MS-DRG 497 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 497 by major payers:
$17,227.22
$18,339.31
$21,527.17
$22,312.29
| 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 497 | ||||||
United | 497 | $22958.46 | 1013906239 - ST FRANCIS MEDICAL CENTER, INC, ST FRANCIS ACUTE REHABILITATION CENTER | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 497 | $20794.18 | 1083696710 - MEDINA HOSPITAL | 340733166 - (OH) MEDINA HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 497 | $15505.84 | 1932411493 - STEWARD ST. ANNES HOSPITAL CORPORATION | 272473637 | MA | General Acute Care Hospital (282N00000X) |
United | 497 | $33855.07 | 1336109107 - SENTARA HOSPITALS, SENTARA CAREPLEX HOSPITAL | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 497 | $53346.23 | 1821152919 - LAWRENCE AND MEMORIAL HOSPITAL, INC. | 60646704 - (CT) LAWRENCE AND MEMORIAL HOSPITAL INC | CT | Psychiatric Hospital Unit (273R00000X) |
United | 497 | $27495.59 | 1841233640 - UNIVERSITY OF KENTUCKY | 616001218 | KY | Critical Access Hospital (282NC0060X) |
United | 497 | $28741.03 | 1003991845 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE PORTLAND MEDICAL CENTER | 930386906 | OR | General Acute Care Hospital (282N00000X) |
United | 497 | $17762.59 | 1083669683 - LEHIGH HMA LLC, LEHIGH REGIONAL MEDICAL CENTER | 871999484 | FL | General Acute Care Hospital (282N00000X) |
United | 497 | $24344.16 | 1518978667 - CATHOLIC HEALTH INITIATIVES COLORADO, CENTURA HEALTH - ST. MARY CORWIN HOSPITAL | 840405257 - CATHOLIC HEALTH INITIATIVES COLORADO | CO | Rehabilitation Hospital Unit (273Y00000X) |
United | 497 | $21649.23 | 1780930412 - UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER | 264827222 - (OH) UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | General Acute Care Hospital (282N00000X) |
United | 497 | $27033.25 | 1891816922 - SOUTHVIEW HOSPITAL PHARMACY | 310564121 - (OH) DAYTON OSTEOPATHIC HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 497 | $15565.46 | 1003347279 - AHS PRYOR HOSPITAL, LLC, HILLCREST HOSPITAL PRYOR | 820651263 | OK | General Acute Care Hospital (282N00000X) |
United | 497 | $36894.64 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 497 | $23914.66 | 1689121188 - AGH MESA LLC, DIGNITY HEALTH ARIZONA GENERAL HOSPITAL | 383990879 - (AZ) AGH MESA LLC | AZ | General Acute Care Hospital (282N00000X) |
United | 497 | $27873.72 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | 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 497 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 497 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 497 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 |
|---|---|---|
| 496-APR-DRG | Moderate | Bacterial And Tuberculous Infections Of Nervous System |
| 496-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices except Hip and Femur with CC |
| 497-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices except Hip and Femur without CC/MCC |
| 498-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices of Hip and Femur with 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 497. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 497 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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