MS-DRG 495 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 495 by major payers:
$40,416.71
$45,569.64
$55,433.24
$56,631.13
| 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 495 | ||||||
United | 495 | $34449.07 | 1538196100 - MERCY HOSPITAL SOUTH, ST. ANTHONY'S MEDICAL CENTER | 430980256 - (MO) MERCY HOSPITAL SOUTH | MO | Psychiatric Hospital Unit (273R00000X) |
United | 495 | $19510.00 | 1477018893 - PULASKI COMMUNITY HOSPITAL, INC. | 540941129 | VA | Psychiatric Hospital Unit (273R00000X) |
United | 495 | $52862.08 | 1497765630 - ST. CHARLES HOSPITAL CORP. | 111871039 - (NY) ST CHARLES HOSPITAL CORP | NY | General Acute Care Hospital (282N00000X) |
United | 495 | $58147.94 | 1669466561 - STATE OF CONNECTICUT, JOHN DEMPSEY HOSPITAL | 66000798 | CT | General Acute Care Hospital (282N00000X) |
United | 495 | $44933.42 | 1598503922 - MERCY MEDICAL CENTER | 992367318 | IL | General Acute Care Hospital (282N00000X) |
United | 495 | $52383.01 | 1962492660 - MCALLEN HOSPITALS L P, SOUTH TEXAS HEALTH SYSTEM | 233069260 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 495 | $29974.39 | 1851601850 - GRAHAM REGIONAL MEDICAL CENTER | 463113489 | TX | Rural Acute Care Hospital (282NR1301X) |
United | 495 | $93359.27 | 1699884858 - BANNER GATEWAY MEDICAL CENTER | 900220728 | AZ | General Acute Care Hospital (282N00000X) |
United | 495 | $94651.32 | 1609846088 - GREENWICH HOSPITAL | 60646659 - (CT) GREENWICH HOSPITAL | CT | General Acute Care Hospital (282N00000X) |
United | 495 | $77482.84 | 1790722346 - CARLSBAD MEDICAL CENTER LLC, CARLSBAD MEDICAL CENTER | 621762526 - (NM) CARLSBAD MEDICAL CENTER LLC | NM | General Acute Care Hospital (282N00000X) |
United | 495 | $28587.26 | 1093336026 - MAGNOLIA REGIONAL HEALTH SYSTEM INC | 850512754 - (AR) MAGNOLIA REGIONAL HEALTH SYSTEM INC | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 495 | $38663.23 | 1508315516 - ADVOCATE HEALTH & HOSPITALS CORPORATION | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Children's Hospital (282NC2000X) |
United | 495 | $87416.50 | 1548291883 - TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | 752890358 - (TX) TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN | TX | General Acute Care Hospital (282N00000X) |
United | 495 | $67241.78 | 1285667493 - WEST PENN ALLEGHENY HEALTH SYSTEM INC., ALLEGHENY GENERAL HOSPITAL | 250969492 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 495 | $32621.88 | 1093744187 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
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 495 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 495 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 495 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 |
|---|---|---|
| 494-APR-DRG | Moderate | Bacterial And Tuberculous Infections Of Nervous System |
| 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 |
| 496-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 495. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 495 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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