MS-DRG 511 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 511 by major payers:
$21,753.08
$25,358.12
$30,756.23
$32,011.15
| 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 511 | ||||||
United | 511 | $28051.35 | 1023065794 - CHCA WOMANS HOSPITAL LP, WOMAN'S HOSPITAL OF TEXAS | 621810381 - (TX) CHCA WOMANS HOSPITAL LP | TX | General Acute Care Hospital (282N00000X) |
United | 511 | $25272.00 | 1548214257 - REDMOND PARK HOSPITAL, LLC, REDMOND REGIONAL MEDICAL CENTER | 581123037 - (GA) REDMOND PARK HOSPITAL LLC | GA | Rehabilitation Hospital Unit (273Y00000X) |
United | 511 | $24818.82 | 1275593337 - COMMUNITY HOSPITAL LLC, COMMUNITY HOSPITAL | 202501360 | OK | General Acute Care Hospital (282N00000X) |
United | 511 | $33195.00 | 1033622642 - OSCEOLA REGIONAL HOSPITAL, INC., HCA FLORIDA OSCEOLA HOSPITAL | 611257509 - (FL) OSCEOLA REGIONAL HOSPITAL INC | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 511 | $26866.46 | 1689658791 - ROGER WILLIAMS HOSPITAL | 464648465 | RI | Psychiatric Hospital Unit (273R00000X) |
United | 511 | $24424.77 | 1619147824 - HEALTH & HOSPITAL CORPORATION OF MARION COUNTY, WISHARD HEALTH SERVICES | 356005697 | IN | General Acute Care Hospital (282N00000X) |
United | 511 | $22700.89 | 1619923919 - METROPOLITAN HOSPITAL, METRO HEALTH HOSPITAL | 380593405 - METROPOLITAN HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 511 | $1500.00 | 1730303942 - SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER, S M RM C SENIOR LIFE | 640468873 | MS | Psychiatric Hospital Unit (273R00000X) |
United | 511 | $16916.00 | 1003236878 - ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL INC, ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET | 221487243 - (NJ) ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | NJ | General Acute Care Hospital (282N00000X) |
United | 511 | $20446.00 | 1578519815 - GOOD SAMARITAN HOSPITAL, L.P., GOOD SAMARITAN HOSPITAL | 621763090 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 511 | $90634.15 | 1275558819 - SIERRA VISTA HOSPITAL, INC., SIERRA VISTA REGIONAL MEDICAL CENTER | 952588614 | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 511 | $45166.71 | 1326142498 - ST ELIZABETH MEDICAL CENTER, INC, ST ELIZABETH DEARBORN | 610445850 - ST ELIZABETH MEDICAL CENTER INC | IN | General Acute Care Hospital (282N00000X) |
United | 511 | $32999.14 | 1912205311 - ST. TAMMANY PARISH HOSPITAL DISTRIC #1, CANCER SERVICES | 720478620 | LA | General Acute Care Hospital (282N00000X) |
United | 511 | $39971.83 | 1851950810 - | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 511 | $17340.92 | 1760598692 - PECOS COUNTY MEMORIAL HOSPITAL | 921628671 | TX | Critical Access Hospital (282NC0060X) |
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 511 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 511 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 511 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 |
|---|---|---|
| 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 |
| 511-MS-DRG | High | Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures with CC |
| 512-APR-DRG | High | UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 511. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 511 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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