MS-DRG 509 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 509 by major payers:
$18,517.89
$22,990.58
$27,234.12
$28,237.12
| 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 509 | ||||||
United | 509 | $14624.90 | 1750788238 - HOKE HEALTHCARE LLC, CAPE FEAR VALLEY HOKE HOSPITAL | 272763125 - (NC) HOKE HEALTHCARE LLC | NC | General Acute Care Hospital (282N00000X) |
United | 509 | $23710.02 | 1134607005 - ADVOCATE NORTH SIDE HEALTH NETWORK, ADVOCATE ILLINOIS MASONIC MEDICAL CENTER REHAB UNIT | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | Rehabilitation Hospital Unit (273Y00000X) |
United | 509 | $59464.30 | 1154775401 - VHS HARLINGEN HOSPITAL COMPANY, LLC, VALLEY BAPTIST MEDICAL CENTER - HARLINGEN | 452662980 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 509 | $44105.46 | 1235764622 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | 509 | $11494.00 | 1447250253 - BAYLOR UNIVERSITY MEDICAL CENTER | 751837454 - (TX) BAYLOR UNIVERSITY MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 509 | $18714.13 | 1679555148 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS COUSHATTA HEALTH CARE CENTER | 720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANA | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 509 | $43618.85 | 1104845015 - TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | 751438726 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | TX | General Acute Care Hospital (282N00000X) |
United | 509 | $26002.66 | 1063572733 - MARY IMOGENE BASSETT HOSPITAL, BASSETT HEALTHCARE | 135596796 - MARY IMOGENE BASSETT HOSPITAL | NY | Psychiatric Hospital Unit (273R00000X) |
United | 509 | $17009.22 | 1790996445 - J C BLAIR MEMORIAL HOSPITAL | 231352159 - (PA) J C BLAIR MEMORIAL HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 509 | $27769.91 | 1679545966 - COMMUNITY HEALTH NETWORK, INC., COMMUNITY HOSPITAL NORTH | 743230935 | IN | Psychiatric Hospital Unit (273R00000X) |
United | 509 | $21786.58 | 1124346754 - INTEGRIS BAPTIST MEDICAL CENTER INC, INTEGRIS MENTAL HEALTH CENTER | 731034824 - (OK) INTEGRIS BAPTIST MEDICAL CENTER INC | OK | Psychiatric Hospital Unit (273R00000X) |
United | 509 | $10123.00 | 1801826839 - BAYLOR SCOTT & WHITE MEDICAL CENTER | 824052186 - (TX) BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIAL | TX | General Acute Care Hospital (282N00000X) |
United | 509 | $18661.00 | 1144894577 - HMH HOSPITALS CORPORATION | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 509 | $31483.58 | 1407815830 - ST. CATHERINE OF SIENA MEDICAL CENTER | 61562701 - (NY) ST CATHERINE OF SIENA MEDICAL CENTER | NY | Psychiatric Hospital Unit (273R00000X) |
United | 509 | $30180.41 | 1649867896 - NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC, NOVANT HEALTH NEW HANOVER BEHAVIORAL HEALTH HOSPITAL | 853777599 | NC | Psychiatric Hospital Unit (273R00000X) |
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 509 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 509 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 509 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 |
|---|---|---|
| 508-MS-DRG | High | Major Shoulder or Elbow Joint Procedures without CC/MCC |
| 509-MS-DRG | High | Arthroscopy |
| 510-APR-DRG | High | PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS |
| 510-MS-DRG | High | Shoulder, Elbow or Forearm Procedures, Except Major Joint 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 509. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 509 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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