MS-DRG 559 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 559 by major payers:
$21,887.08
$29,794.63
$29,123.73
$29,545.17
| 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 559 | ||||||
United | 559 | $38100.82 | 1598337339 - STEWARD NSMC, INC., SWING BED | 862695690 | FL | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 559 | $23023.68 | 1538130083 - MERCY HOSPITAL PARIS | 710655753 - MERCY HOSPITAL PARIS | AR | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 559 | $24789.30 | 1942223482 - LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER | 930386793 - LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER PAYROLL DEPT | OR | Rehabilitation Hospital Unit (273Y00000X) |
United | 559 | $40203.55 | 1457550840 - , PROVIDENCE ST PETER HOSPITAL | 910567732 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 559 | $14412.00 | 1013919315 - ATLANTICARE REGIONAL MEDICAL CENTER | 210634549 - (NJ) ATLANTICARE HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 559 | $8189.00 | 1316294069 - EMCARE | 871999484 | FL | General Acute Care Hospital (282N00000X) |
United | 559 | $30580.68 | 1063545283 - FLUSHING HOSPITAL & MEDICAL CENTER | 111631781 - FLUSHING HOSPITAL & MEDICAL CENTER | NY | Psychiatric Hospital Unit (273R00000X) |
United | 559 | $32206.81 | 1497742365 - OUR LADY OF THE LAKE HOSPITAL, INC., OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER | 720423651 - (LA) OUR LADY OF THE LAKE HOSPITAL INC | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 559 | $23853.46 | 1346241973 - CORNING HOSPITAL | 160393490 - (NY) CORNING HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 559 | $34332.26 | 1003991845 - PROVIDENCE HEALTH & SERVICES OREGON, PROVIDENCE PORTLAND MEDICAL CENTER | 930386906 | OR | General Acute Care Hospital (282N00000X) |
United | 559 | $16425.00 | 1699851758 - RIVERVIEW MEDICAL CENTER FAMILY HEALTH CENTER | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 559 | $20324.63 | 1174706576 - LUTHERAN MUSCULOSKELETAL CENTER LLC, THE ORTHOPAEDIC HOSPITAL OF LUTHERAN HEALTH NETWORK | 261483076 - (IN) LUTHERAN MUSCULOSKELETAL CENTER LLC | IN | General Acute Care Hospital (282N00000X) |
United | 559 | $33922.03 | 1073608139 - VANDERBILT UNIV. MEDICAL CENTER, TVHS | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | General Acute Care Hospital (282N00000X) |
United | 559 | $19416.90 | 1558071894 - CHI ST VINCENT HOSPITAL HOT SPRINGS | 710236913 - CHI ST VINCENT HOSPITAL HOT SPRINGS | AR | Substance Use Disorder Rehabilitation Hospital Unit (276400000X) |
United | 559 | $18953.13 | 1215916812 - WILLIAM BEAUMONT HOSPITAL, COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL REHABILITATION | 381459362 - WILLIAM BEAUMONT HOSPITAL | MI | 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 559 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 559 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 559 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 |
|---|---|---|
| 558-APR-DRG | Moderate | Head Trauma With Coma > 1 Hour Or Hemorrhage |
| 558-MS-DRG | High | Tendinitis, Myositis and Bursitis without MCC |
| 559-MS-DRG | High | Aftercare, Musculoskeletal System and Connective Tissue with MCC |
| 560-APR-DRG | High | VAGINAL DELIVERY |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 559. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 559 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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