MS-DRG 555 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 555 by major payers:
$15,205.67
$19,791.64
$21,196.03
$21,594.45
| 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 555 | ||||||
United | 555 | $22744.07 | 1295755676 - PALM SPRINGS GENERAL HOSPITAL INC NEW CORPORATION, PALM SPRINGS GENERAL HOSPITAL, INC. | 475625607 | FL | General Acute Care Hospital (282N00000X) |
United | 555 | $15381.91 | 1225339898 - SCREVEN COUNTY HOSPITAL, LLC, OPTIM MEDICAL CENTER - SCREVEN | 273100946 | GA | Critical Access Hospital (282NC0060X) |
United | 555 | $19153.71 | 1184655953 - BROOKWOOD HEALTH SERVICES, INC., BROOKWOOD MEDICAL CENTER | 474757851 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 555 | $31755.77 | 1609846088 - GREENWICH HOSPITAL | 60646659 - (CT) GREENWICH HOSPITAL | CT | General Acute Care Hospital (282N00000X) |
United | 555 | $24319.59 | 1598093825 - MERCY HEALTH, MERCY HOSPITAL FAIRFIELD | 310538532 | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 555 | $16282.95 | 1043659816 - ORO VALLEY HOSPITAL LLC, ORO VALLEY HOSPITAL | 522379881 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 555 | $21082.92 | 1508247016 - SAINT THOMAS RIVER PARK HOSPITAL, LLC, ASCENSION SAINT THOMAS RIVER PARK | 474063149 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 555 | $24227.88 | 1750788667 - CARONDELET HEALTH NETWORK, BRIDGES GEROPSYCHIATRIC PROGRAM AT ST. MARY'S HOSPITAL | 474131755 | AZ | Psychiatric Hospital Unit (273R00000X) |
United | 555 | $21082.92 | 1508247016 - SAINT THOMAS RIVER PARK HOSPITAL, LLC, ASCENSION SAINT THOMAS RIVER PARK | 474063149 | TN | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 555 | $34407.01 | 1801878103 - MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE INC, MCLEOD BEHAVIORAL HEALTH SERVICES | 570370242 - MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE INC | SC | Psychiatric Hospital Unit (273R00000X) |
United | 555 | $21653.33 | 1548294606 - EMANATE HEALTH MEDICAL CENTER, CITRUS VALLEY MEDICAL CENTER INC | 956006469 - (CA) EMANATE HEALTH MEDICAL CENTER | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 555 | $24319.59 | 1598093825 - MERCY HEALTH, MERCY HOSPITAL FAIRFIELD | 310538532 | OH | Rehabilitation Hospital Unit (273Y00000X) |
United | 555 | $46488.67 | 1396921839 - NEW YORK PRESBYTERIAN MEDICAL CENTER | 133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 555 | $24121.33 | 1245330281 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | Rehabilitation Hospital Unit (273Y00000X) |
United | 555 | $28743.17 | 1720019995 - NORTH SHORE MEDICAL CENTER, INC., NORTH SHORE MEDICAL CENTER | 862695690 | 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 555 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 555 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 555 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 |
|---|---|---|
| 554-APR-DRG | Moderate | Head Trauma With Coma > 1 Hour Or Hemorrhage |
| 554-MS-DRG | High | Bone Diseases and Arthropathies without MCC |
| 555-MS-DRG | High | Signs and Symptoms of Musculoskeletal System and Connective Tissue with MCC |
| 556-MS-DRG | High | Signs and Symptoms of Musculoskeletal System and Connective Tissue 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 555. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 555 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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