MS-DRG 499 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 499 by major payers:
$15,346.44
$15,260.81
$18,898.26
$19,349.04
| 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 499 | ||||||
United | 499 | $14465.90 | 1134207392 - SINGING RIVER HEALTH SYSTEM, BEHAVORIAL HEALTH SERVICES | 646000515 - SINGING RIVER HEALTH SYSTEM | MS | Psychiatric Hospital Unit (273R00000X) |
United | 499 | $17446.40 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 499 | $11469.87 | 1487605168 - OAKWOOD HEALTHCARE, INC., BEAUMONT HOSPITAL - TAYLOR | 381405141 - (MI) OAKWOOD HEALTHCARE INC | MI | General Acute Care Hospital (282N00000X) |
United | 499 | $12609.08 | 1619915949 - CHI ST VINCENT HOSPITAL HOT SPRINGS | 710236913 - CHI ST VINCENT HOSPITAL HOT SPRINGS | AR | Psychiatric Hospital Unit (273R00000X) |
United | 499 | $14533.21 | 1407364847 - TYLER REGIONAL HOSPITAL LLC | 823878395 | TX | General Acute Care Hospital (282N00000X) |
United | 499 | $4120.00 | 1922003730 - RUSSELL COUNTY MEDICAL CENTER, INC, RUSSELL COUNTY MEDICAL CENTER | 620476282 - MOUNTAIN STATES HEALTH ALLIANCE | VA | General Acute Care Hospital (282N00000X) |
United | 499 | $16432.32 | 1700825262 - OLEAN GENERAL HOSPITAL | 160743102 - OLEAN GENERAL HOSPITAL | NY | Psychiatric Hospital Unit (273R00000X) |
United | 499 | $9665.87 | 1073781225 - ADVOCATE HOPE CHILDREN'S HOSPITAL | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Children's Hospital (282NC2000X) |
United | 499 | $20466.06 | 1619351160 - UCHEALTH GRANDVIEW HOSPITAL, UCHEALTH COLORADO SPRINGS HOSPITAL LLC | 473455146 - (CO) UCHEALTH GRANDVIEW HOSPITAL | CO | General Acute Care Hospital (282N00000X) |
United | 499 | $8334.00 | 1790785913 - TRINITAS REGIONAL MEDICAL CENTER, TRINITAS HOSPITAL - AMBULANCE | 223601678 - (NJ) RWJ BARNABAS HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 499 | $17933.19 | 1255785390 - PROSPECT CCMC, LLC | 811507712 | PA | Psychiatric Hospital Unit (273R00000X) |
United | 499 | $29868.56 | 1255334173 - FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC., FROEDTERT HOSPITAL | 396105970 - (WI) FROEDTERT MEMORIAL LUTHERAN HOSPITAL INC | WI | General Acute Care Hospital (282N00000X) |
United | 499 | $12527.34 | 1770789752 - CHATHAM HOSPITAL INC | 560611546 - (NC) CHATHAM HOSPITAL INC | NC | Critical Access Hospital (282NC0060X) |
United | 499 | $8276.00 | 1902901333 - CLARA MAASS MEDICAL CENTER | 221500556 | NJ | General Acute Care Hospital (282N00000X) |
United | 499 | $15086.91 | 1477128288 - CLHG-LEESVILLE | 824337635 | LA | Rehabilitation Hospital Unit (273Y00000X) |
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 499 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 499 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 499 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 |
|---|---|---|
| 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 |
| 500-APR-DRG | High | MALIGNANCY, MALE REPRODUCTIVE SYSTEM |
| 500-MS-DRG | High | Soft Tissue Procedures 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 499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 499 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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