MS-DRG 543 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 543 by major payers:
$13,450.94
$14,883.64
$16,971.57
$17,187.42
| 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 543 | ||||||
United | 543 | $2122.00 | 1992755292 - GENEVA COUNTY HEALTHCARE AUTHORITY, INC., WIREGRASS MEDICAL CENTER | 636004474 - (AL) GENEVA COUNTY HEALTH CARE AUTHORITY INC DBA WIREGRASS MEDICAL CENTER | AL | General Acute Care Hospital (282N00000X) |
United | 543 | $1838.00 | 1386630705 - STATE OF MISSISSIPPI, HOLMES COUNTY HOSPITAL AND CLINIC | 640662976 - NORTH MISSISSIPPI MEDICAL CENTER INC | MS | Critical Access Hospital (282NC0060X) |
United | 543 | $8080.81 | 1538114434 - HENDERSONVILLE HOSPITAL CORPORATION, TRISTAR HENDERSONVILLE MEDICAL CENTER | 621321255 - (TN) HENDERSONVILLE HOSPITAL CORPORATION | TN | General Acute Care Hospital (282N00000X) |
United | 543 | $14255.00 | 1154411338 - KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2, EVERGREENHEALTH MEDICAL CENTER | 910844563 | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 543 | $14176.91 | 1336289552 - IVINSON MEMORIAL HOSPITAL | 300975387 - (WY) IVINSON MEMORIAL HOSPITAL | WY | Rural Acute Care Hospital (282NR1301X) |
United | 543 | $15149.65 | 1639174204 - SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC., WILSON HEALTH | 344427944 - (OH) SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC | OH | General Acute Care Hospital (282N00000X) |
United | 543 | $5126.29 | 1285701623 - PHC-LOS ALAMOS INC, LOS ALAMOS MEDICAL CENTER | 30390794 | NM | Rural Acute Care Hospital (282NR1301X) |
United | 543 | $27010.50 | 1467871624 - GREENVILLE HEALTH SYSTEM, GHS CANCER INST-EASLEY | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 543 | $21575.51 | 1902844988 - PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA, PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE | 421672810 - (CA) UNITED STATES CATHLOC CONFERENCE | CA | General Acute Care Hospital (282N00000X) |
United | 543 | $5514.56 | 1548773450 - THE HEALTH CARE AUTHORITY OF THE CITY OF EUFAULA, MEDICAL CENTER BARBOUR SENIOR CARE CENTER | 208104245 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 543 | $16159.62 | 1881915585 - ADVOCATE ILLINOIS MASONIC MEDICAL CENTER | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 543 | $16174.91 | 1215063151 - EMANATE HEALTH MEDICAL CENTER, CITRUS VALLEY MEDICAL CENTER,INC | 956006469 - (CA) EMANATE HEALTH MEDICAL CENTER | CA | Psychiatric Hospital Unit (273R00000X) |
United | 543 | $6920.25 | 1093744187 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 543 | $11754.46 | 1538535158 - SMSJ TUCSON HOLDINGS LLC, ST. JOSEPHS HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 543 | $25533.74 | 1114122710 - PIH HEALTH GOOD SAMARITAN HOSPITAL, GOOD SAMARITAN HOSPITAL | 951656366 - (CA) PIH HEALTH GOOD SAMARITAN HOSPITAL | CA | Rehabilitation Hospital Unit (273Y00000X) |
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 543 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 543 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 543 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 |
|---|---|---|
| 542-APR-DRG | High | VAGINAL DELIVERY W O.R. PROCEDURE EXCEPT STERILIZATION &/OR D&C |
| 542-MS-DRG | High | Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCC |
| 543-MS-DRG | High | Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with CC |
| 544-APR-DRG | High | D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 543. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 543 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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