Care Hospital (282N00000X) |
United | 480 | $66116.61 | 1710938949 - NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC, THOMASVILLE MEDICAL CENTER | 560636250 - NOVANT HEALTH THOMASVILLE MEDICAL CENTER LLC | NC | 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 480 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 480 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 480 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 |
|---|---|---|
| 479-MS-DRG | High | Biopsies of Musculoskeletal System and Connective Tissue without CC/MCC |
| 480-MS-DRG | High | Hip and Femur Procedures except Major Joint with MCC |
| 481-APR-DRG | High | Peripheral, Cranial And Autonomic Nerve Disorders |
| 481-MS-DRG | High | Hip and Femur Procedures except Major Joint 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 480. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 480 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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