MS-DRG 561 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 561 by major payers:
$10,206.30
$16,657.65
$12,896.71
$13,301.53
| 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 561 | ||||||
United | 561 | $10277.23 | 1174512792 - TUCSON MEDICAL CENTER | 860137567 - (AZ) TUCSON MEDICAL CENTER | AZ | General Acute Care Hospital (282N00000X) |
United | 561 | $14442.08 | 1053496026 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | Rehabilitation Hospital Unit (273Y00000X) |
United | 561 | $3915.00 | 1164779989 - BRIM HOLDING COMPANY, INC., WADLEY REGIONAL MEDICAL CENTER AT HOPE | 201249189 - (AR) BRIM HOLDING COMPANY, INC. | AR | Psychiatric Hospital Unit (273R00000X) |
United | 561 | $8987.87 | 1992880058 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 561 | $8851.33 | 1902865355 - GOOD SAMARITAN HOSPITAL MEDICAL CENTER | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 561 | $7828.50 | 1568553519 - SILVER CROSS HOSPITAL & MEDICAL CENTERS, SILVER CROSS HOSPITAL | 362174832 - (IL) SILVER CROSS HOSPITAL & MEDICAL CENTERS | IL | General Acute Care Hospital (282N00000X) |
United | 561 | $42849.23 | 1174504849 - GORDON MEMORIAL HOSPITAL, GORDON MEMORIAL HOSPITAL PHYSICAL THERAPY | 470533032 | NE | Critical Access Hospital (282NC0060X) |
United | 561 | $14065.16 | 1639320484 - PROVIDENCE HEALTH & SERVICES, PROV SCRED HRT MED CTR & CHLDS HOS | 364640211 | WA | Psychiatric Hospital Unit (273R00000X) |
United | 561 | $16462.38 | 1891816922 - SOUTHVIEW HOSPITAL PHARMACY | 310564121 - (OH) DAYTON OSTEOPATHIC HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 561 | $23522.34 | 1205096278 - GARNET HEALTH MEDICAL CENTER CATSKILLS, CATSKILL REGIONAL MEDICAL CENTER | 146049030 - (NY) GARNET HEALTH MEDICAL CENTER CATSKILLS | NY | Psychiatric Hospital Unit (273R00000X) |
United | 561 | $20287.92 | 1881082691 - JOHN T MATHER MEMORIAL HOSPITAL | 111639818 - (NY) JOHN T MATHER MEMORIAL HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | 561 | $3556.00 | 1104928548 - FORREST COUNTY GENERAL HOSPITAL | 646001587 - FORREST COUNTY GENERAL HOSPITAL | MS | Rehabilitation Hospital Unit (273Y00000X) |
United | 561 | $11408.08 | 1477809978 - RIPON MEDICAL CENTER | 391101287 - RIPON MEDICAL CENTER INC | WI | General Acute Care Hospital (282N00000X) |
United | 561 | $8046.00 | 1205089026 - PRIME HEALTHCARE SERVICES | 263487583 | CA | General Acute Care Hospital (282N00000X) |
United | 561 | $8349.25 | 1982789046 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | 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 561 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 561 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 561 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 |
|---|---|---|
| 560-APR-DRG | High | VAGINAL DELIVERY |
| 560-MS-DRG | High | Aftercare, Musculoskeletal System and Connective Tissue with CC |
| 561-MS-DRG | High | Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC |
| 562-APR-DRG | Moderate | Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 561. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 561 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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