MS-DRG 481 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 481 by major payers:
$24,989.36
$27,763.88
$33,612.40
$34,272.68
| 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 481 | ||||||
United | 481 | $25920.00 | 1558319863 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE VALLEY HOSPITAL | 620840204 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 481 | $43626.12 | 1932747326 - INSPIRA MEDICAL CENTERS, INC. | 221820210 - (NJ) INSPIRA MEDICAL CENTER WOODBURY | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 481 | $35864.32 | 1811598121 - SMSJ TUCSON HOLDINGS LLC, CARONDELET ST RAPHAELS EMERGENCY CENTER | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 481 | $13032.91 | 1396394961 - CLHG-ACADIAN, LLC, ACADIAN MEDICAL CENTER | 825359949 | LA | General Acute Care Hospital (282N00000X) |
United | 481 | $25920.00 | 1558319863 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE VALLEY HOSPITAL | 620840204 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 481 | $52826.94 | 1437605532 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CENTER FOR PEDIATRIC MED | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 481 | $24586.22 | 1073954186 - NORTHWEST HOSPITAL LLC, NORTHWEST MEDICAL CENTER | 621762430 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 481 | $35030.53 | 1457727810 - ADVANCED INPATIENT MEDICINE | 232421970 - (PA) NORTHEASTERN PENNSYLVANIA HEALTH CORPORATION | PA | General Acute Care Hospital (282N00000X) |
United | 481 | $22809.38 | 1801971916 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 481 | $62693.10 | 1033224704 - UNIVERSITY HOSPITAL AT STONY BROOK, STONY BROOK SOUTHAMPTON HOSPITAL | 113243405 | NY | General Acute Care Hospital (282N00000X) |
United | 481 | $16430.67 | 1104842475 - LOCKNEY GENERAL HOSPITAL DISTRICT, W.J. MANGOLD MEMORIAL HOSPITAL | 751424965 | TX | Critical Access Hospital (282NC0060X) |
United | 481 | $8723.71 | 1205837218 - PIKE COUNTY MEMORIAL HOSPITAL | 436002764 - (MO) PIKE COUNTY MEMORIAL HOSPITAL | MO | Critical Access Hospital (282NC0060X) |
United | 481 | $15949.66 | 1013937705 - MIZELL MEMORIAL HOSPITAL, INC. | 630307951 - (AL) MIZELL MEMORIAL HOSPITAL INC | AL | Rural Acute Care Hospital (282NR1301X) |
United | 481 | $48945.94 | 1558148627 - INTEGRIS HEALTH WOODWARD HOSPITAL INC, INTEGRIS HEALTH WOODWARD HOSPITAL | 932826081 | OK | General Acute Care Hospital (282N00000X) |
United | 481 | $30194.65 | 1548366404 - POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM, SENTARA NORTHERN VIRGINIA MEDICAL CENTER | 540853898 - (VA) POTOMAC HOSPITAL CORPORATION OF PRINCE WILLIAM | VA | 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 481 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 481 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 481 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 |
|---|---|---|
| 480-APR-DRG | High | MAJOR MALE PELVIC PROCEDURES |
| 480-MS-DRG | High | Hip and Femur Procedures except Major Joint with MCC |
| 481-MS-DRG | High | Hip and Femur Procedures except Major Joint with CC |
| 482-APR-DRG | High | TRANSURETHRAL PROSTATECTOMY |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 481. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 481 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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