Cox Medical Center South Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Cox Medical Center South, Springfield, MO in 2024, from traditional Medicare claims. Back to the Cox Medical Center South profile, with quality ratings, finances and negotiated rates.
4,879
Medicare inpatient discharges
In 146 published DRGs
1.99
Case mix index
IPPS FY 2027
27%
Surgical stays
68%
Stays with complications
In DRGs with a CC or MCC
5,754
Medicare outpatient services
In 52 service groups
Inpatient stays by major diagnostic category
Circulatory system991 discharges in 32 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 106 | $44,209 | $8,923 | $11,141 | 1.28 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 99 | $21,832 | $5,096 | $5,502 | 0.74 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 54 | $46,704 | $8,497 | $11,769 | 1.20 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 53 | $180,699 | $41,473 | $45,536 | 6.25 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 49 | $112,504 | $20,139 | $28,351 | 3.24 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 42 | $138,876 | $25,371 | $34,997 | 4.04 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 42 | $102,204 | $11,568 | $25,755 | 1.82 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 40 | $18,652 | $3,993 | $4,700 | 0.55 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 36 | $168,785 | $31,935 | $42,534 | 4.88 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 33 | $40,621 | $10,685 | $10,236 | 1.59 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 31 | $37,072 | $6,660 | $9,342 | 0.91 |
| Hypertension without MCCMS-DRG 305, medical | 31 | $32,563 | $5,143 | $8,206 | 0.75 |
| Other vascular procedures with CCMS-DRG 253, surgical | 30 | $85,174 | $16,656 | $21,464 | 2.55 |
| Syncope and collapseMS-DRG 312, medical | 28 | $34,575 | $6,213 | $8,713 | 0.86 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 26 | $37,809 | $7,398 | $9,528 | 1.08 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 23 | $168,970 | $34,668 | $42,580 | 5.20 |
| Heart failure and shock with CCMS-DRG 292, medical | 23 | $30,198 | $5,565 | $7,610 | 0.86 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 23 | $47,389 | $13,618 | $11,942 | 2.09 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 22 | $182,553 | $36,179 | $46,003 | 5.06 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 21 | $71,002 | $14,321 | $17,892 | 2.16 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 19 | $113,499 | $23,056 | $28,602 | 3.46 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 18 | $123,166 | $22,814 | $31,038 | 4.16 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 16 | $169,382 | $33,042 | $42,684 | 5.24 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 16 | $115,100 | $23,231 | $29,005 | 3.35 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 16 | $123,596 | $19,013 | $31,146 | 2.87 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 15 | $195,370 | $35,538 | $49,233 | 5.88 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 15 | $112,109 | $23,259 | $28,252 | 3.46 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 14 | $238,850 | $51,724 | $60,190 | 7.71 |
| Hypertension with MCCMS-DRG 304, medical | 14 | $40,978 | $7,341 | $10,326 | 1.15 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 13 | $28,234 | $7,416 | $7,115 | 1.07 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 12 | $93,647 | $15,652 | $23,599 | 2.28 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 11 | $39,945 | $4,450 | $10,066 | 0.72 |
Respiratory system655 discharges in 17 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 128 | $47,139 | $9,226 | $11,879 | 1.33 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 84 | $50,814 | $11,191 | $12,805 | 1.70 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 73 | $27,688 | $5,762 | $6,977 | 0.82 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 59 | $41,491 | $6,811 | $10,456 | 1.10 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 40 | $57,018 | $8,203 | $14,369 | 1.23 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 37 | $31,620 | $7,030 | $7,968 | 0.99 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 34 | $27,801 | $5,839 | $7,006 | 0.85 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 32 | $133,989 | $20,241 | $33,765 | 2.70 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 28 | $46,026 | $8,883 | $11,598 | 1.40 |
| Major chest procedures with MCCMS-DRG 163, surgical | 27 | $151,804 | $32,265 | $38,255 | 4.71 |
| Major chest procedures with CCMS-DRG 164, surgical | 25 | $99,604 | $16,353 | $25,100 | 2.55 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 20 | $35,110 | $5,667 | $8,848 | 0.82 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 19 | $38,468 | $6,796 | $9,694 | 0.96 |
| Pneumothorax with CCMS-DRG 200, medical | 16 | $44,498 | $7,537 | $11,213 | 1.08 |
| Major chest trauma with CCMS-DRG 184, medical | 11 | $44,565 | $6,185 | $11,230 | 1.05 |
| Pleural effusion with CCMS-DRG 187, medical | 11 | $32,072 | $5,180 | $8,082 | 1.00 |
| Simple pneumonia and pleurisy without cc/mccMS-DRG 195, medical | 11 | $19,694 | $4,391 | $4,963 | 0.63 |
Infectious and parasitic diseases643 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 | 435 | $65,405 | $13,108 | $16,482 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 90 | $34,834 | $6,602 | $8,778 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 61 | $149,364 | $30,445 | $37,640 | 5.00 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 23 | $66,785 | $12,218 | $16,830 | 2.04 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 23 | $195,811 | $38,989 | $49,344 | 6.96 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 11 | $169,680 | $39,398 | $42,759 | 4.43 |
Nervous system527 discharges in 21 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 111 | $42,850 | $6,675 | $10,798 | 1.02 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 58 | $64,908 | $12,462 | $16,357 | 2.00 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 43 | $136,508 | $27,146 | $34,400 | 4.42 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 34 | $34,777 | $4,875 | $8,764 | 0.69 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 28 | $64,752 | $12,240 | $16,317 | 1.81 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 22 | $53,883 | $9,099 | $13,578 | 1.36 |
| Seizures with MCCMS-DRG 100, medical | 22 | $58,771 | $12,015 | $14,810 | 1.98 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 21 | $49,921 | $8,129 | $12,580 | 1.36 |
| Seizures without MCCMS-DRG 101, medical | 20 | $31,167 | $6,210 | $7,854 | 0.91 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 19 | $196,411 | $33,822 | $49,496 | 5.67 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 16 | $88,873 | $15,920 | $22,396 | 2.43 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 16 | $34,593 | $5,982 | $8,717 | 0.80 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 16 | $36,961 | $6,806 | $9,314 | 1.06 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 15 | $103,388 | $25,572 | $26,054 | 3.79 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 15 | $65,582 | $13,646 | $16,527 | 2.28 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 13 | $52,716 | $8,947 | $13,284 | 1.32 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 13 | $33,367 | $7,556 | $8,409 | 1.03 |
| Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent witMS-DRG 062, medical | 12 | $72,479 | $12,263 | $18,265 | 1.87 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 11 | $44,998 | $10,602 | $11,340 | 1.47 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 11 | $72,522 | $15,076 | $18,275 | 2.39 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 11 | $63,590 | $12,156 | $16,025 | 1.79 |
Musculoskeletal system and connective tissue441 discharges in 17 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 | 62 | $93,296 | $13,257 | $23,511 | 2.07 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 52 | $116,434 | $26,997 | $29,341 | 4.61 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 52 | $77,821 | $13,896 | $19,611 | 2.11 |
| Medical back problems without MCCMS-DRG 552, medical | 36 | $37,039 | $6,456 | $9,334 | 0.97 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 27 | $117,327 | $21,598 | $29,566 | 3.66 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 25 | $132,093 | $33,942 | $33,287 | 6.12 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 25 | $87,273 | $13,936 | $21,993 | 2.40 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 24 | $136,822 | $22,254 | $34,479 | 3.49 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 23 | $166,018 | $23,492 | $41,837 | 2.95 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 19 | $85,718 | $12,738 | $21,601 | 1.88 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 16 | $66,695 | $8,672 | $16,807 | 1.59 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 16 | $30,021 | $5,900 | $7,565 | 0.90 |
| Cervical spinal fusion without cc/mccMS-DRG 473, surgical | 14 | $61,049 | $12,683 | $15,384 | 2.46 |
| Medical back problems with MCCMS-DRG 551, medical | 14 | $56,535 | $9,463 | $14,247 | 1.70 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 13 | $109,516 | $19,453 | $27,598 | 2.99 |
| Lower extremity and humerus procedures except hip, foot and femur with MCCMS-DRG 492, surgical | 12 | $101,640 | $22,609 | $25,613 | 3.46 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 11 | $85,123 | $17,699 | $21,451 | 2.96 |
Digestive system405 discharges in 13 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 | 67 | $29,072 | $5,462 | $7,326 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 56 | $32,786 | $7,056 | $8,262 | 0.98 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 52 | $77,899 | $14,516 | $19,631 | 2.37 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 50 | $156,427 | $32,230 | $39,419 | 4.52 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 33 | $68,866 | $12,834 | $17,354 | 1.79 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 26 | $33,321 | $6,625 | $8,397 | 0.94 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 24 | $26,745 | $5,556 | $6,740 | 0.80 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 22 | $44,912 | $8,513 | $11,318 | 1.28 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 19 | $37,028 | $7,833 | $9,331 | 1.04 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 17 | $44,599 | $11,025 | $11,239 | 1.62 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 15 | $19,553 | $3,841 | $4,927 | 0.56 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 13 | $37,517 | $11,185 | $9,454 | 1.75 |
| Digestive malignancy with MCCMS-DRG 374, medical | 11 | $48,068 | $14,273 | $12,113 | 2.10 |
Kidney and urinary tract372 discharges in 8 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Renal failure with CCMS-DRG 683, medical | 92 | $28,903 | $6,441 | $7,283 | 0.90 |
| Renal failure with MCCMS-DRG 682, medical | 74 | $44,264 | $10,525 | $11,155 | 1.50 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 72 | $33,124 | $5,785 | $8,347 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 41 | $34,355 | $7,980 | $8,658 | 1.17 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 34 | $50,175 | $8,693 | $12,644 | 1.35 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 28 | $49,369 | $11,239 | $12,441 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 17 | $31,614 | $7,231 | $7,967 | 1.02 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 14 | $139,316 | $23,817 | $35,108 | 3.70 |
Endocrine, nutritional and metabolic260 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 | 91 | $47,005 | $9,025 | $11,845 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 70 | $25,673 | $5,483 | $6,470 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 36 | $34,431 | $4,510 | $8,677 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 26 | $42,789 | $9,793 | $10,783 | 1.45 |
| Endocrine disorders with CCMS-DRG 644, medical | 15 | $31,885 | $7,033 | $8,035 | 1.06 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 11 | $47,309 | $12,043 | $11,922 | 1.98 |
| Endocrine disorders with MCCMS-DRG 643, medical | 11 | $80,191 | $11,166 | $20,208 | 1.65 |
Mental diseases and disorders204 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| PsychosesMS-DRG 885, medical | 190 | $22,296 | $9,584 | $5,619 | 1.37 |
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 14 | $28,531 | $11,145 | $7,190 | 1.76 |
Liver, gallbladder and pancreas102 discharges in 7 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 22 | $82,638 | $10,708 | $20,825 | 1.63 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 16 | $75,485 | $13,639 | $19,022 | 1.83 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 14 | $44,495 | $7,499 | $11,213 | 1.09 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 13 | $55,858 | $13,628 | $14,076 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 13 | $45,713 | $7,099 | $11,520 | 0.95 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 12 | $83,528 | $14,483 | $21,049 | 2.32 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 12 | $62,364 | $11,620 | $15,716 | 1.63 |
Skin, subcutaneous tissue and breast64 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 50 | $28,774 | $6,110 | $7,251 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 14 | $61,272 | $12,906 | $15,440 | 1.49 |
Injuries, poisonings and toxic effects of drugs62 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 15 | $44,053 | $10,929 | $11,101 | 1.60 |
| Complications of treatment with MCCMS-DRG 919, medical | 13 | $74,766 | $12,759 | $18,841 | 1.82 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 12 | $172,751 | $27,051 | $43,533 | 3.72 |
| Poisoning and toxic effects of drugs without MCCMS-DRG 918, medical | 11 | $43,240 | $6,437 | $10,896 | 0.86 |
| Complications of treatment with CCMS-DRG 920, medical | 11 | $42,125 | $7,494 | $10,615 | 1.03 |
Other61 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Single level combined anterior and posterior spinal fusion except cervicalMS-DRG 402 | 18 | $113,700 | $23,478 | $28,652 | |
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 18 | $187,775 | $32,026 | $47,319 | 4.74 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 13 | $111,904 | $19,983 | $28,200 | 3.38 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 12 | $89,404 | $16,651 | $22,530 | 2.49 |
Blood and immune system57 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders with MCCMS-DRG 811, medical | 23 | $39,039 | $9,454 | $9,838 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 19 | $42,131 | $6,870 | $10,617 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 15 | $44,249 | $11,142 | $11,151 | 1.56 |
Alcohol and drug use19 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 | 19 | $19,262 | $6,048 | $4,854 | 0.86 |
Factors influencing health status16 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 | 16 | $35,468 | $5,427 | $8,938 | 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 |
|---|---|---|---|---|---|
| Comprehensive Observation ServicesAPC 8011 | 428 | 415 | $18,768 | $1,809 | $2,090 |
| Level 1 Nerve ProceduresAPC 5431 | 418 | 317 | $9,710 | $1,274 | $1,407 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 391 | 367 | $48,954 | $9,322 | $10,772 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 360 | 338 | $8,465 | $1,066 | $1,220 |
| Level 2 Upper GI ProceduresAPC 5302 | 271 | 236 | $10,154 | $1,258 | $1,445 |
| Level 4 Urology and Related ServicesAPC 5374 | 266 | 223 | $24,695 | $2,281 | $2,629 |
| Level 1 Endovascular ProceduresAPC 5191 | 250 | 247 | $20,627 | $1,953 | $2,208 |
| Level 5 Urology and Related ServicesAPC 5375 | 247 | 230 | $27,442 | $3,423 | $3,918 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 232 | 221 | $33,935 | $4,709 | $5,339 |
| Level 1 Intraocular ProceduresAPC 5491 | 205 | 139 | $12,900 | $1,550 | $1,752 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 199 | 195 | $36,645 | $3,806 | $4,358 |
| Level 3 Vascular ProceduresAPC 5183 | 189 | 170 | $17,510 | $1,987 | $2,405 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 151 | 147 | $16,864 | $2,139 | $2,373 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 145 | 140 | $123,339 | $17,863 | $21,117 |
| Level 3 Endovascular ProceduresAPC 5193 | 132 | 124 | $70,039 | $7,549 | $8,874 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 122 | 121 | $51,598 | $6,802 | $8,164 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 121 | 116 | $13,705 | $1,855 | $2,141 |
| Level 3 Urology and Related ServicesAPC 5373 | 100 | 76 | $14,409 | $1,227 | $1,516 |
| Level 4 Endovascular ProceduresAPC 5194 | 86 | 76 | $86,488 | $12,475 | $14,606 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 85 | 80 | $62,395 | $13,841 | $15,763 |
| Level 5 ENT ProceduresAPC 5165 | 83 | 82 | $30,684 | $3,876 | $4,436 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 82 | 80 | $10,886 | $1,050 | $1,196 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 77 | 76 | $110,512 | $24,110 | $26,719 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 76 | 75 | $37,935 | $4,309 | $4,982 |
| Level 2 Endovascular ProceduresAPC 5192 | 72 | 64 | $29,839 | $3,772 | $4,338 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 72 | 72 | $42,478 | $7,241 | $8,569 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 71 | 63 | $22,581 | $2,552 | $2,930 |
| Level 3 Airway EndoscopyAPC 5153 | 68 | 67 | $12,544 | $1,101 | $1,264 |
| Level 3 Lower GI ProceduresAPC 5313 | 60 | 60 | $15,541 | $1,928 | $2,176 |
| Level 2 Vascular ProceduresAPC 5182 | 59 | 55 | $8,683 | $1,053 | $1,204 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 55 | 33 | $18,574 | $2,749 | $4,524 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 51 | 45 | $19,185 | $2,227 | $2,636 |
| Level 4 Vascular ProceduresAPC 5184 | 49 | 46 | $39,488 | $3,682 | $3,946 |
| Level 5 Airway EndoscopyAPC 5155 | 47 | 47 | $25,751 | $4,585 | $5,183 |
| Level 3 Upper GI ProceduresAPC 5303 | 45 | 44 | $21,923 | $2,566 | $2,888 |
| Level 4 Airway EndoscopyAPC 5154 | 44 | 40 | $19,571 | $2,509 | $2,833 |
| Level 4 Gynecologic ProceduresAPC 5414 | 41 | 41 | $20,802 | $2,094 | $2,389 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 39 | 37 | $79,046 | $16,720 | $18,465 |
| Complex GI ProceduresAPC 5331 | 35 | 28 | $26,885 | $3,600 | $4,263 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 30 | 30 | $29,252 | $5,003 | $5,682 |
| Level 4 ENT ProceduresAPC 5164 | 29 | 29 | $14,062 | $2,157 | $2,217 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 28 | 28 | $35,740 | $5,692 | $6,514 |
| Level 6 Urology and Related ServicesAPC 5376 | 18 | 18 | $49,998 | $6,172 | $7,291 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 17 | 17 | $149,163 | $25,951 | $29,375 |
| Level 5 Gynecologic ProceduresAPC 5415 | 16 | 11 | $25,791 | $3,319 | $3,792 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 15 | 15 | $89,209 | $14,718 | $17,052 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 15 | 15 | $11,902 | $1,560 | $1,780 |
| Level 7 Radiation TherapyAPC 5627 | 14 | 11 | $51,869 | $5,217 | $6,121 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 13 | 13 | $24,395 | $6,315 | $7,546 |
| Level 2 Urology and Related ServicesAPC 5372 | 13 | 13 | $7,349 | $408 | $502 |
| Level 4 Breast/Lymphatic Surgery and Related ProceduresAPC 5094 | 11 | 11 | $42,809 | $11,962 | $15,549 |
| Level 1 Neurostimulator and Related ProceduresAPC 5461 | 11 | 11 | $18,856 | $2,280 | $2,547 |
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.