MS-DRG 556 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 556 by major payers:
$9,312.19
$11,163.79
$12,997.45
$13,322.32
| 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 556 | ||||||
United | 556 | $15464.50 | 1245318609 - ST CATHERINE OF SIENA MEDICAL CENTER | 61562701 - (NY) ST CATHERINE OF SIENA MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 556 | $17525.51 | 1205904687 - CLEVELAND CLINIC FOUNDATION | 340714585 - THE CLEVELAND CLINIC FOUNDATION | OH | General Acute Care Hospital (282N00000X) |
United | 556 | $17968.18 | 1447962287 - INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION | 731089149 - (OK) INTEGRIS SOUTH OKLAHOMA CITY HOSPITAL CORPORATION | OK | General Acute Care Hospital (282N00000X) |
United | 556 | $8253.00 | 1013010917 - COMMUNITY MEDICAL CENTER INC | 223452306 | NJ | General Acute Care Hospital (282N00000X) |
United | 556 | $9046.00 | 1104019215 - HOLYOKE MEDICAL CENTER, INC. | 222520073 - (MA) HOLYOKE MEDICAL CENTER INC | MA | Hospitalist Physician (208M00000X) |
United | 556 | $10826.38 | 1073576740 - MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT, VALLEYWISE HEALTH | 860830701 | AZ | General Acute Care Hospital (282N00000X) |
United | 556 | $12085.01 | 1689780249 - DLP SWAIN COUNTY HOSPITAL, LLC, SWAIN COUNTY HOSPITAL | 320441929 | NC | Critical Access Hospital (282NC0060X) |
United | 556 | $10675.29 | 1750805552 - PHOENIXVILLE HOSPITAL, LLC, PHOENIXVILLE HOSPITAL | 822062413 | PA | General Acute Care Hospital (282N00000X) |
United | 556 | $11456.62 | 1295843753 - VALLEY BAPTIST MEDICAL CENTER | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 556 | $13692.70 | 1801299375 - OCHSNER MEDICAL CENTER, OCHSNER MEDICAL COMPLEX - RIVER PARISHES | 205432782 | LA | Critical Access Hospital (282NC0060X) |
United | 556 | $18750.91 | 1407169196 - AMH CATH LABS LLC, TEXAS HEALTH HEART & VASCULAR HOSPITAL ARLINGTON | 203003947 - (TX) AMH CATH LABS LLP | TX | General Acute Care Hospital (282N00000X) |
United | 556 | $7536.00 | 1649340415 - PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA, PHT JMH INPATIENT PSY UNIT | 591713947 - (FL) PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY FLORIDA | FL | Psychiatric Hospital Unit (273R00000X) |
United | 556 | $13102.37 | 1073653523 - MONROE CLINIC, SSM HEALTH MONROE HOSPITAL | 390808509 - THE MONROE CLINIC INC | WI | General Acute Care Hospital (282N00000X) |
United | 556 | $9113.21 | 1770573586 - MCALLEN HOSPITALS L P, SOUTH TEXAS HEALTH SYSTEM | 233069260 | TX | General Acute Care Hospital (282N00000X) |
United | 556 | $19192.85 | 1740254143 - AHS HOSPITAL CORP., OVERLOOK HOSPITAL | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | 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 556 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 556 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 556 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 |
|---|---|---|
| 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 |
| 557-APR-DRG | Moderate | Head Trauma With Coma > 1 Hour Or Hemorrhage |
| 557-MS-DRG | High | Tendinitis, Myositis and Bursitis with 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 556. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 556 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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