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See a sample rate comparisonMS-DRG 535 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 HIP AND PELVIS WITH 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 535 by major payers:
$15,722.63
$17,879.64
$20,921.89
$21,352.60
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MS-DRG 535
5 of 25 sample ratesHigher to lower in this preview
North Colorado Medical Center
$44,572.92Published rateCarondelet Health Network, St Mary'S Hospital
$27,591.42Published rateAdvocate Health And Hospitals Corporation, Advocate Southland Health Network
Advocate Health And Hospitals Corporation
$14,604.95Published rateProvidence Health & Services, Prov Scred Hrt Med Ctr & Chlds Hos
$11,365.84Published rateCity Of Phila Trustee Acting By The Brd Of Dir Of City Trusts
City Of Philadelphia Ttee Administering Wills Eye Institute
$2,412.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 535 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 535 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 535 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 |
|---|---|---|
| 534-MS-DRG | High | FRACTURES OF FEMUR WITHOUT MCC |
| 535-MS-DRG | High | FRACTURES OF HIP AND PELVIS WITH MCC |
| 536-MS-DRG | High | FRACTURES OF HIP AND PELVIS WITHOUT 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 535. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 535 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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