MS-DRG 538 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 538 by major payers:
$8,298.59
$9,589.02
$10,768.58
$11,071.03
| 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 538 | ||||||
United | 538 | $7924.37 | 1467521146 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. JOSEPH HOSPITAL - ST. CHARLES | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 538 | $9379.90 | 1194797472 - WHITE COUNTY COMMUNITY HOSPITAL LLC, HIGHLANDS MEDICAL CENTER | 474063406 | TN | Psychiatric Hospital Unit (273R00000X) |
United | 538 | $16406.65 | 1346213469 - GOOD SAMARITAN HOSPITAL OF SUFFERN | 131740104 - (NY) BON SECOURS CHARITY HEALTH SYSTEM INC | NY | General Acute Care Hospital (282N00000X) |
United | 538 | $13491.78 | 1366536963 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE MILWAUKIE HOSPITAL | 930924302 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | General Acute Care Hospital (282N00000X) |
United | 538 | $10654.00 | 1285395889 - CHILDREN'S HOSPITAL COLORADO, CHILDREN'S HOSPITAL COLORADO - TELSTAR | 840166760 - CHILDRENS HOSPITAL COLORADO | CO | Children's Hospital (282NC2000X) |
United | 538 | $7386.50 | 1205203775 - PLANO SURGICAL HOSPITAL | 843385649 | TX | General Acute Care Hospital (282N00000X) |
United | 538 | $40292.48 | 1548399736 - DOCTORS MEDICAL CENTER OF MODESTO, INC., DOCTORS BEHAVIORAL HEALTH CENTER | 952588614 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 538 | $5468.64 | 1407313760 - HH HEALTH SYSTEM, MARSHALL MEDICAL CENTER | 831651180 | AL | General Acute Care Hospital (282N00000X) |
United | 538 | $8914.83 | 1730166224 - INSIGHT CHICAGO, INC., INSIGHT HOSPITAL & MEDICAL CENTER CHICAGO | 862358048 - INSIGHT CHICAGO INC | IL | General Acute Care Hospital (282N00000X) |
United | 538 | $7243.00 | 1033187182 - SHASTA REGIONAL MEDICAL CENTER, LLC | 263487583 | CA | General Acute Care Hospital (282N00000X) |
United | 538 | $4466.00 | 1972581940 - THE COMMUNITY HOSPITAL OF BRAZOSPORT, BRAZOSPORT MEMORIAL HOSPITAL &BRAZOSPORT REGIONAL HEALTH SYSTEM | 741385192 - (TX) COMMUNITY HOSPITAL OF BRAZOSPORT | TX | General Acute Care Hospital (282N00000X) |
United | 538 | $11968.13 | 1699726695 - NORTHWEST ARKANSAS HOSPITALS, LLC, NORTHWEST MEDICAL CENTER | 205896848 | AR | General Acute Care Hospital (282N00000X) |
United | 538 | $12725.59 | 1821019514 - PROVIDENCE HEALTH SYSTEM, PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO | 421672806 | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 538 | $8412.04 | 1356718787 - PRIME HEALTHCARE SERVICES-SUBURBAN HOSPITAL LLC | 472819044 | PA | Psychiatric Hospital Unit (273R00000X) |
United | 538 | $8956.59 | 1427051002 - CLAYTON HEALTH SYSTEMS INC, UNION COUNTY GENERAL HOSPITAL | 850442957 - (NM) CLAYTON HEALTH SYSTEMS INC | NM | Critical Access Hospital (282NC0060X) |
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 538 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 538 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 538 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 |
|---|---|---|
| 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 |
| 539-APR-DRG | High | CESAREAN SECTION W STERILIZATION |
| 539-MS-DRG | High | Osteomyelitis 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 538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 538 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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