Childrens Hospital At Montefiore Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Childrens Hospital At Montefiore, Bronx, NY in 2024, from traditional Medicare claims. Back to the Childrens Hospital At Montefiore profile, with quality ratings, finances and negotiated rates.
9,060
Medicare inpatient discharges
In 188 published DRGs
2.16
Case mix index
IPPS FY 2027
18%
Surgical stays
70%
Stays with complications
In DRGs with a CC or MCC
3,863
Medicare outpatient services
In 47 service groups
Inpatient stays by major diagnostic category
Circulatory system1,941 discharges in 35 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 390 | $169,882 | $15,597 | $24,293 | 1.28 |
| Syncope and collapseMS-DRG 312, medical | 198 | $81,317 | $9,591 | $11,628 | 0.86 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 108 | $396,289 | $76,598 | $56,669 | 6.25 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 92 | $192,585 | $25,137 | $27,540 | 2.09 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 88 | $110,124 | $12,265 | $15,748 | 1.07 |
| Chest painMS-DRG 313, medical | 86 | $69,431 | $7,888 | $9,929 | 0.72 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 79 | $194,233 | $18,758 | $27,775 | 1.59 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 64 | $93,248 | $8,569 | $13,334 | 0.74 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 60 | $169,127 | $18,459 | $24,185 | 1.58 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 60 | $160,609 | $14,533 | $22,967 | 1.20 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 58 | $322,038 | $40,027 | $46,051 | 3.35 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 51 | $314,721 | $25,195 | $45,005 | 2.16 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 49 | $157,380 | $20,237 | $22,505 | 1.82 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 47 | $116,296 | $10,944 | $16,630 | 0.97 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 44 | $267,687 | $34,034 | $38,279 | 2.87 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 43 | $150,482 | $35,237 | $21,519 | 3.24 |
| Hypertension without MCCMS-DRG 305, medical | 42 | $66,546 | $8,172 | $9,516 | 0.75 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 36 | $601,377 | $67,948 | $85,997 | 5.06 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 36 | $142,154 | $12,006 | $20,328 | 1.08 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 35 | $153,136 | $10,077 | $21,898 | 0.91 |
| Hypertension with MCCMS-DRG 304, medical | 31 | $129,123 | $13,877 | $18,465 | 1.15 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 24 | $370,729 | $44,338 | $53,014 | 3.27 |
| Atherosclerosis without MCCMS-DRG 303, medical | 24 | $79,280 | $6,534 | $11,337 | 0.66 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 24 | $64,158 | $5,213 | $9,175 | 0.55 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 23 | $333,901 | $47,460 | $47,748 | 4.81 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 22 | $305,125 | $60,462 | $43,633 | 4.88 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 21 | $241,043 | $33,729 | $34,469 | 2.81 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 19 | $576,013 | $91,872 | $82,370 | 7.71 |
| Other vascular procedures with CCMS-DRG 253, surgical | 16 | $205,757 | $28,935 | $29,423 | 2.55 |
| Cardiac congenital and valvular disorders with MCCMS-DRG 306, medical | 15 | $303,064 | $25,420 | $43,338 | 1.54 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 12 | $247,757 | $40,415 | $35,429 | 4.04 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 11 | $445,700 | $60,364 | $63,735 | 5.88 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 11 | $179,046 | $27,397 | $25,604 | 2.28 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 11 | $316,620 | $48,290 | $45,277 | 3.90 |
| Angina pectorisMS-DRG 311, medical | 11 | $71,759 | $7,609 | $10,262 | 0.70 |
Infectious and parasitic diseases1,459 discharges in 6 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 | 995 | $212,310 | $23,144 | $30,360 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 190 | $519,773 | $62,253 | $74,328 | 5.00 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 155 | $541,663 | $79,957 | $77,458 | 6.96 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 89 | $106,707 | $11,361 | $15,259 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 18 | $152,033 | $20,706 | $21,741 | 2.04 |
| Viral illness without MCCMS-DRG 866, medical | 12 | $114,824 | $8,377 | $16,420 | 0.92 |
Respiratory system1,016 discharges in 21 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 142 | $130,765 | $15,103 | $18,699 | 1.33 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 136 | $152,658 | $18,565 | $21,830 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 125 | $147,948 | $15,063 | $21,157 | 1.23 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 75 | $87,266 | $8,639 | $12,479 | 0.82 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 72 | $89,393 | $10,756 | $12,783 | 0.96 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 57 | $106,480 | $10,932 | $15,227 | 1.10 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 46 | $332,489 | $33,179 | $47,546 | 2.70 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 43 | $114,249 | $11,162 | $16,338 | 0.99 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 35 | $210,506 | $17,112 | $30,102 | 1.40 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 35 | $69,069 | $9,205 | $9,877 | 0.85 |
| Major chest procedures with MCCMS-DRG 163, surgical | 33 | $399,572 | $56,597 | $57,139 | 4.71 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 31 | $403,019 | $72,363 | $57,632 | 6.91 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 29 | $91,996 | $8,499 | $13,155 | 0.82 |
| Major chest procedures with CCMS-DRG 164, surgical | 27 | $170,760 | $30,375 | $24,419 | 2.55 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 26 | $240,508 | $22,688 | $34,393 | 1.90 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 22 | $185,400 | $20,948 | $26,512 | 1.74 |
| Respiratory signs and symptomsMS-DRG 204, medical | 21 | $70,041 | $9,403 | $10,016 | 0.82 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 21 | $201,611 | $24,378 | $28,830 | 1.81 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 15 | $123,885 | $10,983 | $17,716 | 0.91 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 14 | $316,088 | $47,207 | $45,201 | 4.06 |
| Bronchitis and asthma without cc/mccMS-DRG 203, medical | 11 | $58,630 | $5,829 | $8,384 | 0.69 |
Kidney and urinary tract793 discharges in 11 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 | 152 | $197,267 | $20,881 | $28,209 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 124 | $105,351 | $11,682 | $15,065 | 1.02 |
| Renal failure with MCCMS-DRG 682, medical | 123 | $144,962 | $16,519 | $20,730 | 1.50 |
| Renal failure with CCMS-DRG 683, medical | 119 | $100,000 | $10,111 | $14,300 | 0.90 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 96 | $87,179 | $8,933 | $12,467 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 90 | $122,425 | $13,099 | $17,507 | 1.17 |
| Kidney transplantMS-DRG 652, surgical | 22 | $434,674 | $39,620 | $62,158 | 3.00 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 22 | $378,099 | $37,539 | $54,068 | 3.70 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 17 | $525,982 | $50,845 | $75,215 | 4.50 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 17 | $222,485 | $30,875 | $31,815 | 2.59 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 11 | $192,265 | $17,585 | $27,494 | 1.35 |
Nervous system785 discharges in 20 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 113 | $238,819 | $23,094 | $34,151 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 78 | $127,010 | $11,265 | $18,162 | 1.02 |
| Seizures without MCCMS-DRG 101, medical | 76 | $87,847 | $10,429 | $12,562 | 0.91 |
| Seizures with MCCMS-DRG 100, medical | 75 | $183,154 | $24,908 | $26,191 | 1.98 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 67 | $108,965 | $15,032 | $15,582 | 1.36 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 47 | $94,546 | $11,119 | $13,520 | 1.03 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 36 | $534,169 | $53,120 | $76,386 | 4.42 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 34 | $196,931 | $27,751 | $28,161 | 2.39 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 31 | $458,982 | $67,864 | $65,634 | 5.67 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 30 | $171,262 | $20,909 | $24,490 | 1.79 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 29 | $85,678 | $8,769 | $12,252 | 0.80 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 28 | $116,006 | $11,208 | $16,589 | 1.03 |
| Cranial and peripheral nerve disorders with MCCMS-DRG 073, medical | 25 | $115,739 | $16,169 | $16,551 | 1.51 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 23 | $97,840 | $12,318 | $13,991 | 1.06 |
| Headaches without MCCMS-DRG 103, medical | 21 | $86,773 | $9,760 | $12,409 | 0.84 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 18 | $186,647 | $20,355 | $26,690 | 1.79 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 16 | $236,732 | $31,792 | $33,853 | 2.28 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 15 | $216,750 | $14,584 | $30,995 | 1.47 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 12 | $84,395 | $6,833 | $12,068 | 0.69 |
| Other disorders of nervous system without cc/mccMS-DRG 093, medical | 11 | $72,602 | $8,475 | $10,382 | 0.77 |
Digestive system768 discharges in 16 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 160 | $81,121 | $8,556 | $11,600 | 0.79 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 88 | $191,586 | $22,803 | $27,397 | 1.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 88 | $105,536 | $10,734 | $15,092 | 0.98 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 74 | $134,555 | $18,728 | $19,241 | 1.62 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 63 | $91,860 | $10,644 | $13,136 | 0.94 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 49 | $130,720 | $15,158 | $18,693 | 1.28 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 40 | $106,009 | $9,232 | $15,159 | 0.80 |
| Digestive malignancy with MCCMS-DRG 374, medical | 34 | $261,144 | $24,938 | $37,344 | 2.10 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 33 | $118,022 | $11,237 | $16,877 | 1.04 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 31 | $617,304 | $55,918 | $88,274 | 4.52 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 30 | $223,869 | $26,911 | $32,013 | 2.37 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 24 | $159,746 | $18,896 | $22,844 | 1.45 |
| Digestive malignancy with CCMS-DRG 375, medical | 17 | $127,108 | $11,155 | $18,176 | 1.20 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 13 | $405,636 | $50,300 | $58,006 | 4.28 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 12 | $143,411 | $18,221 | $20,508 | 1.67 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 12 | $255,623 | $22,081 | $36,554 | 1.75 |
Musculoskeletal system and connective tissue721 discharges in 26 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 186 | $121,570 | $20,322 | $17,384 | 1.88 |
| Medical back problems without MCCMS-DRG 552, medical | 70 | $92,784 | $10,265 | $13,268 | 0.97 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 47 | $82,106 | $9,642 | $11,741 | 0.90 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 46 | $79,707 | $8,941 | $11,398 | 0.82 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 43 | $171,278 | $22,254 | $24,493 | 2.07 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 30 | $201,681 | $40,380 | $28,840 | 3.49 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 24 | $199,323 | $25,427 | $28,503 | 2.40 |
| Signs and symptoms of musculoskeletal system and connective tissue without MCCMS-DRG 556, medical | 24 | $67,429 | $9,089 | $9,642 | 0.82 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 22 | $162,176 | $25,387 | $23,191 | 2.11 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 18 | $203,717 | $34,106 | $29,132 | 3.00 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 18 | $207,869 | $33,351 | $29,725 | 2.95 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 18 | $162,369 | $29,915 | $23,219 | 2.48 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 17 | $203,148 | $20,907 | $29,050 | 2.04 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 16 | $83,380 | $12,746 | $11,923 | 1.09 |
| Connective tissue disorders with MCCMS-DRG 545, medical | 15 | $288,076 | $27,911 | $41,195 | 2.49 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCCMS-DRG 562, medical | 13 | $129,602 | $16,468 | $18,533 | 1.52 |
| Revision of hip or knee replacement with MCCMS-DRG 466, surgical | 12 | $349,047 | $54,745 | $49,914 | 5.19 |
| Connective tissue disorders with CCMS-DRG 546, medical | 12 | $115,044 | $13,955 | $16,451 | 1.20 |
| Bone diseases and arthropathies with MCCMS-DRG 553, medical | 12 | $125,055 | $14,937 | $17,883 | 1.35 |
| Tendonitis, myositis and bursitis without MCCMS-DRG 558, medical | 12 | $119,132 | $9,552 | $17,036 | 0.88 |
| Biopsies of musculoskeletal system and connective tissue with CCMS-DRG 478, surgical | 11 | $187,223 | $28,019 | $26,773 | 2.38 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 11 | $88,212 | $9,055 | $12,614 | 0.79 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 11 | $253,257 | $24,243 | $36,216 | 1.82 |
| Medical back problems with MCCMS-DRG 551, medical | 11 | $265,885 | $19,252 | $38,022 | 1.70 |
| Other musculoskeletal system and connective tissue diagnoses with MCCMS-DRG 564, medical | 11 | $272,216 | $20,947 | $38,927 | 1.56 |
| Other musculoskeletal system and connective tissue diagnoses with CCMS-DRG 565, medical | 11 | $163,323 | $11,837 | $23,355 | 1.00 |
Endocrine, nutritional and metabolic401 discharges in 6 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 | 182 | $159,998 | $15,922 | $22,880 | 1.32 |
| Diabetes with MCCMS-DRG 637, medical | 71 | $158,480 | $16,334 | $22,663 | 1.45 |
| Diabetes with CCMS-DRG 638, medical | 63 | $101,139 | $9,485 | $14,463 | 0.90 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 51 | $95,434 | $8,769 | $13,647 | 0.78 |
| Endocrine disorders with MCCMS-DRG 643, medical | 21 | $173,878 | $19,594 | $24,864 | 1.65 |
| Endocrine disorders with CCMS-DRG 644, medical | 13 | $109,350 | $10,795 | $15,637 | 1.06 |
Liver, gallbladder and pancreas205 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 28 | $260,510 | $21,133 | $37,253 | 1.76 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 27 | $384,651 | $28,308 | $55,005 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 25 | $244,493 | $23,195 | $34,963 | 1.83 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 24 | $143,749 | $18,592 | $20,556 | 1.63 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 18 | $178,181 | $16,424 | $25,480 | 1.63 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 17 | $93,720 | $12,945 | $13,402 | 1.09 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 16 | $141,026 | $10,656 | $20,167 | 0.95 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 15 | $126,421 | $9,409 | $18,078 | 0.86 |
| Malignancy of hepatobiliary system or pancreas with CCMS-DRG 436, medical | 12 | $161,687 | $12,553 | $23,121 | 1.10 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 12 | $186,926 | $20,932 | $26,730 | 1.67 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 11 | $158,289 | $12,753 | $22,635 | 1.03 |
Blood and immune system201 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders with MCCMS-DRG 811, medical | 80 | $174,293 | $17,146 | $24,924 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 51 | $102,952 | $9,918 | $14,722 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 31 | $183,664 | $17,111 | $26,264 | 1.56 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 21 | $381,997 | $35,264 | $54,626 | 2.19 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 18 | $170,745 | $13,220 | $24,417 | 1.20 |
Skin, subcutaneous tissue and breast181 discharges in 7 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 72 | $84,740 | $9,546 | $12,118 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 32 | $151,797 | $16,447 | $21,707 | 1.49 |
| Minor skin disorders without MCCMS-DRG 607, medical | 21 | $76,550 | $9,943 | $10,947 | 0.89 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 18 | $78,815 | $10,480 | $11,271 | 0.91 |
| Skin ulcers with CCMS-DRG 593, medical | 15 | $104,559 | $13,034 | $14,952 | 1.21 |
| Skin ulcers with MCCMS-DRG 592, medical | 12 | $151,490 | $24,498 | $21,663 | 2.09 |
| Other skin, subcutaneous tissue and breast procedures with CCMS-DRG 580, surgical | 11 | $81,185 | $15,508 | $11,609 | 1.75 |
Transplants, ECMO and tracheostomy (pre-MDC)98 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and necMS-DRG 003, surgical | 58 | $1,863,362 | $262,286 | $266,461 | 21.32 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 27 | $1,114,431 | $159,871 | $159,364 | 14.70 |
| Chimeric antigen receptor (car) t-cell and other immunotherapiesMS-DRG 018, medical | 13 | $2,711,945 | $422,061 | $387,808 | 36.84 |
Injuries, poisonings and toxic effects of drugs87 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 26 | $220,465 | $24,097 | $31,527 | 1.82 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 21 | $177,536 | $18,699 | $25,388 | 1.60 |
| Complications of treatment with CCMS-DRG 920, medical | 15 | $112,677 | $12,257 | $16,113 | 1.03 |
| Traumatic injury without MCCMS-DRG 914, medical | 14 | $68,963 | $10,414 | $9,862 | 0.91 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 11 | $357,756 | $48,619 | $51,159 | 3.72 |
Mental diseases and disorders85 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 | 64 | $150,088 | $19,773 | $21,463 | 1.76 |
| PsychosesMS-DRG 885, medical | 21 | $249,453 | $13,331 | $35,672 | 1.37 |
Blood cancers and poorly differentiated neoplasms75 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 26 | $338,391 | $33,969 | $48,390 | 3.13 |
| Acute leukemia with MCCMS-DRG 834, medical | 21 | $512,827 | $65,218 | $73,334 | 5.60 |
| Chemotherapy without acute leukemia as secondary diagnosis with CCMS-DRG 847, medical | 15 | $157,903 | $17,386 | $22,580 | 1.21 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 13 | $199,517 | $16,801 | $28,531 | 1.57 |
Ear, nose, mouth and throat59 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 47 | $65,422 | $8,089 | $9,355 | 0.74 |
| Otitis media and uri without MCCMS-DRG 153, medical | 12 | $128,841 | $11,463 | $18,424 | 0.73 |
Other56 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 | 43 | $407,865 | $54,472 | $58,325 | 4.74 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 13 | $492,866 | $56,364 | $70,480 | 3.38 |
Factors influencing health status51 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Signs and symptoms without MCCMS-DRG 948, medical | 40 | $81,056 | $9,583 | $11,591 | 0.80 |
| Signs and symptoms with MCCMS-DRG 947, medical | 11 | $117,061 | $14,241 | $16,740 | 1.25 |
Alcohol and drug use36 discharges in 2 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 | 24 | $116,173 | $9,675 | $16,613 | 0.86 |
| Alcohol, drug abuse or dependence without rehabilitation therapy with MCCMS-DRG 896, medical | 12 | $340,007 | $32,792 | $48,621 | 1.78 |
HIV infections26 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| HIV with major related condition with MCCMS-DRG 974, medical | 26 | $379,689 | $38,126 | $54,296 | 2.92 |
Eye16 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other disorders of the eye without MCCMS-DRG 125, medical | 16 | $78,840 | $9,101 | $11,274 | 0.80 |
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 2 Urology and Related ServicesAPC 5372 | 511 | 343 | $1,852 | $608 | $502 |
| Level 1 Intraocular ProceduresAPC 5491 | 387 | 285 | $25,441 | $2,080 | $1,752 |
| Level 1 Endovascular ProceduresAPC 5191 | 246 | 243 | $43,554 | $2,592 | $2,208 |
| Level 3 Urology and Related ServicesAPC 5373 | 246 | 219 | $10,369 | $1,818 | $1,516 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 159 | 156 | $124,110 | $24,648 | $21,117 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 143 | 138 | $19,019 | $1,444 | $1,220 |
| Level 2 Upper GI ProceduresAPC 5302 | 128 | 106 | $16,274 | $1,709 | $1,445 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 108 | 107 | $47,984 | $5,172 | $4,358 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 105 | 95 | $33,709 | $2,526 | $2,141 |
| Level 2 Intraocular ProceduresAPC 5492 | 102 | 83 | $33,367 | $3,649 | $3,116 |
| Level 3 Vascular ProceduresAPC 5183 | 99 | 95 | $33,544 | $2,774 | $2,405 |
| Level 5 Urology and Related ServicesAPC 5375 | 98 | 95 | $39,368 | $4,641 | $3,918 |
| Level 5 Airway EndoscopyAPC 5155 | 93 | 89 | $38,371 | $6,134 | $5,183 |
| Level 4 Urology and Related ServicesAPC 5374 | 92 | 83 | $30,541 | $3,126 | $2,629 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 87 | 83 | $20,678 | $1,389 | $1,196 |
| Level 1 Nerve ProceduresAPC 5431 | 76 | 69 | $20,132 | $1,733 | $1,407 |
| Level 3 Airway EndoscopyAPC 5153 | 74 | 54 | $10,228 | $1,501 | $1,264 |
| Level 4 Airway EndoscopyAPC 5154 | 74 | 60 | $28,760 | $3,310 | $2,833 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 71 | 69 | $49,889 | $6,330 | $5,339 |
| Level 3 Endovascular ProceduresAPC 5193 | 71 | 68 | $68,465 | $10,724 | $8,874 |
| Comprehensive Observation ServicesAPC 8011 | 68 | 65 | $33,238 | $2,456 | $2,090 |
| Level 4 Vascular ProceduresAPC 5184 | 67 | 62 | $39,243 | $4,774 | $3,946 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 65 | 62 | $32,927 | $2,860 | $2,373 |
| Level 2 Endovascular ProceduresAPC 5192 | 62 | 62 | $53,600 | $5,042 | $4,338 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 61 | 58 | $31,377 | $3,050 | $2,636 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 52 | 46 | $25,406 | $2,057 | $1,780 |
| Level 3 Lower GI ProceduresAPC 5313 | 49 | 45 | $22,651 | $2,475 | $2,176 |
| Level 4 Gynecologic ProceduresAPC 5414 | 38 | 36 | $32,860 | $2,723 | $2,389 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 36 | 36 | $74,611 | $12,799 | $10,772 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 35 | 35 | $65,892 | $10,361 | $8,569 |
| Level 4 Endovascular ProceduresAPC 5194 | 34 | 31 | $92,479 | $18,072 | $14,606 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 34 | 33 | $78,206 | $9,896 | $8,164 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 33 | 30 | $35,392 | $3,421 | $2,930 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 30 | 30 | $114,035 | $35,307 | $29,375 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 27 | 27 | $45,426 | $5,852 | $4,982 |
| Level 5 ENT ProceduresAPC 5165 | 23 | 23 | $54,597 | $5,256 | $4,436 |
| Level 3 Upper GI ProceduresAPC 5303 | 21 | 20 | $18,972 | $3,437 | $2,888 |
| Level 5 Gynecologic ProceduresAPC 5415 | 21 | 11 | $39,572 | $4,464 | $3,792 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 19 | 19 | $49,096 | $7,924 | $6,514 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 18 | 17 | $118,081 | $33,235 | $26,719 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 17 | 17 | $99,027 | $24,843 | $21,011 |
| Level 3 Intraocular ProceduresAPC 5493 | 16 | 15 | $39,735 | $4,691 | $4,004 |
| Level 4 ENT ProceduresAPC 5164 | 15 | 15 | $36,223 | $2,878 | $2,217 |
| Complex GI ProceduresAPC 5331 | 15 | 11 | $33,151 | $5,115 | $4,263 |
| Level 6 Urology and Related ServicesAPC 5376 | 15 | 14 | $55,831 | $8,735 | $7,291 |
| Level 2 Vascular ProceduresAPC 5182 | 11 | 11 | $18,398 | $1,429 | $1,204 |
| Level 7 Radiation TherapyAPC 5627 | 11 | 11 | $68,781 | $7,136 | $6,121 |
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.