MS-DRG 537 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 537 by major payers:
$11,042.49
$12,822.76
$14,614.10
$14,929.79
| 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 537 | ||||||
United | 537 | $6827.64 | 1215151154 - PORTER HOSPITAL LLC, NORTHWEST HEALTH-PORTER | 351088541 | IN | General Acute Care Hospital (282N00000X) |
United | 537 | $5828.27 | 1972781698 - IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME | 370673512 - IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME | IL | Rural Acute Care Hospital (282NR1301X) |
United | 537 | $7462.27 | 1093336026 - MAGNOLIA REGIONAL HEALTH SYSTEM INC | 850512754 - (AR) MAGNOLIA REGIONAL HEALTH SYSTEM INC | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 537 | $6034.00 | 1740469535 - PRIME HEALTHCARE CENTINELA LLC, CENTINELA HOSPITAL MEDICAL CENTER | 261150758 - (CA) PRIME HEALTHCARE CENTINELA LLC | CA | Psychiatric Hospital Unit (273R00000X) |
United | 537 | $12076.58 | 1164495255 - CATAWBA VALLEY MEDICAL CENTER | 560789196 | NC | General Acute Care Hospital (282N00000X) |
United | 537 | $11799.61 | 1356891600 - SSM SELECT REHAB ST. LOUIS, LLC | 263694972 | MO | Rehabilitation Hospital (283X00000X) |
United | 537 | $13948.58 | 1760472799 - MANATEE MEMORIAL HOSPITAL L P, MANATEE MEMORIAL HOSPITAL | 232798290 - (FL) MANATEE MEMORIAL HOSPITAL, L.P. | FL | General Acute Care Hospital (282N00000X) |
United | 537 | $2800.00 | 1669480323 - KELL WEST REGIONAL HOSPITAL LLC | 752756307 - KELL WEST REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 537 | $8827.00 | 1407011133 - RHODE ISLAND HOSPITAL, REHABILITATION UNIT | 50258954 - RHODE ISLAND HOSPITAL | RI | Rehabilitation Hospital Unit (273Y00000X) |
United | 537 | $14406.24 | 1619289998 - VHS DETROIT RECEIVING HOSPITAL INC, DETROIT RECEIVING HOSPITAL | 272844942 | MI | General Acute Care Hospital (282N00000X) |
United | 537 | $9471.08 | 1407573132 - DEACONESS ILLINOIS RED BUD REGIONAL HOSPITAL INC, RED BUD REGIONAL HOSPITAL | 884142509 | IL | Critical Access Hospital (282NC0060X) |
United | 537 | $15214.95 | 1790747780 - APPALACHIAN REGIONAL HEALTHCARE, INC, BECKLEY ARH HOSPITAL | 520795508 - APPALACHIAN REGIONAL HEALTHCARE INC | WV | Psychiatric Hospital Unit (273R00000X) |
United | 537 | $2737.00 | 1275782039 - ST. BARNABAS HOSPITAL-FTMHC | 131740122 - (NY) ST BARNABAS HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 537 | $5662.37 | 1427092006 - DOCTORS MEMORIAL HOSPITAL INC | 593122517 - (FL) DOCTORS MEMORIAL HOSPITAL INC | FL | General Acute Care Hospital (282N00000X) |
United | 537 | $9670.00 | 1669420766 - MCDONOUGH COUNTY HOSPITAL DISTRICT, MCDONOUGH DISTRICT HOSPITAL | 376016777 | IL | 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 537 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 537 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 537 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 |
|---|---|---|
| 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 |
| 538-MS-DRG | High | Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh without 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 537. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 537 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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