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See a sample rate comparisonMS-DRG 485 Fee Schedule
Last Verified: September 2026
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.
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
| 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 485 by major payers:
$38,081.92
$42,688.88
$50,383.83
$51,936.30
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MS-DRG 485
5 of 25 sample ratesHigher to lower in this preview
Bon Secours Memorial Regional Medical Center LLC, Memorial Regional Medical Center
Bon Secours Memorial Regional Medical Center LLC
$107,575.45Published rateMedical University Hospital Authority, Musc Health Lancaster Medical Center
Medical University Hospital Authority
$79,447.93Published rateNorth Kansas City Hospital
$43,570.01Published ratePhc- Morgan City L.P., Teche Regional Medical Center
$36,867.42Published rateLancaster Hospital Corporation, Palmdale Regional Medical Center
Lancaster Hospital Corporation
$3,045.00Published rate
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See a sample payer proposalMS-DRG 485 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 485 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 485 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 |
|---|---|---|
| 483-APR-DRG | High | PENIS, TESTES & SCROTAL PROCEDURES |
| 483-MS-DRG | High | MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES |
| 485-MS-DRG | High | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC |
| 486-MS-DRG | High | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION 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 485. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 485 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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