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See a sample rate comparisonMS-DRG 534 Fee Schedule
Last Verified: September 2026
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.
FRACTURES OF FEMUR WITHOUT MCC
| 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 534 by major payers:
$10,335.53
$11,111.43
$12,919.92
$13,283.08
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MS-DRG 534
5 of 25 sample ratesHigher to lower in this preview
Providence Health & Services Oregon, Providence Portland Medical Center
$22,101.73Published rateWest Allis Memorial Hospital, Inc., Aurora West Allis Medical Center
Aurora Health Care Inc
$16,535.59Published rateFranciscan Health Michigan City, Franciscan St. Anthony Health - Michigan City
Franciscan Health Michigan City
$10,925.50Published rateUrgent Care Centers Of St. Anthony'S Medical Center, Lc
Mercy Hospital South
$8,762.70Published rateShriners Hospitals For Children
$3,665.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 534 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 534 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 534 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 |
|---|---|---|
| 533-MS-DRG | High | FRACTURES OF FEMUR WITH MCC |
| 534-MS-DRG | High | FRACTURES OF FEMUR WITHOUT MCC |
| 535-MS-DRG | High | FRACTURES OF HIP AND PELVIS WITH 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 534. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 534 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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