MS-DRG 492 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 492 by major payers:
$39,285.91
$44,164.21
$54,756.82
$56,854.67
| 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 492 | ||||||
United | 492 | $38722.28 | 1154936987 - KREMMLING MEMORIAL HOSPITAL DISTRICT, MIDDLE PARK MEDICAL CENTER - GRANBY | 840676212 - (CO) KREMMLING MEMORIAL HOSPITAL DISTRICT | CO | Critical Access Hospital (282NC0060X) |
United | 492 | $74989.09 | 1730494816 - VIERA HOSPITAL INC, VIERA HOSPITAL INC | 264019868 - (FL) VIERA HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 492 | $95633.82 | 1346213469 - GOOD SAMARITAN HOSPITAL OF SUFFERN | 131740104 - (NY) BON SECOURS CHARITY HEALTH SYSTEM INC | NY | General Acute Care Hospital (282N00000X) |
United | 492 | $114526.20 | 1548291883 - TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | 752890358 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | TX | General Acute Care Hospital (282N00000X) |
United | 492 | $33164.66 | 1063900975 - MCCURTAIN MEMORIAL MEDICAL MANAGEMENT, INC., MCCURTAIN MEMORIAL HOSPITAL | 736617937 - (OK) MCCURTAIN MEMORIAL MEDICAL MANAGEMENT INC | OK | Critical Access Hospital (282NC0060X) |
United | 492 | $32973.03 | 1477874337 - RCHP, NORTH ALABAMA MEDICAL CENTER | 272451336 | AL | General Acute Care Hospital (282N00000X) |
United | 492 | $73695.40 | 1104897859 - CRESTVIEW HOSPITAL COMPANY, LLC, NORTH OKALOOSA MEDICAL CENTER | 650460321 | FL | General Acute Care Hospital (282N00000X) |
United | 492 | $13450.00 | 1467495796 - TCMC MADISON-PORTLAND, INC., TENNESSEE CHRISTIAN MEDICAL CENTER | 621560757 | TN | General Acute Care Hospital (282N00000X) |
United | 492 | $35473.92 | 1487917233 - PEACEHEALTH, PEACE ISLAND MEDICAL CENTER | 383868360 - (WA) PEACEHEALTH | WA | Critical Access Hospital (282NC0060X) |
United | 492 | $61954.23 | 1487633509 - VHS SAN ANTONIO PARTNERS LLC, BAPTIST HEALTH SYSTEM | 760714523 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 492 | $56389.51 | 1952900920 - VANDERBILT BEDFORD HOSPITAL, LLC, VANDERBILT BEDFORD HOSPITAL | 853419620 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 492 | $60547.96 | 1518957950 - BOLIVAR GENERAL HOSPITAL, INC., WEST TENNESSEE HEALTHCARE BOLIVAR HOSPITAL | 621624171 - (TN) BOLIVAR GENERAL HOSPITAL INC | TN | Critical Access Hospital (282NC0060X) |
United | 492 | $59880.32 | 1972857282 - STATE OF CONNECTICUT, JOHN DEMPSEY HOSPITAL-HEMOPHILIA CENTER | 66000798 | CT | General Acute Care Hospital (282N00000X) |
United | 492 | $54453.23 | 1477641892 - ST ELIZABETH MEDICAL CENTER, MOHAWK VALLEY HEALTH SYSTEM INC | 150532245 - (NY) ST ELIZABETH MEDICAL CENTER | NY | Psychiatric Hospital Unit (273R00000X) |
United | 492 | $29096.81 | 1851601850 - GRAHAM REGIONAL MEDICAL CENTER | 463113489 | TX | Rural Acute Care Hospital (282NR1301X) |
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 492 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 492 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 492 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 |
|---|---|---|
| 489-MS-DRG | High | Knee Procedures without Principal Diagnosis of Infection without CC/MCC |
| 492-MS-DRG | High | Lower Extremity and Humerus Procedures except Hip, Foot and Femur with MCC |
| 493-APR-DRG | Moderate | Bacterial And Tuberculous Infections Of Nervous System |
| 493-MS-DRG | High | Lower Extremity and Humerus Procedures except Hip, Foot and Femur 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 492. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 492 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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