MS-DRG 494 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 494 by major payers:
$20,170.55
$24,088.18
$29,347.24
$30,497.72
| 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 494 | ||||||
United | 494 | $28951.52 | 1841221017 - NORTHSHORE REGIONAL MEDICAL CENTER, LLC, NORTHSHORE REGIONAL MEDICAL CENTER | 271770321 | LA | General Acute Care Hospital (282N00000X) |
United | 494 | $3000.00 | 1851632616 - LANCASTER REGIONAL HOSPITAL, LP, CRESCENT MEDICAL CENTER LANCASTER | 273815440 - (TX) LANCASTER REGIONAL HOSPITAL, LP | TX | General Acute Care Hospital (282N00000X) |
United | 494 | $8888.00 | 1568442309 - THE COOPER HEALTH SYSTEM | 210634462 - (NJ) COOPER HEALTH SYSTEM A NEW JERSEY NON-PROFIT CORPORATION | NJ | General Acute Care Hospital (282N00000X) |
United | 494 | $22014.89 | 1477583334 - NEW MEDICAL HORIZONS II, LTD., CYPRESS FAIRBANKS MEDICAL CENTER HOSPITAL | 742129954 - (TX) NEW MEDICAL HORIZONS II LTD | TX | General Acute Care Hospital (282N00000X) |
United | 494 | $6893.02 | 1861882532 - CLEAR LAKE INSTITUTE FOR REHABILITATION LLC, PAM REHABILITATION HOSPITAL OF CLEAR LAKE | 465646835 | TX | Rehabilitation Hospital (283X00000X) |
United | 494 | $37436.33 | 1417946021 - SAINT JOSEPH HOSPITAL, INC, SAINT JOSEPH HOSPITAL | 840417134 - (CO) SAINT JOSEPH HOSPITAL | CO | General Acute Care Hospital (282N00000X) |
United | 494 | $37708.00 | 1780819102 - EPHRATA COMMUNITY HOSPITAL | 231370484 - EPHRATA COMMUNITY HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 494 | $5228.75 | 1215908454 - HERINGTON MUNICIPAL HOSPITAL | 862388631 - (KS) HERINGTON HOSPITAL INC | KS | Critical Access Hospital (282NC0060X) |
United | 494 | $44966.78 | 1992120851 - GREENVILLE HEALTH SYSTEM, GHS CROSS CREEK SURGERY CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 494 | $59270.53 | 1952332801 - THE NEW YORK AND PRESBYTERIAN HOSPITAL, NEW YORK-PRESBYTERIAN HOSPITAL | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 494 | $16762.28 | 1427040328 - CARILION TAZEWELL COMMUNITY HOSPITAL | 546074580 - CARILION TAZEWELL COMMUNITY HOSPITAL | VA | General Acute Care Hospital (282N00000X) |
United | 494 | $33712.00 | 1972014728 - GRAND STRAND REGIONAL MEDICAL CENTER, LLC, GRAND STRAND MEDICAL CENTER | 621768105 - (SC) GRAND STRAND REGIONAL MEDICAL CENTER LLC | SC | Psychiatric Hospital Unit (273R00000X) |
United | 494 | $39951.62 | 1568664613 - ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH, LLC | 350868085 - (IN) PARKVIEW HOSPITAL INC | IN | Special Hospital (284300000X) |
United | 494 | $29904.33 | 1427065499 - MEMORIAL MEDICAL CENTER, CENTEGRA HOSPITAL WOODSTOCK | 362338884 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatric Hospital Unit (273R00000X) |
United | 494 | $23382.73 | 1336252717 - INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION, INTEGRIS JIM THORPE INPATIENT REHABILITATION | 731089149 - (OK) INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION | OK | 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 |
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MS-DRG 494 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 494 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 494 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 |
|---|---|---|
| 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 |
| 494-MS-DRG | High | Lower Extremity and Humerus Procedures except Hip, Foot and Femur without CC/MCC |
| 495-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices except Hip and Femur with 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 494. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 494 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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