MS-DRG 551 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 551 by major payers:
$18,786.55
$22,405.28
$25,700.12
$27,199.26
| 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 551 | ||||||
United | 551 | $25698.38 | 1295883395 - FRYE REGIONAL MEDICAL CENTER, INC., FRYE REGIONAL MEDICAL CENTER -ALEXANDER CAMPUS | 352547114 | NC | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 551 | $14641.45 | 1952419681 - VALLEY MEDICAL FACILITIES, INC., VALLEY MEDICAL FACILITIES D/B/A SEWICKLEY VALLEY HOSPITAL INPT REHAB U | 251801532 - (PA) HERITAGE VALLEY HEALTH SYSTEM | PA | Rehabilitation Hospital Unit (273Y00000X) |
United | 551 | $96961.06 | 1275558819 - SIERRA VISTA HOSPITAL, INC., SIERRA VISTA REGIONAL MEDICAL CENTER | 952588614 | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 551 | $18758.46 | 1659456994 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 551 | $17466.71 | 1235230046 - SAINT JOSEPH HEALTH SYSTEM, INC, CHI SAINT JOSEPH MOUNT STERLING SNF | 611334601 - (KY) SAINT JOSEPH HEALTH SYSTEM INC | KY | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 551 | $26458.13 | 1538186143 - NASSAU HEALTH CARE CORPORATION, NASSAU UNIV MED CENTER-PSYCH | 113465690 | NY | Psychiatric Hospital Unit (273R00000X) |
United | 551 | $9326.00 | 1386654515 - STATEN ISLAND UNIVERSITY HOSPITAL | 112868878 - (NY) STATEN ISLAND UNIVERSITY HOSPITAL | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 551 | $37987.87 | 1225113376 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 551 | $38113.00 | 1043267701 - COLUMBIA VALLEY HEALTHCARE SYSTEM, L.P., VALLEY REGIONAL MEDICAL CENTER | 621669572 - (TX) COLUMBIA VALLEY HEALTHCARE SYSTEM LP | TX | General Acute Care Hospital (282N00000X) |
United | 551 | $18758.46 | 1659456994 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 551 | $46772.42 | 1467493551 - MERCY HEALTH, MERCY HEALTH ST VINCENT MEDICAL CENTER | 344428250 - MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC | OH | General Acute Care Hospital (282N00000X) |
United | 551 | $35419.73 | 1851833230 - ST. VINCENT HOSPITAL & HEALTH CARE CENTER, INC., ST. VINCENT NEIGHBORHOOD HOSPITAL | 350869066 - (IN) ST VINCENT HOSPITAL & HEALTH CARE | IN | General Acute Care Hospital (282N00000X) |
United | 551 | $13445.29 | 1780786699 - PALACIOS COMMUNITY MEDICAL CENTER | 760698013 - (TX) PALACIOS COMMUNITY MEDICAL CENTER | TX | Critical Access Hospital (282NC0060X) |
United | 551 | $21164.48 | 1912978685 - MERCY HOSPITAL WALDRON | 710557895 - MERCY HOSPITAL WALDRON | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 551 | $18758.81 | 1528387842 - DESOTO COUNTY HOSPITAL DISTRICT, DESOTO MEMORIAL HOSPITAL | 591205441 - (FL) DESOTO MEMORIAL HOSPITAL | FL | Rural Acute Care Hospital (282NR1301X) |
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 551 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 551 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 551 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 |
|---|---|---|
| 550-MS-DRG | High | Septice Arthritis without CC/MCC |
| 551-MS-DRG | High | Medical Back Problems with MCC |
| 552-APR-DRG | Moderate | Head Trauma With Coma > 1 Hour Or Hemorrhage |
| 552-MS-DRG | High | Medical Back Problems without 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 551. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 551 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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