MS-DRG 552 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 552 by major payers:
$10,790.40
$13,321.60
$15,348.69
$15,617.92
| 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 552 | ||||||
United | 552 | $20596.41 | 1912334517 - FAUQUIER MEDICAL CENTER LLC, FAUQUIER HOSPITAL | 463107896 | VA | General Acute Care Hospital (282N00000X) |
United | 552 | $10593.59 | 1700874062 - RIVERSIDE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER | 720629905 - (LA) RIVERSIDE MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | 552 | $13269.59 | 1053375576 - BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI, INC | 640772726 - BAPTIST MEMORIAL HOSPITAL-NORTH MISSISSIPPI INC | MS | General Acute Care Hospital (282N00000X) |
United | 552 | $28760.94 | 1821216391 - DELRAY MEDICAL CENTER, INC., PINECREST REHABILITATION HOSPITAL | 752922687 | FL | Rehabilitation Hospital Unit (273Y00000X) |
United | 552 | $16384.59 | 1679632137 - EHCA JOHNS CREEK, LLC, EMORY JOHNS CREEK HOSPITAL | 582433436 | GA | General Acute Care Hospital (282N00000X) |
United | 552 | $11477.70 | 1043450828 - SSM SELECT REHAB ST LOUIS LLC, SSM PHYSICAL THERAPY | 263694972 | MO | Rehabilitation Hospital (283X00000X) |
United | 552 | $2531.00 | 1215038096 - ST. BARNABAS HOSPITAL | 131740122 - (NY) ST BARNABAS HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 552 | $19146.00 | 1831112895 - HOUSTON NORTHWEST PARTNERS, LTD., HOUSTON NORTHWEST MEDICAL CENTER | 261512163 | TX | General Acute Care Hospital (282N00000X) |
United | 552 | $40260.82 | 1659546125 - WESTCHESTER COUNTY HEALTH CARE CORPORATION, WESTCHESTER MEDICAL CENTER | 133964321 - (NY) PEO MID-HUDSON VALLEY STAFFCO | NY | Psychiatric Hospital Unit (273R00000X) |
United | 552 | $17825.48 | 1114015971 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE ST VINCENT MEDICAL CENTER | 930386929 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | OR | General Acute Care Hospital (282N00000X) |
United | 552 | $14071.48 | 1750399192 - MARYVIEW HOSPITAL LLC, BON SECOURS MARYVIEW MEDICAL CENTER | 540506463 | VA | General Acute Care Hospital (282N00000X) |
United | 552 | $21921.49 | 1467492421 - ST ELIZABETH MEDICAL CENTER, INC | 610445850 - ST ELIZABETH MEDICAL CENTER INC | KY | General Acute Care Hospital (282N00000X) |
United | 552 | $13004.54 | 1104653153 - HSA CGH LLC | 995038459 | FL | General Acute Care Hospital (282N00000X) |
United | 552 | $20652.31 | 1306406285 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 552 | $20919.68 | 1497327233 - STEWARD PGH, INC. | 862724926 | FL | 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 552 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 552 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 552 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 |
|---|---|---|
| 551-APR-DRG | Moderate | Head Trauma With Coma > 1 Hour Or Hemorrhage |
| 551-MS-DRG | High | Medical Back Problems with MCC |
| 552-MS-DRG | High | Medical Back Problems without MCC |
| 553-APR-DRG | Moderate | Head Trauma With Coma > 1 Hour Or Hemorrhage |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 552. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 552 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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