MS-DRG 486 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 486 by major payers:
$25,461.38
$28,590.18
$33,477.01
$34,540.22
| 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 486 | ||||||
United | 486 | $30543.08 | 1518178268 - J C BLAIR MEMORIAL HOSPITAL, PENN HIGHLANDS HUNTINGDON | 231352159 - (PA) J C BLAIR MEMORIAL HOSPITAL | PA | Psychiatric Hospital Unit (273R00000X) |
United | 486 | $33527.19 | 1720434806 - THEDACARE REGIONAL MEDICAL CENTER, THEDA CLARK MEDICAL CENTER, INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | General Acute Care Hospital (282N00000X) |
United | 486 | $27118.00 | 1588637201 - DECATUR COUNTY MEMORIAL HOSPITAL, DECATUR COUNTY MEMORIAL HOSPITAL DIAGNOSTIC CENTER | 351141109 - DECATUR COUNTY MEMORIAL HOSPITAL | IN | Critical Access Hospital (282NC0060X) |
United | 486 | $19471.44 | 1689655912 - NOCONA HOSPITAL DISTRICT, NOCONA GENERAL HOSPITAL | 751368648 | TX | General Acute Care Hospital (282N00000X) |
United | 486 | $64562.82 | 1780927277 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 486 | $32445.00 | 1881367217 - NORTHERN VIRGINIA COMMUNITY HOSPITAL, LLC, STONESPRINGS HOSPITAL CENTER | 43665595 - (VA) NORTHERN VIRGINIA COMMUNITY HOSPITAL LLC | VA | Psychiatric Hospital Unit (273R00000X) |
United | 486 | $7587.00 | 1124143557 - APHMFP | 461175423 - LANDMARK MEDICAL CENTER | RI | General Acute Care Hospital (282N00000X) |
United | 486 | $33879.26 | 1710368220 - SAINT THOMAS RIVER PARK HOSPITAL, LLC, ASCENSION SAINT THOMAS RIVER PARK | 474063149 | TN | Rehabilitation Hospital Unit (273Y00000X) |
United | 486 | $42418.00 | 1083615587 - EPHRATA COMMUNITY HOSPITAL, WELLSPAN EPHRATA COMMUNITY HOSPITAL | 231370484 - EPHRATA COMMUNITY HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 486 | $33527.19 | 1902832306 - THEDACARE REGIONAL MEDICAL CENTER, APPLETON MEDICAL CENTER,INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | General Acute Care Hospital (282N00000X) |
United | 486 | $38059.00 | 1043523210 - HCA HEALTH SERVICES OF FLORIDA, INC., HCA FLORIDA ST. LUCIE HOSPITAL | 621113740 | FL | Psychiatric Hospital Unit (273R00000X) |
United | 486 | $2765.00 | 1811915838 - TAKOMA HOSPITAL & SANITARIUM TRAINING SCHOOL, INC., TAKOMA ADVENTIST HOSPITAL | 510603966 - TAKOMA REGIONAL HOSPITAL INC | TN | Psychiatric Hospital Unit (273R00000X) |
United | 486 | $19652.25 | 1295764330 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST ORANGE HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 486 | $18127.33 | 1477859254 - NASHOBA VALLEY MEDICAL CENTER, A STEWARD FAMILY HOSPITAL, INC, NASHOBA VALLEY MEDICAL CENTER | 274157855 | MA | General Acute Care Hospital (282N00000X) |
United | 486 | $24579.10 | 1922542604 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Rehabilitation Hospital Unit (273Y00000X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
MS-DRG 486 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 486 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 486 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 |
|---|---|---|
| 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 |
| 487-MS-DRG | High | Knee Procedures with Principal Diagnosis of Infection 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 486. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 486 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like MS-DRG 486) and we'll show you how you compare in 15 minutes or less.