MS-DRG 520 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 520 by major payers:
$16,844.27
$19,099.61
$23,659.02
$23,934.73
| 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 520 | ||||||
United | 520 | $18809.32 | 1598835308 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH DEPAUL HOSPITAL - ST. LOUIS | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 520 | $24790.72 | 1417290958 - CARONDELET HEALTH NETWORK, O'RIELLY TRANSITIONS INTENSIVE OUTPATIENT PROGRAM | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 520 | $12316.62 | 1720623853 - BON SECOURS MERCY HEALTH PETERSBURG LLC, BON SECOURS - SOUTHSIDE MEDICAL CENTER | 843050337 | VA | General Acute Care Hospital (282N00000X) |
United | 520 | $2805.00 | 1245260660 - WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC., HAWKINS COUNTY MEMORIAL HOSPITAL SWING BED | 621816368 - (TN) WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL INC | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 520 | $13482.15 | 1326564071 - MULTICARE HEALTH SYSTEM, MULTICARE COVINGTON MEDICAL CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 520 | $35586.35 | 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 | 520 | $33551.21 | 1154876985 - LONGS PEAK HOSPITAL | 611786722 - (CO) LONGS PEAK HOSPITAL | CO | General Acute Care Hospital (282N00000X) |
United | 520 | $13949.37 | 1770814626 - TROY HOSPITAL HEALTH CARE AUTHORITY, TROY REGIONAL MEDICAL CENTER | 271534178 | AL | Rural Acute Care Hospital (282NR1301X) |
United | 520 | $14873.29 | 1376822676 - MORTON HOSPITAL, A STEWARD FAMILY HOSPITAL, INC., MORTON HOSPITAL (EBHS) | 451209304 - (MA) MORTON HOSPITAL, A STEWARD FAMILY HOSPITAL, INC. | MA | Psychiatric Hospital Unit (273R00000X) |
United | 520 | $27679.39 | 1043500655 - PECONIC BAY MEDICAL CENTER | 111661359 - (NY) CENTRAL SUFFOLK HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 520 | $4869.00 | 1558319863 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE VALLEY HOSPITAL | 620840204 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 520 | $39587.85 | 1073530879 - LAWRENCE AND MEMORIAL HOSPITAL, INC., LAWRENCE AND MEMORIAL HOSPITAL | 60646704 - (CT) LAWRENCE AND MEMORIAL HOSPITAL INC | CT | General Acute Care Hospital (282N00000X) |
United | 520 | $14543.46 | 1902031180 - HENRY FORD WYANDOTTE | 382791823 - (MI) HENRY FORD WYANDOTTE HOSPITAL CORPORATION | MI | General Acute Care Hospital (282N00000X) |
United | 520 | $4869.00 | 1558319863 - PARKRIDGE MEDICAL CENTER, INC., PARKRIDGE VALLEY HOSPITAL | 620840204 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 520 | $26333.03 | 1548716665 - UPSTATE AFFILIATE ORGANIZATION, GHS CANCER INST-ANDREWS | 811723202 - PRISMA HEALTH - UPSTATE | SC | 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 520 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 520 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 520 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 |
|---|---|---|
| 519-APR-DRG | High | UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA |
| 519-MS-DRG | High | Back and Neck Procedures except Spinal Fusion with CC |
| 520-MS-DRG | High | Back and Neck Procedures except Spinal Fusion without CC/MCC |
| 521-APR-DRG | Moderate | Alteration In Consciousness |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 520 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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