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See a sample rate comparisonMS-DRG 494 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.
LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/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 494 by major payers:
$20,170.55
$24,088.18
$29,347.24
$30,497.72
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MS-DRG 494
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
$59,270.53Published rateSaint Joseph Hospital, Inc, Saint Joseph Hospital
Saint Joseph Hospital
$37,436.33Published rateFranciscan Health Olympia Fields, Franciscan Health Olympia Fields & Chicago Heights
Franciscan Health Olympia Fields
$25,147.47Published rateHolland Community Hospital, Holland Hospital
Holland Community Hospital
$17,620.61Published rateLancaster Regional Hospital, Lp, Crescent Medical Center Lancaster
Lancaster Regional Hospital, Lp
$3,000.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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