MS-DRG 540 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 540 by major payers:
$16,113.35
$17,879.74
$20,453.55
$20,802.68
| 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 540 | ||||||
United | 540 | $6663.31 | 1548452261 - CHAMBERS COUNTY PUBLIC HOSPITAL DISTRICT NO 1, OMNI POINT HEALTH HOSPITAL | 760153629 | TX | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 540 | $31462.16 | 1184974529 - SUNY HEALTHSCIENCE CENTER AT SYRACUSE, UPSTATE UNIVERSITY HOSPITAL | 161469571 | NY | General Acute Care Hospital (282N00000X) |
United | 540 | $21743.47 | 1699718437 - NEBRASKA HEART HOSPITAL, CHI HEALTH NEBRASKA HEART | 392031968 - (NE) NEBRASKA HEART HOSPITAL | NE | General Acute Care Hospital (282N00000X) |
United | 540 | $14158.15 | 1982629630 - MERCY HOSPITAL SOUTH, MERCY HOSPITAL SOUTH | 430980256 - (MO) MERCY HOSPITAL SOUTH | MO | Rehabilitation Hospital Unit (273Y00000X) |
United | 540 | $31462.16 | 1578554630 - SUNY HEALTH SCIENCE CENTER AT SYRACUSE, UPSTATE MEDICAL UNIVERSITY | 161469571 | NY | General Acute Care Hospital (282N00000X) |
United | 540 | $22858.98 | 1467537506 - CARONDELET HEALTH NETWORK, ST. MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 540 | $34316.94 | 1952560914 - BANNER BOSWELL MEDICAL CENTER | 900389314 | AZ | General Acute Care Hospital (282N00000X) |
United | 540 | $21425.11 | 1568461440 - APPALACHIAN REGIONAL HEALTHCARE, INC, BECKLEY ARH HOSPITAL | 520795508 - APPALACHIAN REGIONAL HEALTHCARE INC | WV | General Acute Care Hospital (282N00000X) |
United | 540 | $20671.94 | 1114972007 - CANNON COUNTY HOSPITAL LLC, STONES RIVER HOSPITAL | 474063232 | TN | General Acute Care Hospital (282N00000X) |
United | 540 | $17232.55 | 1033112230 - ST JUDE CHILDRENS RESEARCH HOSPITAL INC | 620646012 - ST JUDE CHILDRENS RESEARCH HOSPITAL INC | TN | Children's Hospital (282NC2000X) |
United | 540 | $14016.40 | 1407800436 - OH MUHLENBERG, LLC, OWENSBORO HEALTH MUHLENBERG COMMUNITY HOSPITAL | 473944197 - (KY) OH MUHLENBERG LLC | KY | General Acute Care Hospital (282N00000X) |
United | 540 | $14226.04 | 1710353339 - SMSJ TUCSON HOLDINGS LLC, ST. MARYS HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 540 | $24389.90 | 1891367629 - STEWARD NSMC, INC., STEWARD FLORIDA MEDICAL CENTER A CAMPUS OF NORTH SHORE | 995054044 | FL | General Acute Care Hospital (282N00000X) |
United | 540 | $28418.43 | 1154335909 - SVMC HOLDINGS, INC | 832550272 - (CT) SVMC HOLDINGS INC | CT | Psychiatric Hospital Unit (273R00000X) |
United | 540 | $20616.31 | 1770527236 - ENDEAVOR HEALTH CLINICAL OPERATIONS, HIGHLAND PARK HOSPITAL-PSYCH UNIT | 362167060 - (IL) NORTHSHORE UNIVERSITY HEALTHSYSTEM | IL | Psychiatric Hospital Unit (273R00000X) |
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 540 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 540 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 540 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 |
|---|---|---|
| 539-APR-DRG | High | CESAREAN SECTION W STERILIZATION |
| 539-MS-DRG | High | Osteomyelitis with MCC |
| 540-MS-DRG | High | Osteomyelitis with CC |
| 541-APR-DRG | High | VAGINAL DELIVERY W STERILIZATION &/OR D&C |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 540 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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