Baptist Medical Center Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Baptist Medical Center, San Antonio, TX in 2024, from traditional Medicare claims. Back to the Baptist Medical Center profile, with quality ratings, finances and negotiated rates.
7,692
Medicare inpatient discharges
In 185 published DRGs
2.16
Case mix index
IPPS FY 2027
30%
Surgical stays
74%
Stays with complications
In DRGs with a CC or MCC
4,288
Medicare outpatient services
In 43 service groups
Inpatient stays by major diagnostic category
Circulatory system1,862 discharges in 43 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 279 | $99,000 | $8,786 | $8,415 | 1.28 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 194 | $129,708 | $10,486 | $11,025 | 1.59 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 77 | $214,415 | $22,520 | $18,225 | 3.35 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 71 | $326,720 | $20,958 | $27,771 | 3.24 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 66 | $61,067 | $4,847 | $5,191 | 0.74 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 63 | $529,307 | $32,548 | $44,991 | 4.88 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 60 | $112,365 | $6,132 | $9,551 | 0.91 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 59 | $368,748 | $19,336 | $31,344 | 2.87 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 59 | $282,411 | $10,891 | $24,005 | 1.82 |
| Syncope and collapseMS-DRG 312, medical | 58 | $83,499 | $5,910 | $7,097 | 0.86 |
| Hypertension without MCCMS-DRG 305, medical | 55 | $68,890 | $4,995 | $5,856 | 0.75 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 55 | $108,837 | $12,521 | $9,251 | 2.09 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 49 | $97,466 | $8,083 | $8,285 | 1.20 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 44 | $386,808 | $34,508 | $32,879 | 5.06 |
| Chest painMS-DRG 313, medical | 38 | $61,295 | $4,949 | $5,210 | 0.72 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 37 | $470,625 | $31,252 | $40,003 | 5.88 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 37 | $201,699 | $13,700 | $17,144 | 2.16 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 36 | $289,830 | $28,496 | $24,636 | 4.81 |
| Other vascular procedures with CCMS-DRG 253, surgical | 36 | $264,766 | $16,440 | $22,505 | 2.55 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 36 | $149,405 | $6,806 | $12,699 | 1.08 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 32 | $42,157 | $3,329 | $3,583 | 0.55 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 31 | $289,982 | $22,376 | $24,648 | 3.46 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 31 | $141,648 | $11,740 | $12,040 | 1.58 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 29 | $309,805 | $23,726 | $26,333 | 3.46 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 28 | $86,624 | $7,262 | $7,363 | 1.07 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 27 | $219,717 | $14,279 | $18,676 | 2.28 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 26 | $227,418 | $21,984 | $19,331 | 3.27 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 21 | $151,535 | $14,531 | $12,880 | 2.81 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 20 | $616,546 | $44,321 | $52,406 | 7.80 |
| Hypertension with MCCMS-DRG 304, medical | 19 | $131,481 | $8,003 | $11,176 | 1.15 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 18 | $91,913 | $4,353 | $7,813 | 0.72 |
| Acute myocardial infarction, expired with MCCMS-DRG 283, medical | 18 | $185,262 | $12,588 | $15,747 | 1.97 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 18 | $75,368 | $6,138 | $6,406 | 0.97 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 16 | $209,065 | $12,293 | $17,771 | 1.83 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 15 | $971,109 | $59,906 | $82,544 | 9.71 |
| Coronary intravascular lithotripsy with intraluminal device with MCCMS-DRG 323, surgical | 15 | $509,886 | $26,155 | $43,340 | 4.14 |
| Cardiac defibrillator implant with MCC or carotid sinus neurostimulatorMS-DRG 276, surgical | 14 | $623,438 | $38,458 | $52,992 | 6.21 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 13 | $403,904 | $27,429 | $34,332 | 4.04 |
| Other vascular procedures without cc/mccMS-DRG 254, surgical | 13 | $190,669 | $10,804 | $16,207 | 1.74 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 13 | $278,798 | $27,744 | $23,698 | 4.16 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 12 | $576,029 | $50,625 | $48,962 | 7.71 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 12 | $580,970 | $40,816 | $49,382 | 6.25 |
| Coronary intravascular lithotripsy with intraluminal device without MCCMS-DRG 324, surgical | 12 | $389,879 | $18,218 | $33,140 | 2.97 |
Infectious and parasitic diseases1,187 discharges in 7 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Septicemia or severe sepsis without MV >96 hours with MCCMS-DRG 871, medical | 805 | $157,028 | $12,781 | $13,347 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 158 | $412,154 | $30,505 | $35,033 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 112 | $105,716 | $6,346 | $8,986 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 48 | $357,789 | $38,575 | $30,412 | 6.96 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 34 | $186,434 | $11,428 | $15,847 | 2.04 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 18 | $147,326 | $12,021 | $12,523 | 1.84 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 12 | $289,497 | $24,221 | $24,607 | 4.43 |
Nervous system937 discharges in 28 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 157 | $163,642 | $12,409 | $13,910 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 118 | $110,757 | $6,589 | $9,414 | 1.02 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 70 | $89,973 | $5,354 | $7,648 | 0.80 |
| Seizures with MCCMS-DRG 100, medical | 53 | $154,621 | $13,504 | $13,143 | 1.98 |
| Seizures without MCCMS-DRG 101, medical | 53 | $84,275 | $6,095 | $7,163 | 0.91 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 50 | $463,407 | $32,064 | $39,390 | 5.67 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 38 | $452,915 | $28,177 | $38,498 | 4.42 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 33 | $118,701 | $11,853 | $10,090 | 1.79 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 33 | $84,759 | $6,797 | $7,205 | 1.03 |
| Headaches without MCCMS-DRG 103, medical | 29 | $78,696 | $5,509 | $6,689 | 0.84 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 27 | $141,750 | $7,705 | $12,049 | 1.14 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 25 | $91,617 | $8,737 | $7,787 | 1.36 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 25 | $165,203 | $15,498 | $14,042 | 2.28 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 21 | $82,934 | $4,358 | $7,049 | 0.69 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 21 | $110,661 | $9,700 | $9,406 | 1.36 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 19 | $119,939 | $10,155 | $10,195 | 1.79 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 18 | $106,450 | $13,566 | $9,048 | 2.39 |
| Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurMS-DRG 041, surgical | 17 | $233,306 | $13,946 | $19,831 | 2.23 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 16 | $101,241 | $7,677 | $8,605 | 1.06 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 15 | $71,257 | $6,055 | $6,057 | 1.03 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 14 | $124,082 | $9,299 | $10,547 | 1.47 |
| Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent witMS-DRG 062, medical | 14 | $207,036 | $11,372 | $17,598 | 1.87 |
| Carotid artery stent procedures with CCMS-DRG 035, surgical | 13 | $279,051 | $15,450 | $23,719 | 2.30 |
| Extracranial procedures with CCMS-DRG 038, surgical | 13 | $183,794 | $9,250 | $15,623 | 1.60 |
| Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent witMS-DRG 061, medical | 12 | $257,456 | $18,944 | $21,884 | 2.80 |
| Carotid artery stent procedures with MCCMS-DRG 034, surgical | 11 | $369,647 | $26,726 | $31,420 | 3.90 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 11 | $209,151 | $11,014 | $17,778 | 1.81 |
| Hypertensive encephalopathy with CCMS-DRG 078, medical | 11 | $105,048 | $7,003 | $8,929 | 1.02 |
Musculoskeletal system and connective tissue741 discharges in 28 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 83 | $202,109 | $12,689 | $17,179 | 2.07 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 79 | $200,997 | $12,269 | $17,085 | 1.88 |
| Medical back problems without MCCMS-DRG 552, medical | 66 | $74,248 | $6,065 | $6,311 | 0.97 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 58 | $208,541 | $13,840 | $17,726 | 2.11 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 39 | $343,349 | $21,640 | $29,185 | 3.49 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 29 | $288,966 | $16,548 | $24,562 | 2.67 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 28 | $226,863 | $17,605 | $19,283 | 2.95 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 28 | $242,158 | $16,625 | $20,583 | 2.48 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 27 | $271,342 | $17,441 | $23,064 | 2.99 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 25 | $734,962 | $43,408 | $62,472 | 6.12 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 24 | $62,813 | $6,139 | $5,339 | 0.90 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 23 | $537,029 | $28,287 | $45,647 | 4.61 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 20 | $558,037 | $26,191 | $47,433 | 3.66 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 20 | $203,321 | $13,887 | $17,282 | 2.40 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 20 | $166,820 | $9,512 | $14,180 | 1.49 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 16 | $309,658 | $18,442 | $26,321 | 2.96 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 16 | $142,036 | $9,755 | $12,073 | 1.59 |
| Fractures of hip and pelvis with MCCMS-DRG 535, medical | 16 | $83,332 | $8,355 | $7,083 | 1.30 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 15 | $57,833 | $5,320 | $4,916 | 0.79 |
| Medical back problems with MCCMS-DRG 551, medical | 15 | $107,807 | $9,781 | $9,164 | 1.70 |
| Major hip and knee joint replacement or reattachment of lower extremity with MCC or totaMS-DRG 469, surgical | 13 | $244,812 | $20,907 | $20,809 | 3.33 |
| Combined anterior and posterior spinal fusion with MCCMS-DRG 453, surgical | 12 | $911,647 | $60,089 | $77,490 | 8.86 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 463, surgical | 12 | $357,209 | $28,891 | $30,363 | 5.66 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 12 | $228,153 | $13,094 | $19,393 | 1.97 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 12 | $89,485 | $7,563 | $7,606 | 1.09 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 11 | $333,735 | $17,825 | $28,367 | 3.00 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 11 | $216,944 | $13,454 | $18,440 | 2.04 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCCMS-DRG 562, medical | 11 | $131,448 | $9,703 | $11,173 | 1.52 |
Respiratory system667 discharges in 16 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 181 | $112,621 | $8,732 | $9,573 | 1.33 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 136 | $130,108 | $10,851 | $11,059 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 66 | $104,345 | $8,372 | $8,869 | 1.23 |
| Major chest procedures with CCMS-DRG 164, surgical | 33 | $240,895 | $15,926 | $20,476 | 2.55 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 30 | $73,023 | $5,509 | $6,207 | 0.82 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 27 | $332,880 | $34,454 | $28,295 | 6.91 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 27 | $151,107 | $17,146 | $12,844 | 2.70 |
| Major chest procedures with MCCMS-DRG 163, surgical | 26 | $364,640 | $30,731 | $30,994 | 4.71 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 25 | $142,417 | $9,660 | $12,105 | 1.40 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 24 | $81,850 | $6,003 | $6,957 | 0.99 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 23 | $76,784 | $7,225 | $6,527 | 1.10 |
| Pleural effusion with MCCMS-DRG 186, medical | 17 | $118,825 | $9,999 | $10,100 | 1.55 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 14 | $280,695 | $23,262 | $23,859 | 4.06 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 14 | $162,880 | $12,686 | $13,845 | 1.74 |
| Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolisMS-DRG 173, surgical | 12 | $231,798 | $19,291 | $19,703 | 3.08 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 12 | $62,117 | $6,313 | $5,280 | 0.96 |
Digestive system657 discharges in 20 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 83 | $103,577 | $6,464 | $8,804 | 0.98 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 76 | $230,227 | $15,165 | $19,569 | 2.37 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 73 | $140,331 | $12,179 | $11,928 | 1.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 71 | $371,261 | $25,030 | $31,557 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 69 | $70,832 | $5,133 | $6,021 | 0.79 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 41 | $86,088 | $5,344 | $7,317 | 0.80 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 41 | $84,006 | $6,755 | $7,141 | 0.94 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 36 | $148,210 | $10,526 | $12,598 | 1.62 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 21 | $97,311 | $8,544 | $8,271 | 1.28 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 20 | $429,281 | $32,345 | $36,489 | 5.08 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 16 | $195,550 | $10,466 | $16,622 | 1.67 |
| Digestive malignancy with MCCMS-DRG 374, medical | 16 | $144,251 | $11,785 | $12,261 | 2.10 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 16 | $104,314 | $9,509 | $8,867 | 1.45 |
| Peritoneal adhesiolysis with MCCMS-DRG 335, surgical | 12 | $277,029 | $23,426 | $23,547 | 3.58 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 11 | $252,751 | $14,172 | $21,484 | 2.11 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 11 | $213,446 | $12,667 | $18,143 | 1.75 |
| Digestive malignancy with CCMS-DRG 375, medical | 11 | $136,040 | $7,752 | $11,563 | 1.20 |
| Complicated peptic ulcer with MCCMS-DRG 380, medical | 11 | $200,730 | $12,987 | $17,062 | 1.95 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 11 | $32,776 | $3,975 | $2,786 | 0.56 |
| Appendix procedures with CCMS-DRG 398, surgical | 11 | $133,155 | $9,052 | $11,318 | 1.51 |
Kidney and urinary tract648 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 128 | $130,689 | $10,996 | $11,109 | 1.65 |
| Renal failure with MCCMS-DRG 682, medical | 115 | $117,855 | $10,008 | $10,018 | 1.50 |
| Renal failure with CCMS-DRG 683, medical | 108 | $82,458 | $6,183 | $7,009 | 0.90 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 103 | $96,510 | $7,834 | $8,203 | 1.17 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 73 | $79,524 | $5,256 | $6,760 | 0.81 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 53 | $78,974 | $6,455 | $6,713 | 1.02 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 28 | $109,512 | $8,398 | $9,309 | 1.35 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 28 | $201,701 | $25,422 | $17,145 | 3.70 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 12 | $77,674 | $6,461 | $6,602 | 1.05 |
Endocrine, nutritional and metabolic399 discharges in 7 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 204 | $89,420 | $9,019 | $7,601 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 62 | $67,417 | $5,080 | $5,730 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 44 | $84,326 | $6,142 | $7,168 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 39 | $132,385 | $9,530 | $11,253 | 1.45 |
| Endocrine disorders with MCCMS-DRG 643, medical | 20 | $123,750 | $10,580 | $10,519 | 1.65 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 19 | $201,242 | $10,849 | $17,106 | 1.98 |
| Endocrine disorders with CCMS-DRG 644, medical | 11 | $109,444 | $7,358 | $9,303 | 1.06 |
Liver, gallbladder and pancreas188 discharges in 10 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 41 | $150,098 | $13,171 | $12,758 | 1.92 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 33 | $149,368 | $9,578 | $12,696 | 1.63 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 16 | $118,741 | $8,277 | $10,093 | 1.31 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 16 | $130,009 | $11,712 | $11,051 | 1.76 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 16 | $57,537 | $6,956 | $4,891 | 1.09 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 15 | $209,105 | $15,763 | $17,774 | 2.32 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 14 | $143,945 | $12,517 | $12,235 | 1.83 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 13 | $182,108 | $6,218 | $15,479 | 0.95 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 13 | $113,772 | $11,222 | $9,671 | 1.63 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 11 | $116,498 | $10,272 | $9,902 | 1.67 |
Injuries, poisonings and toxic effects of drugs85 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with CCMS-DRG 920, medical | 27 | $101,085 | $7,516 | $8,592 | 1.03 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 25 | $116,189 | $9,871 | $9,876 | 1.60 |
| Complications of treatment with MCCMS-DRG 919, medical | 18 | $159,526 | $13,510 | $13,560 | 1.82 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 15 | $335,933 | $25,206 | $28,554 | 3.72 |
Skin, subcutaneous tissue and breast77 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 46 | $77,073 | $5,443 | $6,551 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 18 | $112,154 | $10,010 | $9,533 | 1.49 |
| Other skin, subcutaneous tissue and breast procedures without cc/mccMS-DRG 581, surgical | 13 | $290,394 | $8,423 | $24,683 | 1.35 |
Blood and immune system73 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders with MCCMS-DRG 811, medical | 41 | $108,452 | $9,707 | $9,218 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 32 | $82,239 | $6,319 | $6,990 | 0.90 |
Other54 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 39 | $360,913 | $29,906 | $30,678 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 15 | $227,562 | $16,522 | $19,343 | 2.49 |
Ear, nose, mouth and throat34 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 34 | $73,961 | $4,503 | $6,287 | 0.74 |
Mental diseases and disorders33 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 20 | $131,072 | $9,138 | $11,141 | 1.76 |
| Acute adjustment reaction and psychosocial dysfunctionMS-DRG 880, medical | 13 | $79,105 | $6,425 | $6,724 | 0.95 |
Factors influencing health status20 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Signs and symptoms without MCCMS-DRG 948, medical | 20 | $70,024 | $5,422 | $5,952 | 0.80 |
Transplants, ECMO and tracheostomy (pre-MDC)19 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 19 | $498,335 | $63,246 | $42,359 | 14.70 |
Alcohol and drug use11 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 11 | $80,663 | $5,395 | $6,856 | 0.86 |
Source: CMS Medicare Inpatient Hospitals by Provider and Service (2024 data, released 2026-04-10), traditional Medicare only; CMS omits DRGs with fewer than 11 discharges. Estimated cost is average charges times the hospital's Medicare cost-to-charge ratio from the IPPS Impact File. Weights are the MS-DRG relative weights for the same year.
Outpatient services
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Level 5 Musculoskeletal ProceduresAPC 5115 | 796 | 759 | $154,236 | $9,603 | $10,772 |
| Level 1 Endovascular ProceduresAPC 5191 | 313 | 313 | $81,232 | $2,002 | $2,208 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 256 | 252 | $83,122 | $3,877 | $4,358 |
| Comprehensive Observation ServicesAPC 8011 | 184 | 181 | $53,157 | $1,857 | $2,090 |
| Level 4 Vascular ProceduresAPC 5184 | 159 | 147 | $97,615 | $3,742 | $3,946 |
| Level 3 Vascular ProceduresAPC 5183 | 157 | 152 | $55,134 | $2,179 | $2,405 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 152 | 151 | $136,994 | $4,813 | $5,339 |
| Level 2 Upper GI ProceduresAPC 5302 | 145 | 124 | $32,533 | $1,301 | $1,445 |
| Level 3 Endovascular ProceduresAPC 5193 | 135 | 122 | $178,056 | $7,846 | $8,874 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 122 | 120 | $35,863 | $1,095 | $1,220 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 117 | 117 | $59,524 | $1,930 | $2,141 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 113 | 109 | $222,215 | $14,120 | $15,763 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 110 | 110 | $155,791 | $7,109 | $8,164 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 95 | 93 | $419,779 | $18,725 | $21,117 |
| Level 3 Urology and Related ServicesAPC 5373 | 93 | 73 | $39,169 | $1,388 | $1,516 |
| Level 5 Urology and Related ServicesAPC 5375 | 91 | 89 | $73,521 | $3,514 | $3,918 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 90 | 90 | $139,940 | $7,628 | $8,569 |
| Level 4 Endovascular ProceduresAPC 5194 | 87 | 73 | $186,538 | $12,306 | $14,606 |
| Level 2 Endovascular ProceduresAPC 5192 | 76 | 73 | $108,675 | $3,947 | $4,338 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 74 | 69 | $80,059 | $2,609 | $2,930 |
| Level 4 Gynecologic ProceduresAPC 5414 | 74 | 74 | $51,561 | $2,100 | $2,389 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 72 | 69 | $66,097 | $2,201 | $2,373 |
| Level 4 Urology and Related ServicesAPC 5374 | 69 | 65 | $64,989 | $2,386 | $2,629 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 67 | 65 | $104,490 | $4,405 | $4,982 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 64 | 63 | $108,150 | $5,684 | $6,514 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 57 | 54 | $32,923 | $1,109 | $1,196 |
| Level 2 Intraocular ProceduresAPC 5492 | 52 | 49 | $66,826 | $2,716 | $3,116 |
| Level 4 Airway EndoscopyAPC 5154 | 48 | 47 | $79,037 | $2,589 | $2,833 |
| Level 2 Vascular ProceduresAPC 5182 | 48 | 47 | $31,792 | $1,106 | $1,204 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 46 | 44 | $84,158 | $2,312 | $2,636 |
| Level 1 Nerve ProceduresAPC 5431 | 40 | 34 | $39,465 | $1,301 | $1,407 |
| Level 3 Airway EndoscopyAPC 5153 | 37 | 36 | $49,298 | $1,168 | $1,264 |
| Level 3 Lower GI ProceduresAPC 5313 | 36 | 36 | $48,197 | $1,728 | $2,176 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 36 | 35 | $232,814 | $16,820 | $18,465 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 31 | 31 | $406,793 | $25,963 | $29,375 |
| Level 6 Urology and Related ServicesAPC 5376 | 25 | 25 | $138,681 | $6,114 | $7,291 |
| Complex GI ProceduresAPC 5331 | 24 | 24 | $68,481 | $3,938 | $4,263 |
| Level 5 Airway EndoscopyAPC 5155 | 20 | 20 | $99,526 | $4,495 | $5,183 |
| Level 5 Gynecologic ProceduresAPC 5415 | 20 | 20 | $96,298 | $3,439 | $3,792 |
| Level 3 Upper GI ProceduresAPC 5303 | 19 | 18 | $45,040 | $2,648 | $2,888 |
| Level 6 Gynecologic ProceduresAPC 5416 | 15 | 15 | $105,319 | $4,875 | $5,836 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 12 | 12 | $189,042 | $15,239 | $17,052 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 11 | $142,349 | $4,728 | $4,524 |
Source: CMS Medicare Outpatient Hospitals by Provider and Service (2024 data, released 2026-06-24), comprehensive APCs for traditional Medicare; CMS omits services with fewer than 11 claims. The US average weights every hospital by its services.