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See a sample rate comparisonMS-DRG 536 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 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 536 by major payers:
$9,781.41
$11,650.59
$12,878.15
$13,221.92
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MS-DRG 536
5 of 25 sample ratesHigher to lower in this preview
University Of Colorado
University Of Colorado Hospital Authority
$24,793.26Published rateNathan Littauer Hospital Association, Nathan Littauer Hospital & Nursing Home
Nathan Littauer Hospital Association
$16,330.71Published rateLee Memorial Health System, Gulf Coast Medical Center
Lee Memorial Health System
$13,078.58Published rateFreeman Neosho Hospital
$8,623.00Published rateThe Health Care Authority Of The City Of Anniston, Regional Psychiatric Services
The Health Care Authority Of The City Of Anniston
$1,488.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 536 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 536 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 536 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 |
|---|---|---|
| 535-MS-DRG | High | FRACTURES OF HIP AND PELVIS WITH MCC |
| 536-MS-DRG | High | FRACTURES OF HIP AND PELVIS WITHOUT MCC |
| 537-MS-DRG | High | SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH 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 536. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 536 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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