MS-DRG 565 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 565 by major payers:
$12,088.54
$13,889.69
$16,081.13
$16,453.22
| 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 565 | ||||||
United | 565 | $8106.62 | 1659566859 - RIVERVIEW REGIONAL MEDICAL CENTER LLC, RIVERVIEW REGIONAL MEDICAL CENTER | 472228529 | AL | Psychiatric Hospital Unit (273R00000X) |
United | 565 | $24614.22 | 1811936529 - NYU LUTHERAN MEDICAL CENTER | 133971298 - NYU LANGONE HOSPITALS | NY | Rehabilitation Hospital Unit (273Y00000X) |
United | 565 | $7786.43 | 1487993630 - LUBBOCK COUNTY HOSPITAL DISTRICT, UMC MEDICAL PROFESSIONAL SERVICES | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | Hospitalist Physician (208M00000X) |
United | 565 | $20184.96 | 1427064310 - MARY IMMACULATE HOSPITAL LLC, MARY IMMACULATE HOSPITAL | 540548200 | VA | General Acute Care Hospital (282N00000X) |
United | 565 | $5787.39 | 1912395203 - CHG HOSPITAL AUSTIN, LLC, CORNERSTONE SPECIALTY HOSPITALS AUSTIN | 472638917 | TX | Long Term Care Hospital (282E00000X) |
United | 565 | $23269.07 | 1912061706 - GOOD SAMARITAN HOSPITAL | 131740104 - (NY) BON SECOURS CHARITY HEALTH SYSTEM INC | NY | Hospitalist Physician (208M00000X) |
United | 565 | $17442.99 | 1760513980 - INOVA HEALTH CARE SERVICES, INOVA FAIR OAKS HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | General Acute Care Hospital (282N00000X) |
United | 565 | $9175.33 | 1629089966 - METROPLEX ADVENTIST HOSPITAL INC, ADVENTHEALTH CENTRAL TEXAS | 742225672 - (TX) METROPLEX ADVENTIST HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 565 | $17260.64 | 1255640819 - VHS OF ARROWHEAD, INC., ABRAZO ARIZONA HEART HOSPITAL | 621811285 | AZ | General Acute Care Hospital (282N00000X) |
United | 565 | $17008.59 | 1205845567 - SAINT AGNES MEDICAL CENTER | 941437713 - (CA) SAINT AGNES MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | 565 | $1500.00 | 1356418974 - THROCKMORTON COUNTY MEMORIAL HOSP | 756003473 - (TX) THROCKMORTON COUNTY MEMORIAL HOSP | TX | Critical Access Hospital (282NC0060X) |
United | 565 | $20699.91 | 1982666111 - MEMORIAL HERMANN HEALTH SYSTEM, MEMORIAL HERMANN HOSPITAL | 741152597 - (TX) MEMORIAL HERMANN HEALTH SYSTEM | TX | General Acute Care Hospital (282N00000X) |
United | 565 | $27978.52 | 1356366314 - LEXINGTON COUNTY HEALTH SERVICES DISTRICT INC, LEXINGTON MEDICAL CENTER | 852276567 - LEXINGTON HEALTH INC | SC | General Acute Care Hospital (282N00000X) |
United | 565 | $12754.41 | 1417961137 - BRONSON METHODIST HOSPITAL, BRONSON MEDICAL GROUP | 381359087 - (MI) BRONSON METHODIST HOSPITAL | MI | Hospitalist Physician (208M00000X) |
United | 565 | $27720.53 | 1427041581 - NORWALK HOSPITAL ASSOCIATION | 66068853 - (CT) NORWALK HOSPITAL ASSOCIATION | CT | 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 565 vs. Other Diseases & Disorders of the Musculoskeletal System & Connective Tissue Codes
The MS-DRG 565 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 565 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 |
|---|---|---|
| 564-APR-DRG | High | ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY |
| 564-MS-DRG | High | Other Musculoskeletal System and Connective Tissue Diagnoses with MCC |
| 565-MS-DRG | High | Other Musculoskeletal System and Connective Tissue Diagnoses with CC |
| 566-APR-DRG | High | ANTEPARTUM W/O O.R. PROCEDURE |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 565. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 565 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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