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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.
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC
| 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 493 by major payers:
$26,151.68
$30,507.19
$37,325.91
$38,737.78
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MS-DRG 493
5 of 25 sample ratesHigher to lower in this preview
The New York And Presbyterian Hospital, New York-Presbyterian Hospital
The New York And Presbyterian Hospital
$82,889.71Published rateAllina Health System, Mercy Hospital
Allina Health System
$50,368.17Published rateMunster Medical Research Foundation Inc, Community Hospital
Munster Medical Research Foundation Inc
$35,124.23Published rateMethodist Healthcare System Of San Antonio, Ltd., LLP, Methodist Hospital Atascosa
$25,139.00Published rateThe Health Care Authority Of The City Of Eufaula, Medical Center Barbour Senior Care Center
$12,480.40Published rate
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See a sample payer proposalMS-DRG 493 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 493 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 493 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 |
|---|---|---|
| 492-APR-DRG | Moderate | Bacterial And Tuberculous Infections Of Nervous System |
| 492-MS-DRG | High | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC |
| 493-MS-DRG | High | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC |
| 494-APR-DRG | Moderate | Bacterial And Tuberculous Infections Of Nervous System |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 493. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 493 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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