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See a sample rate comparisonMS-DRG 542 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.
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH 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 542 by major payers:
$22,387.38
$24,808.61
$29,264.58
$29,732.55
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MS-DRG 542
5 of 25 sample ratesHigher to lower in this preview
Westchester County Health Care Corporation, Mid-Hudson Valley Division Of Westchester Medical Center
Peo Mid-Hudson Valley Staffco
$77,910.82Published rateUniversity Hospitals Cleveland Medical Center, University Hospitals Case Medical Center - Rehab
University Hospitals Health System Inc
$36,154.96Published ratePrinceton Baptist Medical Center, Princeton Baptist Medical Center
$32,307.25Published rateFairfield Medical Center
$26,688.80Published rateD. W. Mcmillan Memorial Hospital
D.W. Mcmillan Memorial Hospital
$9,791.78Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-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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