MS-DRG 542 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 542 by major payers:
$22,387.38
$24,808.61
$29,264.58
$29,732.55
| 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 542 | ||||||
United | 542 | $26569.49 | 1518993880 - THEDACARE REGIONAL MEDICAL CENTER-NEENAH, INC., THEDA CLARK MEDICAL CENTER INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | General Acute Care Hospital (282N00000X) |
United | 542 | $32307.25 | 1770673535 - PRINCETON BAPTIST MEDICAL CENTER, PRINCETON BAPTIST MEDICAL CENTER | 474775351 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 542 | $35618.67 | 1588243117 - INTEGRIS HEALTH EDMOND, INC, INTEGRIS HEALTH JIM THORPE REHABILITATION HOSPITAL EDMOND | 451027361 - (OK) INTEGRIS HEALTH EDMOND INC | OK | Rehabilitation Hospital Unit (273Y00000X) |
United | 542 | $28639.38 | 1386608859 - HONORHEALTH, SCOTTSDALE HEALTHCARE SHEA MEDICAL CENTER | 860181654 - HONORHEALTH | AZ | General Acute Care Hospital (282N00000X) |
United | 542 | $31630.23 | 1043282338 - DYERSBURG HEALTH, WEST TENNESSEE HEALTHCARE DYERSBURG HOSPITAL | 825179383 - (TN) DYERSBURG HEALTH | TN | General Acute Care Hospital (282N00000X) |
United | 542 | $45344.30 | 1487821237 - UNIVERSITY HOSPITAL @ SYRACUSE | 161469571 | NY | Critical Access Hospital (282NC0060X) |
United | 542 | $30043.17 | 1861635971 - MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL, LLC | 800337676 | WI | Special Hospital (284300000X) |
United | 542 | $11822.87 | 1033635263 - MANGUM CITY HOSPITAL AUTHORITY, MANGUM REGIONAL MEDICAL CENTER | 822087512 | OK | Critical Access Hospital (282NC0060X) |
United | 542 | $9791.78 | 1609811538 - D. W. MCMILLAN MEMORIAL HOSPITAL | 636000288 - (AL) D.W. MCMILLAN MEMORIAL HOSPITAL | AL | General Acute Care Hospital (282N00000X) |
United | 542 | $16450.17 | 1538208210 - RIVERSIDE MEDICAL CENTER | 362414944 - (IL) RIVERSIDE MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | 542 | $36154.96 | 1578640728 - UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER, UNIVERSITY HOSPITALS CASE MEDICAL CENTER - REHAB | 341567805 - UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 542 | $32307.25 | 1770673535 - PRINCETON BAPTIST MEDICAL CENTER, PRINCETON BAPTIST MEDICAL CENTER | 474775351 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 542 | $30979.11 | 1427103589 - SWEDISH HEALTH SERVICES, SWEDISH MEDICAL CENTER, CHERRY HILL | 910373400 - (WA) SWEDISH HEALTH SERVICES | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 542 | $12065.84 | 1932595659 - LANDMARK HOSPITAL OF SOUTHWEST FLORIDA, LLC | 454182542 - (FL) LANDMARK HOSPITAL OF SOUTHWEST FLORIDA LLC | FL | Long Term Care Hospital (282E00000X) |
United | 542 | $47934.94 | 1902834880 - HARTFORD HOSPITAL | 60646668 - HARTFORD HOSPITAL | CT | 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 542 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 542 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 542 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 |
|---|---|---|
| 541-APR-DRG | High | VAGINAL DELIVERY W STERILIZATION &/OR D&C |
| 541-MS-DRG | High | Osteomyelitis without CC/MCC |
| 542-MS-DRG | High | Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCC |
| 543-APR-DRG | High | ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 542 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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