MS-DRG 498 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 498 by major payers:
$28,974.24
$32,290.88
$39,845.90
$40,837.78
| 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 498 | ||||||
United | 498 | $8576.95 | 1699844654 - KINDRED HOSPITALS LIMITED PARTNERSHIP, KINDRED HOSPITAL - DALLAS | 522085561 | TX | Long Term Care Hospital (282E00000X) |
United | 498 | $53863.69 | 1942224696 - SVMC HOLDINGS, INC | 832550272 - (CT) SVMC HOLDINGS INC | CT | General Acute Care Hospital (282N00000X) |
United | 498 | $2500.00 | 1023363348 - DREW MEMORIAL HOSPITAL, INC. | 352414105 - (AR) DREW MEMORIAL HOSPITAL INC | AR | General Acute Care Hospital (282N00000X) |
United | 498 | $39580.32 | 1285816090 - WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE, UNIVERSITY PHYSICIAN GROU | 272844942 | MI | General Acute Care Hospital (282N00000X) |
United | 498 | $34635.17 | 1518634864 - VHS SAN ANTONIO PARTNERS, LLC, MISSION TRAIL BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 498 | $38792.51 | 1619916806 - ST JOSEPH MEDICAL CENTER, OSF SAINT JOSEPH MEDICAL CENTER | 370662576 | IL | General Acute Care Hospital (282N00000X) |
United | 498 | $46460.12 | 1689672693 - SAINT CLARE HOSPITAL, ST. CLARE HOSPITAL | 911487485 | WA | General Acute Care Hospital (282N00000X) |
United | 498 | $8744.96 | 1013999705 - EAST CAROLINA HEALTH-BERTIE, VIDANT BERTIE HOSPITAL | 562072002 - (NC) EAST CAROLINA HEALTH | NC | Critical Access Hospital (282NC0060X) |
United | 498 | $7662.00 | 1487724241 - PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA, PHT JMH INPATIENT REHAB UNIT | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 498 | $78236.54 | 1952347205 - NEWYORK-PRESBYTERIAN-QUEENS | 111839362 - NEWYORK-PRESBYTERIAN-QUEENS | NY | General Acute Care Hospital (282N00000X) |
United | 498 | $37523.78 | 1922542604 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 498 | $58567.33 | 1174035604 - AHS HOSPITAL CORP. | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 498 | $14798.45 | 1871953802 - FREEDOM HOSPITAL OF MAGNOLIA, LLC, BEACHAM MEMORIAL HOSPITAL | 811097331 | MS | Rural Acute Care Hospital (282NR1301X) |
United | 498 | $32225.30 | 1124189733 - PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK, PRESENCE SAINT JOSEPH MEDICAL CENTER-REHAB UNIT | 992141118 | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 498 | $39580.32 | 1285816090 - WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE, UNIVERSITY PHYSICIAN GROU | 272844942 | MI | 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 498 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 498 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 498 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 |
|---|---|---|
| 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 |
| 498-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices of Hip and Femur with CC/MCC |
| 499-MS-DRG | High | Local Excision and Removal of Internal Fixation Devices of 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 498. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 498 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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