MS-DRG 515 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 515 by major payers:
$37,348.55
$40,461.14
$47,274.35
$49,460.58
| 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 515 | ||||||
United | 515 | $25813.65 | 1477859254 - NASHOBA VALLEY MEDICAL CENTER, A STEWARD FAMILY HOSPITAL, INC, NASHOBA VALLEY MEDICAL CENTER | 274157855 | MA | General Acute Care Hospital (282N00000X) |
United | 515 | $68052.46 | 1932427283 - INTEGRIS BASS BAPTIST HEALTH CENTER, INTEGRIS BASS BEHAVIORAL HEALTH CENTER | 730612674 | OK | Psychiatric Hospital Unit (273R00000X) |
United | 515 | $31474.44 | 1669870937 - VHS OF PHOENIX INC, ABRAZO CENTRAL CAMPUS | 621809851 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 515 | $75538.06 | 1619997079 - WELLSTAR SYLVAN GROVE HOSPITAL, INC, WELLSTAR SYLVAN GROVE HOSPITAL | 810875069 - (GA) WELLSTAR SYLVAN GROVE HOSPITAL INC | GA | Critical Access Hospital (282NC0060X) |
United | 515 | $26221.48 | 1679880041 - SALINE COUNTY MEDICAL CENTER, SALINE MEMORIAL HOSPITAL | 812816675 | AR | General Acute Care Hospital (282N00000X) |
United | 515 | $24404.09 | 1124071980 - ENGLEWOOD HOSPITAL AND MEDICAL CENTER, ENGLEWOOD HOSPITAL PSYCH UNIT | 221487173 - (NJ) ENGLEWOOD HOSPITAL AND MEDICAL CENTER A NEW JERSEY NONPROFIT CORP | NJ | Psychiatric Hospital Unit (273R00000X) |
United | 515 | $51268.80 | 1093834608 - MADISON PARISH HOSPITAL SERVICE DISTRICT, MADISON PARISH HOSPITAL | 720985610 - (LA) MADISON PARISH HOSPITAL SERVICE DISTRICT | LA | Critical Access Hospital (282NC0060X) |
United | 515 | $44207.28 | 1184911877 - VHS BROWNSVILLE HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER - BROWNSVILLE | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 515 | $36212.00 | 1407989288 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | Psychiatric Hospital Unit (273R00000X) |
United | 515 | $12601.74 | 1922001015 - TREGO COUNTY LEMKE MEMORIAL HOSPITAL | 480769700 - (KS) TREGO COUNTY LEMKE MEMORIAL HOSPITAL | KS | Critical Access Hospital (282NC0060X) |
United | 515 | $79182.77 | 1992996235 - EMANUEL MEDICAL CENTER, INC., EMANUEL FAMILY PRACTICE - COLORADO | 752918774 | CA | General Acute Care Hospital (282N00000X) |
United | 515 | $29625.18 | 1427086313 - BAXTER COUNTY REGIONAL HOSPITAL, INC, BAXTER REGIONAL MEDICAL CENTER | 710561765 - BAXTER COUNTY REGIONAL HOSPITAL INC | AR | Rehabilitation Hospital Unit (273Y00000X) |
United | 515 | $37020.76 | 1912932336 - PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA, JACKSON NORTH MEDICAL CENTER REHAB | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 515 | $11448.48 | 1427048453 - MEDINA COUNTY HOSPITAL DISTRICT, MEDINA REGIONAL HOSPITAL | 270492434 | TX | Critical Access Hospital (282NC0060X) |
United | 515 | $50482.00 | 1104874684 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE MEDICAL CENTER | 620840204 | TN | 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 515 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 515 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 515 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 |
|---|---|---|
| 514-APR-DRG | High | FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES |
| 514-MS-DRG | High | Hand or Wrist Procedures, Except Major Thumb or Joint Procedures without CC/MCC |
| 515-MS-DRG | High | Other Musculoskeletal System and Connective Tissue O.R. Procedures with MCC |
| 516-MS-DRG | High | Other Musculoskeletal System and Connective Tissue O.R. Procedures with CC |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 515. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 515 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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