MS-DRG 516 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 516 by major payers:
$24,264.72
$26,812.20
$32,411.04
$32,570.28
| 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 516 | ||||||
United | 516 | $7419.00 | 1114924834 - SAINT PETER'S UNIVERSITY HOSPITAL | 221487330 - (NJ) SAINT PETERS UNIVERSITY HOSPITAL | NJ | General Acute Care Hospital (282N00000X) |
United | 516 | $23557.00 | 1730383084 - THE BROOKDALE HOSPITAL MEDICAL CENTER | 111631746 - BROOKDALE HOSPITAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 516 | $20738.98 | 1972542264 - GENESIS HEALTH SYSTEM, GENESIS MEDICAL CENTER DAVENPORT | 421418847 - GENESIS HEALTH SYSTEM | IA | General Acute Care Hospital (282N00000X) |
United | 516 | $37542.00 | 1568409647 - LAWNWOOD MEDICAL CENTER INC, HCA FLORIDA LAWNWOOD HOSPITAL | 591764486 | FL | General Acute Care Hospital (282N00000X) |
United | 516 | $46341.51 | 1053354100 - LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH, LONG ISLAND COMMUNITY HOSPITAL | 133971298 - NYU LANGONE HOSPITALS | NY | General Acute Care Hospital (282N00000X) |
United | 516 | $38111.66 | 1225272552 - MAPLE GROVE HOSPITAL CORPORATION | 208316475 - MAPLE GROVE HOSPITAL CORPORATION | MN | General Acute Care Hospital (282N00000X) |
United | 516 | $10339.53 | 1215937982 - SELECT SPECIALTY HOSPITAL | 251813119 | TN | Long Term Care Hospital (282E00000X) |
United | 516 | $36542.53 | 1427007384 - ASCENSION SE WISCONSIN HOSPITAL, INC, ASCENSION SE WISCONSIN HOSPITAL-ST JOSEPH CAMPUS | 350868157 - SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS INC | WI | General Acute Care Hospital (282N00000X) |
United | 516 | $47839.03 | 1215961248 - BANNER HEART HOSPITAL | 861035549 - (AZ) BANNER HEART HOSPITAL | AZ | Special Hospital (284300000X) |
United | 516 | $24338.48 | 1902162639 - MOUNTAIN VISTA MEDICAL CENTER LP | 202066363 - (AZ) MOUNTAIN VISTA MEDICAL CENTER LP | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 516 | $48140.05 | 1245220300 - KERSHAW HOSPITAL LLC | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 516 | $50507.75 | 1033298351 - KINGS COUNTY HOSPITAL CENTER | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Critical Access Hospital (282NC0060X) |
United | 516 | $37542.00 | 1568409647 - LAWNWOOD MEDICAL CENTER INC, HCA FLORIDA LAWNWOOD HOSPITAL | 591764486 | FL | General Acute Care Hospital (282N00000X) |
United | 516 | $12347.51 | 1902805062 - GREATER REGIONAL MEDICAL CENTER | 426037626 - (IA) GREATER REGIONAL MEDICAL CENTER | IA | Critical Access Hospital (282NC0060X) |
United | 516 | $21837.00 | 1821103516 - PONTOTOC HEALTH SERVICES, INC., PONTOTOC HEALTH SERVICES CAH | 640751410 - (MS) PONTOTOC HEALTH SERVICES INC | MS | 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 516 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 516 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 516 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 |
|---|---|---|
| 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 |
| 517-APR-DRG | High | DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES |
| 517-MS-DRG | High | Other Musculoskeletal System and Connective Tissue O.R. 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 516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 516 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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