Massachusetts General Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Massachusetts General Hospital, Boston, MA in 2024, from traditional Medicare claims. Back to the Massachusetts General Hospital profile, with quality ratings, finances and negotiated rates.
13,982
Medicare inpatient discharges
In 298 published DRGs
2.77
Case mix index
IPPS FY 2027
42%
Surgical stays
71%
Stays with complications
In DRGs with a CC or MCC
15,898
Medicare outpatient services
In 52 service groups
Inpatient stays by major diagnostic category
Circulatory system3,584 discharges in 53 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 466 | $78,997 | $13,441 | $19,749 | 1.28 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 263 | $337,937 | $80,983 | $84,484 | 7.71 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 256 | $98,766 | $34,351 | $24,691 | 3.24 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 200 | $152,627 | $24,648 | $38,157 | 2.16 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 196 | $245,368 | $69,785 | $61,342 | 6.25 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 179 | $169,160 | $51,930 | $42,290 | 4.88 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 119 | $83,545 | $11,789 | $20,886 | 1.08 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 110 | $171,861 | $31,849 | $42,965 | 2.87 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 107 | $38,144 | $7,141 | $9,536 | 0.74 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 107 | $109,221 | $18,241 | $27,305 | 1.82 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 102 | $120,476 | $17,693 | $30,119 | 1.59 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 99 | $103,129 | $23,154 | $25,782 | 2.09 |
| Syncope and collapseMS-DRG 312, medical | 93 | $66,947 | $8,911 | $16,737 | 0.86 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 89 | $265,221 | $59,279 | $66,305 | 5.88 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 64 | $80,438 | $23,728 | $20,109 | 2.28 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 64 | $209,493 | $42,210 | $52,373 | 3.35 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 58 | $364,725 | $69,797 | $91,181 | 5.06 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 55 | $336,032 | $74,430 | $84,008 | 7.80 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 55 | $63,716 | $11,335 | $15,929 | 1.07 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 55 | $76,445 | $11,844 | $19,111 | 1.20 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 52 | $195,044 | $44,215 | $48,761 | 3.90 |
| Other vascular procedures with CCMS-DRG 253, surgical | 51 | $150,221 | $27,176 | $37,555 | 2.55 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 50 | $106,326 | $18,215 | $26,581 | 1.58 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 49 | $57,747 | $10,694 | $14,437 | 0.97 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 47 | $242,992 | $53,228 | $60,748 | 5.24 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 47 | $228,730 | $39,615 | $57,182 | 3.27 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 44 | $69,253 | $9,381 | $17,313 | 0.91 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 41 | $168,170 | $36,373 | $42,043 | 3.46 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 37 | $176,526 | $43,910 | $44,132 | 4.16 |
| Coronary intravascular lithotripsy with intraluminal device without MCCMS-DRG 324, surgical | 31 | $153,131 | $31,866 | $38,283 | 2.97 |
| Coronary intravascular lithotripsy with intraluminal device with MCCMS-DRG 323, surgical | 30 | $245,273 | $52,350 | $61,318 | 4.14 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 29 | $150,255 | $37,683 | $37,564 | 3.46 |
| Other cardiothoracic procedures with MCCMS-DRG 228, surgical | 27 | $233,453 | $62,006 | $58,363 | 5.04 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 26 | $525,945 | $111,325 | $131,486 | 9.71 |
| Hypertension without MCCMS-DRG 305, medical | 23 | $35,537 | $7,407 | $8,884 | 0.75 |
| Atherosclerosis without MCCMS-DRG 303, medical | 22 | $55,210 | $6,847 | $13,803 | 0.66 |
| Acute myocardial infarction, expired with MCCMS-DRG 283, medical | 19 | $166,303 | $24,118 | $41,576 | 1.97 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 18 | $362,893 | $67,625 | $90,723 | 4.81 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 17 | $25,381 | $4,065 | $6,345 | 0.55 |
| Other cardiothoracic procedures without MCCMS-DRG 229, surgical | 16 | $134,221 | $29,721 | $33,555 | 3.18 |
| Percutaneous cardiovascular procedures without intraluminal device with MCCMS-DRG 250, surgical | 16 | $188,179 | $27,193 | $47,045 | 2.35 |
| Cardiac defibrillator implant with cardiac catheterization and MCCMS-DRG 275, surgical | 16 | $305,475 | $76,349 | $76,369 | 7.04 |
| Cardiac congenital and valvular disorders with MCCMS-DRG 306, medical | 16 | $85,660 | $15,711 | $21,415 | 1.54 |
| Heart failure and shock with CCMS-DRG 292, medical | 15 | $41,425 | $7,933 | $10,356 | 0.86 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 14 | $200,944 | $40,661 | $50,236 | 4.04 |
| Aortic and heart assist procedures except pulsation balloon with MCCMS-DRG 268, surgical | 13 | $499,103 | $75,502 | $124,776 | 6.85 |
| Atherosclerosis with MCCMS-DRG 302, medical | 13 | $55,485 | $11,097 | $13,871 | 1.12 |
| Cardiac defibrillator implant without MCCMS-DRG 277, surgical | 12 | $155,915 | $51,560 | $38,979 | 4.78 |
| Chest painMS-DRG 313, medical | 12 | $80,541 | $6,908 | $20,135 | 0.72 |
| Other heart assist system implantMS-DRG 215, surgical | 11 | $509,050 | $125,592 | $127,262 | 10.21 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 11 | $148,735 | $30,321 | $37,184 | 2.81 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 11 | $53,025 | $5,700 | $13,256 | 0.72 |
| Hypertension with MCCMS-DRG 304, medical | 11 | $117,271 | $12,336 | $29,318 | 1.15 |
Respiratory system1,466 discharges in 27 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 329 | $89,121 | $17,031 | $22,280 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 149 | $70,792 | $13,295 | $17,698 | 1.33 |
| Major chest procedures with CCMS-DRG 164, surgical | 127 | $96,764 | $25,679 | $24,191 | 2.55 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 91 | $61,942 | $9,863 | $15,486 | 0.99 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 89 | $43,603 | $7,502 | $10,901 | 0.82 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 74 | $62,036 | $11,124 | $15,509 | 1.10 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 49 | $69,445 | $12,148 | $17,361 | 1.23 |
| Major chest procedures with MCCMS-DRG 163, surgical | 47 | $180,896 | $50,749 | $45,224 | 4.71 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 44 | $73,733 | $18,364 | $18,433 | 1.88 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 42 | $101,101 | $14,258 | $25,275 | 1.40 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 42 | $104,631 | $18,795 | $26,158 | 1.81 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 40 | $118,077 | $18,383 | $29,519 | 1.74 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 38 | $159,806 | $26,771 | $39,951 | 2.70 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 33 | $142,131 | $22,162 | $35,533 | 1.90 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 30 | $50,209 | $7,404 | $12,552 | 0.82 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 27 | $45,157 | $8,088 | $11,289 | 0.85 |
| Major chest trauma with CCMS-DRG 184, medical | 26 | $53,538 | $10,754 | $13,384 | 1.05 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 25 | $48,792 | $9,584 | $12,198 | 0.96 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 24 | $323,213 | $72,166 | $80,803 | 6.91 |
| Major chest trauma with MCCMS-DRG 183, medical | 21 | $99,999 | $14,621 | $25,000 | 1.57 |
| Respiratory neoplasms with CCMS-DRG 181, medical | 20 | $72,773 | $10,470 | $18,193 | 1.10 |
| Pneumothorax with MCCMS-DRG 199, medical | 19 | $96,004 | $20,219 | $24,001 | 1.77 |
| Pneumothorax with CCMS-DRG 200, medical | 19 | $45,428 | $11,145 | $11,357 | 1.08 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 18 | $180,358 | $32,653 | $45,089 | 4.06 |
| Other respiratory system o.r. procedures with CCMS-DRG 167, surgical | 16 | $79,967 | $18,314 | $19,992 | 1.82 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 16 | $57,029 | $9,231 | $14,257 | 0.91 |
| Pleural effusion with CCMS-DRG 187, medical | 11 | $53,265 | $10,833 | $13,316 | 1.00 |
Musculoskeletal system and connective tissue1,464 discharges in 41 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 | 131 | $118,023 | $20,939 | $29,506 | 2.07 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 106 | $133,105 | $35,085 | $33,276 | 3.66 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 97 | $82,926 | $18,668 | $20,732 | 1.88 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 65 | $94,343 | $19,683 | $23,586 | 1.97 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 63 | $118,743 | $24,025 | $29,686 | 2.40 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 62 | $120,991 | $21,948 | $30,248 | 2.04 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 56 | $111,855 | $23,598 | $27,964 | 2.48 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 54 | $188,923 | $33,858 | $47,231 | 2.95 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 47 | $135,560 | $29,175 | $33,890 | 2.96 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 47 | $60,877 | $10,994 | $15,219 | 1.09 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 46 | $111,978 | $21,804 | $27,995 | 2.11 |
| Medical back problems without MCCMS-DRG 552, medical | 45 | $51,627 | $9,199 | $12,907 | 0.97 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 44 | $92,568 | $18,832 | $23,142 | 1.82 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 43 | $196,408 | $59,131 | $49,102 | 6.12 |
| Spinal fusion except cervical with spinal curvature, malignancy, infection or extensiveMS-DRG 457, surgical | 39 | $226,211 | $64,613 | $56,553 | 6.08 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 35 | $87,676 | $14,882 | $21,919 | 1.49 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 34 | $173,629 | $39,242 | $43,407 | 3.49 |
| Medical back problems with MCCMS-DRG 551, medical | 31 | $91,427 | $17,116 | $22,857 | 1.70 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 26 | $154,852 | $31,705 | $38,713 | 3.00 |
| Spinal fusion except cervical with spinal curvature, malignancy, infection or extensiveMS-DRG 456, surgical | 25 | $319,209 | $92,317 | $79,802 | 8.43 |
| Other musculoskeletal system and connective tissue o.r. procedures with MCCMS-DRG 515, surgical | 25 | $133,314 | $33,057 | $33,328 | 3.16 |
| Lower extremity and humerus procedures except hip, foot and femur without cc/mccMS-DRG 494, surgical | 24 | $97,632 | $19,473 | $24,408 | 1.87 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 463, surgical | 23 | $334,279 | $74,521 | $83,570 | 5.66 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 23 | $183,316 | $33,595 | $45,829 | 2.99 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 23 | $44,940 | $7,042 | $11,235 | 0.82 |
| Soft tissue procedures with CCMS-DRG 501, surgical | 21 | $82,580 | $18,037 | $20,645 | 1.74 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 19 | $124,514 | $48,600 | $31,128 | 4.61 |
| Back and neck procedures except spinal fusion without cc/mccMS-DRG 520, surgical | 19 | $88,052 | $13,166 | $22,013 | 1.43 |
| Connective tissue disorders with MCCMS-DRG 545, medical | 19 | $140,221 | $27,046 | $35,055 | 2.49 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 18 | $80,173 | $24,824 | $20,043 | 2.67 |
| Connective tissue disorders with CCMS-DRG 546, medical | 16 | $72,809 | $12,211 | $18,202 | 1.20 |
| Revision of hip or knee replacement with MCCMS-DRG 466, surgical | 15 | $262,085 | $59,785 | $65,521 | 5.19 |
| Biopsies of musculoskeletal system and connective tissue with MCCMS-DRG 477, surgical | 15 | $213,289 | $37,538 | $53,322 | 3.37 |
| Biopsies of musculoskeletal system and connective tissue with CCMS-DRG 478, surgical | 15 | $120,396 | $22,826 | $30,099 | 2.38 |
| Aftercare, musculoskeletal system and connective tissue with CCMS-DRG 560, medical | 15 | $49,048 | $11,113 | $12,262 | 1.13 |
| Major hip and knee joint replacement or reattachment of lower extremity with MCC or totaMS-DRG 469, surgical | 14 | $168,386 | $31,669 | $42,096 | 3.33 |
| Amputation for musculoskeletal system and connective tissue disorders with CCMS-DRG 475, surgical | 14 | $143,667 | $21,011 | $35,917 | 2.14 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 14 | $53,298 | $8,546 | $13,324 | 0.90 |
| Other musculoskeletal system and connective tissue diagnoses with MCCMS-DRG 564, medical | 13 | $167,000 | $25,493 | $41,750 | 1.56 |
| Cervical spinal fusion with MCCMS-DRG 471, surgical | 12 | $188,028 | $52,794 | $47,007 | 4.92 |
| Soft tissue procedures without cc/mccMS-DRG 502, surgical | 11 | $109,132 | $12,276 | $27,283 | 1.38 |
Nervous system1,373 discharges in 30 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 192 | $169,716 | $43,923 | $42,429 | 4.42 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 181 | $108,296 | $19,889 | $27,074 | 2.00 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 97 | $70,561 | $13,988 | $17,640 | 1.36 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 77 | $62,540 | $9,885 | $15,635 | 1.02 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 64 | $128,797 | $26,033 | $32,199 | 2.39 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 55 | $108,956 | $25,235 | $27,239 | 2.43 |
| Seizures with MCCMS-DRG 100, medical | 54 | $146,431 | $23,760 | $36,608 | 1.98 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 51 | $116,948 | $30,423 | $29,237 | 2.95 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 49 | $114,291 | $20,840 | $28,573 | 1.79 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 48 | $220,856 | $63,682 | $55,214 | 5.67 |
| Ventricular shunt procedures with CCMS-DRG 032, surgical | 44 | $80,392 | $22,006 | $20,098 | 2.15 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 43 | $68,890 | $14,264 | $17,223 | 1.47 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 43 | $60,150 | $10,499 | $15,038 | 1.03 |
| Seizures without MCCMS-DRG 101, medical | 40 | $80,829 | $10,049 | $20,207 | 0.91 |
| Extracranial procedures with CCMS-DRG 038, surgical | 38 | $122,094 | $16,308 | $30,523 | 1.60 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 33 | $100,224 | $23,764 | $25,056 | 2.28 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 32 | $109,287 | $23,662 | $27,322 | 2.27 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 29 | $69,244 | $11,286 | $17,311 | 1.03 |
| Ventricular shunt procedures without cc/mccMS-DRG 033, surgical | 28 | $74,679 | $16,204 | $18,670 | 1.62 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 27 | $86,732 | $11,148 | $21,683 | 1.14 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 22 | $61,263 | $13,728 | $15,316 | 1.36 |
| Intracranial vascular procedures with principal diagnosis hemorrhage with MCCMS-DRG 020, surgical | 21 | $143,467 | $86,422 | $35,867 | 8.45 |
| Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurMS-DRG 041, surgical | 16 | $91,802 | $23,967 | $22,951 | 2.23 |
| Peripheral, cranial nerve and other nervous system procedures with MCCMS-DRG 040, surgical | 15 | $294,596 | $59,901 | $73,649 | 3.85 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 15 | $33,268 | $13,322 | $8,317 | 1.32 |
| Ventricular shunt procedures with MCCMS-DRG 031, surgical | 13 | $161,482 | $40,814 | $40,370 | 4.12 |
| Spinal procedures with CC or spinal neurostimulatorsMS-DRG 029, surgical | 12 | $115,477 | $34,630 | $28,869 | 3.43 |
| Non-bacterial infection of nervous system except viral meningitis with MCCMS-DRG 097, medical | 12 | $168,707 | $35,472 | $42,177 | 3.64 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 11 | $50,834 | $5,889 | $12,708 | 0.69 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 11 | $109,510 | $21,982 | $27,377 | 1.79 |
Digestive system1,337 discharges in 26 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 147 | $110,176 | $24,627 | $27,544 | 2.37 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 131 | $52,115 | $7,771 | $13,029 | 0.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 108 | $196,810 | $47,444 | $49,203 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 92 | $66,559 | $13,218 | $16,640 | 1.28 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 89 | $106,674 | $19,153 | $26,668 | 1.79 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 89 | $56,155 | $10,069 | $14,039 | 0.94 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 86 | $89,463 | $18,609 | $22,366 | 1.62 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 79 | $48,312 | $9,513 | $12,078 | 0.98 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 60 | $46,958 | $7,827 | $11,739 | 0.80 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 46 | $123,652 | $25,445 | $30,913 | 2.50 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 46 | $70,375 | $16,907 | $17,594 | 1.67 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 41 | $239,552 | $52,130 | $59,888 | 5.08 |
| Digestive malignancy with MCCMS-DRG 374, medical | 40 | $114,668 | $24,262 | $28,667 | 2.10 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 37 | $91,330 | $14,386 | $22,832 | 1.45 |
| Digestive malignancy with CCMS-DRG 375, medical | 36 | $60,773 | $11,544 | $15,193 | 1.20 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 30 | $225,767 | $54,425 | $56,442 | 4.28 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 28 | $56,118 | $10,920 | $14,030 | 1.04 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 26 | $76,140 | $17,351 | $19,035 | 1.75 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 21 | $26,914 | $4,515 | $6,729 | 0.56 |
| Hernia procedures except inguinal and femoral with CCMS-DRG 354, surgical | 20 | $92,806 | $17,115 | $23,202 | 1.72 |
| Other digestive system diagnoses without cc/mccMS-DRG 395, medical | 17 | $30,019 | $6,303 | $7,505 | 0.65 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 16 | $108,815 | $20,448 | $27,204 | 2.11 |
| Hernia procedures except inguinal and femoral without cc/mccMS-DRG 355, surgical | 15 | $75,163 | $13,704 | $18,791 | 1.36 |
| Other digestive system o.r. procedures with CCMS-DRG 357, surgical | 13 | $92,928 | $22,263 | $23,232 | 2.20 |
| Inflammatory bowel disease with CCMS-DRG 386, medical | 13 | $48,440 | $9,902 | $12,110 | 0.97 |
| Peritoneal adhesiolysis without cc/mccMS-DRG 337, surgical | 11 | $93,697 | $15,842 | $23,424 | 1.50 |
Infectious and parasitic diseases1,132 discharges in 12 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 | 640 | $107,566 | $20,956 | $26,892 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 143 | $283,332 | $60,410 | $70,833 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 88 | $58,567 | $9,932 | $14,642 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 46 | $300,925 | $70,657 | $75,231 | 6.96 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 43 | $81,888 | $18,643 | $20,472 | 1.84 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 39 | $121,578 | $24,002 | $30,395 | 2.14 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 36 | $261,496 | $55,025 | $65,374 | 4.43 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 23 | $109,893 | $18,366 | $27,473 | 2.04 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 21 | $39,546 | $9,840 | $9,886 | 1.01 |
| Viral illness with MCCMS-DRG 865, medical | 21 | $99,634 | $16,116 | $24,908 | 1.64 |
| Viral illness without MCCMS-DRG 866, medical | 21 | $54,732 | $9,031 | $13,683 | 0.92 |
| Fever and inflammatory conditionsMS-DRG 864, medical | 11 | $34,703 | $8,859 | $8,676 | 0.88 |
Kidney and urinary tract945 discharges in 17 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 | 163 | $101,771 | $18,480 | $25,443 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 126 | $53,545 | $10,820 | $13,386 | 1.02 |
| Renal failure with MCCMS-DRG 682, medical | 106 | $81,669 | $15,765 | $20,417 | 1.50 |
| Renal failure with CCMS-DRG 683, medical | 92 | $49,977 | $8,959 | $12,494 | 0.90 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 92 | $69,204 | $11,865 | $17,301 | 1.17 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 78 | $42,477 | $7,705 | $10,619 | 0.81 |
| Kidney transplantMS-DRG 652, surgical | 71 | $294,194 | $31,278 | $73,548 | 3.00 |
| Kidney and ureter procedures for neoplasm with CCMS-DRG 657, surgical | 39 | $99,049 | $18,152 | $24,762 | 1.84 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 30 | $132,509 | $39,899 | $33,127 | 3.70 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 29 | $148,852 | $26,756 | $37,213 | 2.59 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 27 | $71,927 | $13,177 | $17,982 | 1.35 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 24 | $393,407 | $59,794 | $98,352 | 4.50 |
| Major bladder procedures with CCMS-DRG 654, surgical | 20 | $188,284 | $27,724 | $47,071 | 2.74 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 13 | $73,023 | $23,617 | $18,256 | 2.38 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 12 | $50,651 | $8,819 | $12,663 | 1.05 |
| Transurethral procedures with CCMS-DRG 669, surgical | 12 | $64,546 | $16,002 | $16,136 | 1.53 |
| Kidney and ureter procedures for neoplasm with MCCMS-DRG 656, surgical | 11 | $276,076 | $46,221 | $69,019 | 3.14 |
Liver, gallbladder and pancreas521 discharges in 18 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 | 65 | $85,378 | $18,264 | $21,344 | 1.76 |
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 62 | $135,211 | $30,252 | $33,803 | 2.89 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 49 | $82,356 | $17,270 | $20,589 | 1.63 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 47 | $139,688 | $21,425 | $34,922 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 46 | $104,994 | $21,190 | $26,249 | 1.83 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 39 | $300,625 | $54,658 | $75,156 | 5.51 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 29 | $68,745 | $10,707 | $17,186 | 1.09 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 22 | $130,079 | $17,100 | $32,520 | 1.67 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 21 | $61,025 | $8,502 | $15,256 | 0.86 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 20 | $94,876 | $16,079 | $23,719 | 1.63 |
| Pancreas, liver and shunt procedures without cc/mccMS-DRG 407, surgical | 19 | $111,058 | $19,981 | $27,764 | 2.15 |
| Malignancy of hepatobiliary system or pancreas with CCMS-DRG 436, medical | 18 | $49,529 | $11,270 | $12,382 | 1.10 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 17 | $58,475 | $8,880 | $14,619 | 0.95 |
| Cholecystectomy except by laparoscope without C.D.E. with CCMS-DRG 415, surgical | 15 | $101,777 | $19,224 | $25,444 | 1.98 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 15 | $101,571 | $24,871 | $25,393 | 2.32 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 14 | $77,252 | $10,363 | $19,313 | 1.03 |
| Disorders of the biliary tract without cc/mccMS-DRG 446, medical | 12 | $47,246 | $7,320 | $11,811 | 0.80 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 11 | $71,660 | $13,486 | $17,915 | 1.31 |
Endocrine, nutritional and metabolic401 discharges in 11 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 | 95 | $95,743 | $15,420 | $23,936 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 72 | $53,741 | $7,455 | $13,435 | 0.78 |
| Endocrine disorders with MCCMS-DRG 643, medical | 44 | $79,924 | $17,076 | $19,981 | 1.65 |
| Diabetes with CCMS-DRG 638, medical | 41 | $71,439 | $9,582 | $17,860 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 40 | $109,430 | $15,626 | $27,357 | 1.45 |
| Adrenal and pituitary procedures with cc/mccMS-DRG 614, surgical | 30 | $82,825 | $23,124 | $20,706 | 2.25 |
| Endocrine disorders with CCMS-DRG 644, medical | 26 | $53,198 | $10,442 | $13,300 | 1.06 |
| Adrenal and pituitary procedures without cc/mccMS-DRG 615, surgical | 15 | $69,691 | $14,742 | $17,423 | 1.47 |
| Skin grafts and wound debridement for endocrine, nutritional and metabolic disorders witMS-DRG 623, surgical | 14 | $105,351 | $15,262 | $26,338 | 1.86 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 13 | $111,475 | $18,944 | $27,869 | 1.98 |
| Inborn and other disorders of metabolismMS-DRG 642, medical | 11 | $156,311 | $19,917 | $39,078 | 1.30 |
Blood cancers and poorly differentiated neoplasms338 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Chemotherapy without acute leukemia as secondary diagnosis with CCMS-DRG 847, medical | 71 | $54,922 | $13,099 | $13,731 | 1.21 |
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 56 | $211,302 | $39,330 | $52,825 | 3.13 |
| Chemotherapy without acute leukemia as secondary diagnosis with MCCMS-DRG 846, medical | 42 | $87,940 | $25,357 | $21,985 | 2.44 |
| Acute leukemia with MCCMS-DRG 834, medical | 38 | $409,570 | $81,532 | $102,393 | 5.60 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 34 | $94,109 | $17,246 | $23,527 | 1.57 |
| Myeloproliferative disorders or poorly differentiated neoplasms with major o.r. procedurMS-DRG 827, surgical | 22 | $129,447 | $25,546 | $32,362 | 2.32 |
| Myeloproliferative disorders or poorly differentiated neoplasms with other procedures wiMS-DRG 829, surgical | 19 | $308,481 | $61,580 | $77,120 | 3.15 |
| Lymphoma and non-acute leukemia with other procedures with MCCMS-DRG 823, surgical | 16 | $330,246 | $63,791 | $82,561 | 4.50 |
| Lymphoma and non-acute leukemia with other procedures with CCMS-DRG 824, surgical | 14 | $130,567 | $23,651 | $32,642 | 2.23 |
| Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapMS-DRG 838, medical | 14 | $83,727 | $21,752 | $20,932 | 2.00 |
| Myeloproliferative disorders or poorly differentiated neoplasms with major o.r. procedurMS-DRG 828, surgical | 12 | $77,718 | $15,651 | $19,430 | 1.64 |
Blood and immune system273 discharges in 7 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Coagulation disordersMS-DRG 813, medical | 88 | $93,192 | $17,342 | $23,298 | 1.56 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 50 | $97,974 | $16,180 | $24,493 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 50 | $54,692 | $8,962 | $13,673 | 0.90 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 31 | $109,313 | $19,265 | $27,328 | 1.20 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 28 | $95,696 | $22,316 | $23,924 | 2.19 |
| Reticuloendothelial and immunity disorders with MCCMS-DRG 814, medical | 14 | $201,859 | $40,148 | $50,465 | 2.13 |
| Reticuloendothelial and immunity disorders with CCMS-DRG 815, medical | 12 | $68,339 | $9,611 | $17,085 | 0.99 |
Transplants, ECMO and tracheostomy (pre-MDC)239 discharges in 7 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 | 63 | $1,201,916 | $262,180 | $300,479 | 21.32 |
| Chimeric antigen receptor (car) t-cell and other immunotherapiesMS-DRG 018, medical | 47 | $1,653,572 | $425,324 | $413,393 | 36.84 |
| Allogeneic bone marrow transplantMS-DRG 014, medical | 46 | $292,942 | $124,082 | $73,235 | 11.46 |
| Heart transplant or implant of heart assist system with MCCMS-DRG 001, surgical | 30 | $1,365,024 | $290,467 | $341,256 | 27.10 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 24 | $680,249 | $158,334 | $170,062 | 14.70 |
| Lung transplantMS-DRG 007, surgical | 16 | $962,281 | $135,503 | $240,570 | 12.27 |
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 13 | $808,624 | $110,032 | $202,156 | 10.35 |
Skin, subcutaneous tissue and breast183 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 60 | $52,166 | $7,822 | $13,041 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 31 | $114,158 | $19,190 | $28,539 | 1.49 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 16 | $37,194 | $9,176 | $9,298 | 0.91 |
| Other skin, subcutaneous tissue and breast procedures with CCMS-DRG 580, surgical | 15 | $96,020 | $18,005 | $24,005 | 1.75 |
| Skin graft for skin ulcer or cellulitis with CCMS-DRG 574, surgical | 13 | $140,550 | $33,485 | $35,137 | 3.41 |
| Skin graft except for skin ulcer or cellulitis with CCMS-DRG 577, surgical | 13 | $142,747 | $30,511 | $35,687 | 2.65 |
| Other skin, subcutaneous tissue and breast procedures with MCCMS-DRG 579, surgical | 12 | $120,226 | $30,748 | $30,056 | 3.34 |
| Minor skin disorders without MCCMS-DRG 607, medical | 12 | $54,808 | $8,252 | $13,702 | 0.89 |
| Skin debridement with CCMS-DRG 571, surgical | 11 | $94,207 | $15,659 | $23,552 | 1.69 |
Other180 discharges in 8 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 | 79 | $255,017 | $54,517 | $63,754 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 22 | $148,429 | $26,148 | $37,107 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 22 | $256,103 | $38,190 | $64,026 | 3.38 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 988, surgical | 13 | $103,190 | $16,981 | $25,797 | 1.70 |
| Single level combined anterior and posterior spinal fusion except cervicalMS-DRG 402 | 11 | $143,527 | $43,491 | $35,882 | |
| Multiple level spinal fusion except cervical without MCCMS-DRG 448 | 11 | $147,291 | $45,734 | $36,823 | |
| Single level spinal fusion except cervical without MCCMS-DRG 451 | 11 | $115,701 | $30,974 | $28,925 | |
| Extensive o.r. procedures unrelated to principal diagnosis without cc/mccMS-DRG 983, surgical | 11 | $83,557 | $17,206 | $20,889 | 1.64 |
Injuries, poisonings and toxic effects of drugs175 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 | 67 | $91,711 | $20,018 | $22,928 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 39 | $67,949 | $11,654 | $16,987 | 1.03 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 27 | $118,689 | $20,135 | $29,672 | 1.60 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 22 | $212,905 | $38,955 | $53,226 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 20 | $119,474 | $21,455 | $29,868 | 2.00 |
Mental diseases and disorders108 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 58 | $131,370 | $18,362 | $32,842 | 1.76 |
| PsychosesMS-DRG 885, medical | 28 | $117,766 | $16,414 | $29,442 | 1.37 |
| Acute adjustment reaction and psychosocial dysfunctionMS-DRG 880, medical | 22 | $85,030 | $11,870 | $21,258 | 0.95 |
Factors influencing health status83 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Signs and symptoms without MCCMS-DRG 948, medical | 49 | $54,067 | $7,855 | $13,517 | 0.80 |
| Signs and symptoms with MCCMS-DRG 947, medical | 21 | $73,145 | $13,864 | $18,286 | 1.25 |
| Other factors influencing health statusMS-DRG 951, medical | 13 | $42,904 | $5,775 | $10,726 | 0.59 |
Alcohol and drug use58 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 | 30 | $79,526 | $9,288 | $19,881 | 0.86 |
| Alcohol, drug abuse or dependence without rehabilitation therapy with MCCMS-DRG 896, medical | 28 | $106,897 | $18,585 | $26,724 | 1.78 |
Female reproductive system43 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Uterine and adnexa procedures for ovarian or adnexal malignancy with CCMS-DRG 737, surgical | 31 | $119,193 | $18,756 | $29,798 | 1.97 |
| Uterine and adnexa procedures for non-malignancy with cc/mccMS-DRG 742, surgical | 12 | $136,308 | $20,150 | $34,077 | 1.78 |
Male reproductive system22 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major male pelvic procedures with cc/mccMS-DRG 707, surgical | 11 | $99,190 | $18,478 | $24,798 | 1.96 |
| Major male pelvic procedures without cc/mccMS-DRG 708, surgical | 11 | $77,611 | $12,301 | $19,403 | 1.46 |
Burns19 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Full thickness burn with skin graft or inhalation injury with cc/mccMS-DRG 928, surgical | 19 | $224,834 | $69,213 | $56,208 | 6.92 |
Multiple significant trauma16 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other multiple significant trauma with MCCMS-DRG 963, medical | 16 | $125,106 | $29,541 | $31,277 | 2.73 |
Eye11 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 | 11 | $53,337 | $7,910 | $13,334 | 0.80 |
Ear, nose, mouth and throat11 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Otitis media and uri without MCCMS-DRG 153, medical | 11 | $32,081 | $6,317 | $8,020 | 0.73 |
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 | 2,507 | 2,205 | $19,776 | $2,329 | $2,090 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 1,339 | 1,258 | $8,054 | $1,372 | $1,220 |
| Level 2 Upper GI ProceduresAPC 5302 | 846 | 738 | $8,210 | $1,619 | $1,445 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 760 | 745 | $108,829 | $23,647 | $21,117 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 650 | 626 | $43,344 | $6,045 | $5,339 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 638 | 540 | $14,608 | $2,390 | $2,141 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 624 | 604 | $50,594 | $12,378 | $10,772 |
| Level 1 Endovascular ProceduresAPC 5191 | 502 | 499 | $30,021 | $2,486 | $2,208 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 473 | 465 | $35,831 | $4,874 | $4,358 |
| Level 4 Urology and Related ServicesAPC 5374 | 465 | 377 | $20,085 | $2,950 | $2,629 |
| Level 5 Urology and Related ServicesAPC 5375 | 450 | 431 | $29,561 | $4,378 | $3,918 |
| Level 3 Urology and Related ServicesAPC 5373 | 441 | 369 | $13,717 | $1,711 | $1,516 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 406 | 397 | $27,092 | $2,727 | $2,373 |
| Level 3 Vascular ProceduresAPC 5183 | 399 | 346 | $19,703 | $2,685 | $2,405 |
| Level 3 Endovascular ProceduresAPC 5193 | 377 | 341 | $77,593 | $10,113 | $8,874 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 357 | 338 | $22,664 | $2,935 | $2,636 |
| Level 4 Vascular ProceduresAPC 5184 | 337 | 182 | $19,124 | $2,679 | $3,946 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 334 | 326 | $59,535 | $9,242 | $8,164 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 333 | 306 | $26,766 | $3,242 | $2,930 |
| Level 1 Nerve ProceduresAPC 5431 | 309 | 279 | $15,318 | $1,647 | $1,407 |
| Level 2 Endovascular ProceduresAPC 5192 | 297 | 263 | $36,045 | $4,841 | $4,338 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 274 | 251 | $12,237 | $1,309 | $1,196 |
| Level 4 Airway EndoscopyAPC 5154 | 271 | 233 | $27,018 | $3,157 | $2,833 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 209 | 207 | $44,959 | $5,552 | $4,982 |
| Complex GI ProceduresAPC 5331 | 195 | 118 | $20,916 | $4,551 | $4,263 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 194 | 191 | $79,590 | $18,334 | $15,763 |
| Level 5 ENT ProceduresAPC 5165 | 180 | 179 | $41,653 | $4,935 | $4,436 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 176 | 176 | $35,754 | $9,822 | $8,569 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 154 | 154 | $36,825 | $7,437 | $6,514 |
| Level 3 Lower GI ProceduresAPC 5313 | 148 | 139 | $13,338 | $2,387 | $2,176 |
| Level 4 Endovascular ProceduresAPC 5194 | 124 | 119 | $93,282 | $17,156 | $14,606 |
| Level 4 Gynecologic ProceduresAPC 5414 | 115 | 114 | $19,687 | $2,652 | $2,389 |
| Level 2 Vascular ProceduresAPC 5182 | 107 | 103 | $9,024 | $1,356 | $1,204 |
| Level 5 Gynecologic ProceduresAPC 5415 | 97 | 95 | $32,191 | $4,212 | $3,792 |
| Level 3 Upper GI ProceduresAPC 5303 | 89 | 87 | $18,103 | $3,243 | $2,888 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 85 | 84 | $99,106 | $33,586 | $29,375 |
| Level 7 Radiation TherapyAPC 5627 | 84 | 76 | $42,817 | $6,730 | $6,121 |
| Level 3 Airway EndoscopyAPC 5153 | 75 | 66 | $10,456 | $1,451 | $1,264 |
| Level 5 Airway EndoscopyAPC 5155 | 73 | 69 | $43,465 | $5,693 | $5,183 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 73 | 48 | $24,899 | $4,326 | $4,524 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 44 | 43 | $104,629 | $31,614 | $26,719 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 42 | 41 | $69,972 | $21,799 | $18,465 |
| Level 2 Nerve ProceduresAPC 5432 | 37 | 36 | $52,656 | $5,700 | $4,674 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 35 | 35 | $62,931 | $19,242 | $17,052 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 31 | 31 | $52,557 | $23,612 | $21,011 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 30 | 30 | $56,808 | $8,483 | $7,546 |
| Level 2 Urology and Related ServicesAPC 5372 | 25 | 23 | $8,225 | $509 | $502 |
| Level 4 ENT ProceduresAPC 5164 | 22 | 22 | $24,359 | $2,755 | $2,217 |
| Level 1 Neurostimulator and Related ProceduresAPC 5461 | 22 | 22 | $25,933 | $2,911 | $2,547 |
| Level 6 Gynecologic ProceduresAPC 5416 | 17 | 17 | $55,569 | $6,483 | $5,836 |
| Level 8 Urology and Related ServicesAPC 5378 | 15 | 14 | $90,663 | $19,976 | $17,428 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 11 | 11 | $45,511 | $6,390 | $5,682 |
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.