MS-DRG 496 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 496 by major payers:
$24,174.70
$25,765.36
$31,612.27
$32,366.69
| 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 496 | ||||||
United | 496 | $22788.03 | 1659456994 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 496 | $19351.17 | 1962408203 - ONEIDA HEALTH SYSTEMS, INC, ONEIDA HEALTHCARE CENTER | 161492011 - (NY) ONEIDA HEALTHCARE SYSTEMS INC | NY | General Acute Care Hospital (282N00000X) |
United | 496 | $58006.19 | 1659352987 - USMD HOSPITAL AT ARLINGTON, L.P. | 731662763 - (TX) USMD HOSPITAL AT ARLINGTON, LP | TX | General Acute Care Hospital (282N00000X) |
United | 496 | $5069.00 | 1457347239 - UHS-CORONA INC, CORONA REGIONAL MEDICAL CENTER | 432035443 | CA | General Acute Care Hospital (282N00000X) |
United | 496 | $65320.10 | 1457382483 - AMISUB OF SOUTH CAROLINA, INC., PIEDMONT MEDICAL CENTER | 953561198 - (SC) AMISUB OF SOUTH CAROLINA INC | SC | General Acute Care Hospital (282N00000X) |
United | 496 | $29931.22 | 1699777458 - SAINT MICHAEL'S MEDICAL CENTER, INC., SAINT MICHAEL'S MEDICAL CENTER | 463487442 | NJ | General Acute Care Hospital (282N00000X) |
United | 496 | $42441.23 | 1700978558 - SOUTHWEST VOLUSIA HEALTHCARE CORPORATION, ADVENTHEALTH FISH MEMORIAL | 591113901 - (FL) UNIVERSITY COMMUNITY HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 496 | $66553.24 | 1841069044 - EAST COOPER MEDICAL CENTER LLC | 934555562 | SC | General Acute Care Hospital (282N00000X) |
United | 496 | $9250.67 | 1043343304 - STAFFORD HOSPITAL, LLC, STAFFORD HOSPITAL | 134316364 - (VA) STAFFORD HOSPITAL LLC | VA | General Acute Care Hospital (282N00000X) |
United | 496 | $49526.51 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 496 | $52352.73 | 1538522412 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE TRANSMOUNTAIN CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 496 | $31661.23 | 1871678458 - OSWEGO HOSPITAL | 150532220 - (NY) OSWEGO HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 496 | $29713.38 | 1295883395 - FRYE REGIONAL MEDICAL CENTER, INC., FRYE REGIONAL MEDICAL CENTER -ALEXANDER CAMPUS | 352547114 | NC | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 496 | $29713.38 | 1295883395 - FRYE REGIONAL MEDICAL CENTER, INC., FRYE REGIONAL MEDICAL CENTER -ALEXANDER CAMPUS | 352547114 | NC | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 496 | $37364.16 | 1982150009 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH GREER MEMORIAL HOSPITAL | 811723202 - PRISMA HEALTH - UPSTATE | SC | 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 496 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 496 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 496 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 |
|---|---|---|
| 495-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices except Hip and Femur with MCC |
| 496-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices except Hip and Femur with CC |
| 497-APR-DRG | Moderate | Bacterial And Tuberculous Infections Of Nervous System |
| 497-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices except Hip and Femur without CC/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 496. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 496 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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