MS-DRG 564 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 564 by major payers:
$17,982.04
$20,891.63
$24,643.84
$25,037.86
| 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 564 | ||||||
United | 564 | $89165.07 | 1407016793 - DOCTORS MEDICAL CENTER, DOCTORS BEHAVIORAL HEALTH | 952588614 | CA | Psychiatric Hospital (283Q00000X) |
United | 564 | $42068.67 | 1154775401 - VHS HARLINGEN HOSPITAL COMPANY, LLC, VALLEY BAPTIST MEDICAL CENTER - HARLINGEN | 452662980 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 564 | $22928.25 | 1497765630 - ST. CHARLES HOSPITAL CORP. | 111871039 - (NY) ST CHARLES HOSPITAL CORP | NY | General Acute Care Hospital (282N00000X) |
United | 564 | $27619.49 | 1275552747 - NORTHSHORE REGIONAL MEDICAL CENTER, LLC, NORTHSHORE REGIONAL MEDICAL CENTER | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Rehabilitation Hospital Unit (273Y00000X) |
United | 564 | $20621.60 | 1710051941 - FRANCISCAN HEALTH MICHIGAN CITY, FRANCISCAN ST. ANTHONY HEALTH - MICHIGAN CITY | 350876394 - (IN) FRANCISCAN HEALTH MICHIGAN CITY | IN | General Acute Care Hospital (282N00000X) |
United | 564 | $6706.00 | 1285064907 - PRIME HEALTHCARE PARADISE VALLEY LLC, PARADISE VALLEY HOSPITAL | 205837239 | CA | Psychiatric Hospital Unit (273R00000X) |
United | 564 | $35388.60 | 1851336044 - ST. JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC., FROEDTERT WEST BEND HOSPITAL | 390806302 - (WI) ST JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC | WI | General Acute Care Hospital (282N00000X) |
United | 564 | $13340.20 | 1356528269 - MULTICARE HEALTH SYSTEM, MULTICARE DEACONESS HOSPITAL | 911352172 - MULTICARE HEALTH SYSTEM | WA | General Acute Care Hospital (282N00000X) |
United | 564 | $16765.33 | 1538667035 - CARTHAGE HOSPITAL, LLC | 824005981 | TX | General Acute Care Hospital (282N00000X) |
United | 564 | $24785.50 | 1346802915 - UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS, UT SOUTHWESTERN PSYCHIATRIC CARE UNIT | 753175630 | TX | Psychiatric Hospital Unit (273R00000X) |
United | 564 | $89165.07 | 1275558819 - SIERRA VISTA HOSPITAL, INC., SIERRA VISTA REGIONAL MEDICAL CENTER | 952588614 | CA | Rehabilitation Hospital Unit (273Y00000X) |
United | 564 | $21146.53 | 1700926169 - HALLMARK HEALTH | 42767880 - MELROSEWAKEFIELD HEALTHCARE INC | MA | Rehabilitation Hospital Unit (273Y00000X) |
United | 564 | $29177.84 | 1902466840 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 564 | $31595.83 | 1316966518 - KETTERING MEDICAL CENTER, KETTERING HEALTH MIAMISBURG | 310621866 - (OH) KETTERING COLLEGE | OH | General Acute Care Hospital (282N00000X) |
United | 564 | $28697.52 | 1205181120 - HOSPITAL FOR SPECIAL SURGERY- NP | 131624135 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING | NY | Special Hospital (284300000X) |
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 564 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 564 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 564 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 |
|---|---|---|
| 563-APR-DRG | High | Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma |
| 563-MS-DRG | High | Fracture, Sprain, Strain and Dislocation except Femur, Hip, Pelvis and Thigh without MCC |
| 564-MS-DRG | High | Other Musculoskeletal System and Connective Tissue Diagnoses with MCC |
| 565-APR-DRG | High | 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 564. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 564 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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