MS-DRG 518 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 518 by major payers:
$40,496.03
$42,038.72
$51,232.15
$56,032.96
| 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 518 | ||||||
United | 518 | $140073.46 | 1750988770 - KECK MEDICAL CENTER OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 518 | $66162.95 | 1548698723 - ES REHABILITATION LLC, EMORY REHABILITATION HOSPITAL | 463808276 | GA | Rehabilitation Hospital (283X00000X) |
United | 518 | $43770.46 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 518 | $25415.00 | 1184135758 - GRAND STRAND REGIONAL MEDICAL CENTER, LLC, GRAND STRAND MEDICAL CENTER | 621768105 - (SC) GRAND STRAND REGIONAL MEDICAL CENTER LLC | SC | Rehabilitation Hospital Unit (273Y00000X) |
United | 518 | $49936.26 | 1023305034 - LEGACY MERIDIAN PARK HOSPITAL | 930618975 - LEGACY MERIDIAN PARK HOSPITAL | OR | Hospitalist Physician (208M00000X) |
United | 518 | $3000.00 | 1851632616 - LANCASTER REGIONAL HOSPITAL, LP, CRESCENT MEDICAL CENTER LANCASTER | 273815440 - (TX) LANCASTER REGIONAL HOSPITAL, LP | TX | General Acute Care Hospital (282N00000X) |
United | 518 | $58075.50 | 1619176997 - PROVIDENCE HEALTH & SERVICES WASHINGTON | 910567732 | WA | General Acute Care Hospital (282N00000X) |
United | 518 | $80809.07 | 1376139139 - NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC, NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER | 853777599 | NC | General Acute Care Hospital (282N00000X) |
United | 518 | $50950.14 | 1407962046 - DLP HARRIS REGIONAL HOSPITAL LLC, HARRIS REGIONAL HOSPITAL | 383932775 | NC | General Acute Care Hospital (282N00000X) |
United | 518 | $37058.48 | 1477583334 - NEW MEDICAL HORIZONS II, LTD., CYPRESS FAIRBANKS MEDICAL CENTER HOSPITAL | 742129954 - (TX) NEW MEDICAL HORIZONS II LTD | TX | General Acute Care Hospital (282N00000X) |
United | 518 | $23498.00 | 1710272893 - EISENHOWER MEDICAL CENTER, EISENHOWER | 956130458 - EISENHOWER MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | 518 | $111949.57 | 1073931218 - , VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 518 | $77507.57 | 1881651990 - ALLINA HEALTH SYSTEM, OWATONNA HOSPITAL | 363261413 - ALLINA HEALTH SYSTEM | MN | Psychiatric Hospital Unit (273R00000X) |
United | 518 | $62272.00 | 1043670342 - SUTTER BAY HOSPITALS, MILLS HEALTH CENTER D/P APH | 940562680 - (CA) SUTTER BAY HOSPITALS | CA | Psychiatric Hospital Unit (273R00000X) |
United | 518 | $3942.00 | 1801107198 - ARNOT OGDEN MEDICAL CENTER | 160743905 - ARNOT OGDEN MEDICAL CENTER | NY | 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 518 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 518 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 518 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 |
|---|---|---|
| 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 |
| 518-MS-DRG | High | Back and Neck Procedures except Spinal Fusion with MCC or Disc Device or Neurostimulator |
| 519-APR-DRG | High | UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 518. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 518 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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