MS-DRG 504 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 504 by major payers:
$20,328.15
$23,612.66
$27,878.34
$28,610.22
| 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 504 | ||||||
United | 504 | $17579.83 | 1336101302 - SWEDISH COVENANT HEALTH | 362179813 - (IL) SWEDISH COVENANT HEALTH | IL | Psychiatric Hospital Unit (273R00000X) |
United | 504 | $44034.71 | 1932131489 - SAN RAMON REGIONAL MEDICAL CENTER, LLC | 752918809 | CA | General Acute Care Hospital (282N00000X) |
United | 504 | $11424.76 | 1548254931 - MARY RUTAN HOSPITAL | 341407259 - MARY RUTAN HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 504 | $20101.72 | 1689627903 - ORO VALLEY HOSPITAL LLC, NORTHWEST TRANSITIONS | 522379881 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 504 | $22462.24 | 1912964081 - ST VINCENT INFIRMARY MEDICAL CENTER, ST VINCENT HEALTH SYSTEMS | 710236917 - (AR) ST VINCENT INFIRMARY MEDICAL CENTER | AR | General Acute Care Hospital (282N00000X) |
United | 504 | $23761.43 | 1780648352 - BAPTIST MEMORIAL HOSPITAL UNION COUNTY, INC. | 630997281 - BAPTIST MEMORIAL HOSPITAL UNION COUNTY INC | MS | General Acute Care Hospital (282N00000X) |
United | 504 | $20756.38 | 1558472803 - TISHOMINGO HEALTH SERVICES, INC., TISHOMINGO HEALTH SWING BED | 640741047 - TISHOMINGO HEALTH SERVICES INC | MS | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 504 | $16601.60 | 1265906663 - MOSAIC MEDICAL CENTER | 832249459 - MOSAIC MEDICAL CENTER - MARYVILLE | MO | General Acute Care Hospital (282N00000X) |
United | 504 | $21833.58 | 1942354642 - PRESENCE CHICAGO HOSPITALS NETWORK, PRESENCE SAINTS MARY AND ELIZABETH MEDICAL CENTER-REHABILITATION UNIT | 362235165 - (IL) PRESENCE CHICAGO HOSPITALS NETWORK | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 504 | $11816.00 | 1669732707 - BAY AREA HEALTHCARE GROUP, LTD., CORPUS CHRISTI MEDICAL CENTER - INPATIENT REHABILITATION | 752387418 | TX | Rehabilitation Hospital Unit (273Y00000X) |
United | 504 | $43332.71 | 1275552747 - NORTHSHORE REGIONAL MEDICAL CENTER, LLC, NORTHSHORE REGIONAL MEDICAL CENTER | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 504 | $18030.18 | 1083041917 - STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER, UNIVERSITY OF MISSISSIPPI CENTER - GRENADA PSYCH | 646008520 | MS | Psychiatric Hospital (283Q00000X) |
United | 504 | $58744.10 | 1174768071 - BETH ISRAEL MEDICAL CENTER, KINGS HIGHWAY DIVISION | 135564934 - (NY) BETH ISRAEL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 504 | $13786.04 | 1710982194 - ROCK COUNTY HOSPITAL | 476000999 | NE | Critical Access Hospital (282NC0060X) |
United | 504 | $44034.71 | 1932131489 - SAN RAMON REGIONAL MEDICAL CENTER, LLC | 752918809 | CA | 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 504 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 504 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 504 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 |
|---|---|---|
| 503-APR-DRG | Moderate | Non-Bacterial Infections Of Nervous System Except Viral Meningitis |
| 503-MS-DRG | High | Foot Procedures with MCC |
| 504-MS-DRG | High | Foot Procedures with CC |
| 505-MS-DRG | High | Foot Procedures 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 504. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 504 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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