North Shore University Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for North Shore University Hospital, Manhasset, NY in 2024, from traditional Medicare claims. Back to the North Shore University Hospital profile, with quality ratings, finances and negotiated rates.
12,259
Medicare inpatient discharges
In 245 published DRGs
2.11
Case mix index
IPPS FY 2027
25%
Surgical stays
65%
Stays with complications
In DRGs with a CC or MCC
8,874
Medicare outpatient services
In 49 service groups
Inpatient stays by major diagnostic category
Circulatory system2,738 discharges in 48 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 455 | $144,582 | $13,356 | $22,410 | 1.28 |
| Syncope and collapseMS-DRG 312, medical | 190 | $87,147 | $7,823 | $13,508 | 0.86 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 153 | $249,893 | $48,261 | $38,733 | 4.88 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 141 | $132,579 | $15,686 | $20,550 | 1.82 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 113 | $90,858 | $9,393 | $14,083 | 1.08 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 112 | $191,879 | $21,256 | $29,741 | 2.09 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 109 | $230,794 | $22,682 | $35,773 | 2.16 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 101 | $76,149 | $6,965 | $11,803 | 0.74 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 95 | $206,335 | $31,927 | $31,982 | 3.24 |
| Chest painMS-DRG 313, medical | 85 | $64,492 | $6,091 | $9,996 | 0.72 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 83 | $227,039 | $27,691 | $35,191 | 2.87 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 82 | $113,346 | $11,814 | $17,569 | 1.20 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 60 | $475,214 | $71,211 | $73,658 | 6.25 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 51 | $167,556 | $17,242 | $25,971 | 1.59 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 51 | $77,051 | $10,274 | $11,943 | 1.07 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 47 | $164,712 | $16,784 | $25,530 | 1.58 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 46 | $408,759 | $53,233 | $63,358 | 5.06 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 41 | $142,458 | $22,775 | $22,081 | 2.28 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 41 | $241,537 | $32,495 | $37,438 | 3.35 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 37 | $97,430 | $9,168 | $15,102 | 0.97 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 36 | $83,700 | $8,471 | $12,974 | 0.91 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 35 | $611,888 | $83,666 | $94,843 | 7.71 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 35 | $429,465 | $57,676 | $66,567 | 5.88 |
| Other vascular procedures with CCMS-DRG 253, surgical | 33 | $155,924 | $25,062 | $24,168 | 2.55 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 33 | $59,063 | $4,189 | $9,155 | 0.55 |
| Other cardiothoracic procedures without MCCMS-DRG 229, surgical | 31 | $170,694 | $32,580 | $26,458 | 3.18 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 29 | $111,095 | $17,185 | $17,220 | 1.83 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 28 | $339,542 | $37,343 | $52,629 | 3.27 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 28 | $290,004 | $41,175 | $44,951 | 3.90 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 27 | $269,851 | $36,085 | $41,827 | 4.04 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 26 | $571,736 | $100,176 | $88,619 | 9.71 |
| Other cardiothoracic procedures with MCCMS-DRG 228, surgical | 26 | $399,824 | $60,205 | $61,973 | 5.04 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 26 | $345,868 | $48,487 | $53,609 | 5.20 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 24 | $362,760 | $47,976 | $56,228 | 4.81 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 20 | $495,822 | $70,831 | $76,852 | 7.80 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 20 | $182,609 | $41,450 | $28,304 | 4.16 |
| Cardiac defibrillator implant without MCCMS-DRG 277, surgical | 20 | $282,951 | $45,714 | $43,857 | 4.78 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 19 | $184,400 | $34,540 | $28,582 | 3.46 |
| Hypertension without MCCMS-DRG 305, medical | 19 | $81,961 | $6,611 | $12,704 | 0.75 |
| Cardiac congenital and valvular disorders with MCCMS-DRG 306, medical | 19 | $159,002 | $13,928 | $24,645 | 1.54 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 16 | $223,193 | $25,139 | $34,595 | 2.81 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 16 | $219,170 | $32,527 | $33,971 | 3.46 |
| Heart failure and shock with CCMS-DRG 292, medical | 15 | $76,387 | $8,400 | $11,840 | 0.86 |
| Atherosclerosis without MCCMS-DRG 303, medical | 15 | $65,462 | $5,262 | $10,147 | 0.66 |
| Cardiac congenital and valvular disorders without MCCMS-DRG 307, medical | 14 | $84,567 | $8,337 | $13,108 | 0.94 |
| Concomitant aortic and mitral valve proceduresMS-DRG 212, surgical | 13 | $723,863 | $114,797 | $112,199 | 10.77 |
| Cardiac pacemaker revision except device replacement with MCCMS-DRG 260, surgical | 11 | $206,025 | $31,068 | $31,934 | 3.32 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 11 | $51,602 | $4,973 | $7,998 | 0.72 |
Infectious and parasitic diseases1,764 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 | 1,177 | $179,219 | $19,970 | $27,779 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 237 | $92,271 | $9,189 | $14,302 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 153 | $404,800 | $51,767 | $62,744 | 5.00 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 48 | $673,222 | $80,514 | $104,349 | 6.96 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 24 | $168,498 | $18,787 | $26,117 | 2.04 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 22 | $153,805 | $17,811 | $23,840 | 1.84 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 22 | $88,637 | $9,361 | $13,739 | 1.01 |
| Viral illness without MCCMS-DRG 866, medical | 21 | $97,672 | $8,932 | $15,139 | 0.92 |
| Fever and inflammatory conditionsMS-DRG 864, medical | 19 | $67,270 | $8,133 | $10,427 | 0.88 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 17 | $292,191 | $43,439 | $45,290 | 4.43 |
| Viral illness with MCCMS-DRG 865, medical | 13 | $107,675 | $14,600 | $16,690 | 1.64 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 11 | $169,367 | $21,859 | $26,252 | 2.14 |
Musculoskeletal system and connective tissue1,431 discharges in 35 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 | 242 | $94,640 | $16,403 | $14,669 | 1.88 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 162 | $131,967 | $19,873 | $20,455 | 2.07 |
| Medical back problems without MCCMS-DRG 552, medical | 149 | $84,974 | $8,478 | $13,171 | 0.97 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 82 | $72,066 | $7,940 | $11,170 | 0.90 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 69 | $138,280 | $19,088 | $21,433 | 2.11 |
| Medical back problems with MCCMS-DRG 551, medical | 54 | $133,212 | $17,102 | $20,648 | 1.70 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 50 | $76,193 | $6,759 | $11,810 | 0.79 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 42 | $92,090 | $15,379 | $14,274 | 1.59 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 39 | $69,541 | $7,472 | $10,779 | 0.82 |
| Signs and symptoms of musculoskeletal system and connective tissue without MCCMS-DRG 556, medical | 39 | $66,630 | $7,566 | $10,328 | 0.82 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 38 | $206,711 | $30,380 | $32,040 | 2.95 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 31 | $320,948 | $60,386 | $49,747 | 6.12 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 30 | $185,462 | $28,048 | $28,747 | 2.99 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 29 | $208,571 | $35,102 | $32,329 | 3.66 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 27 | $82,574 | $10,443 | $12,799 | 1.09 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 25 | $153,478 | $27,219 | $23,789 | 2.96 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 25 | $136,689 | $22,910 | $21,187 | 2.40 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 23 | $140,170 | $23,473 | $21,726 | 2.67 |
| Lower extremity and humerus procedures except hip, foot and femur without cc/mccMS-DRG 494, surgical | 23 | $116,896 | $17,546 | $18,119 | 1.87 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 23 | $165,168 | $17,653 | $25,601 | 1.82 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with MCCMS-DRG 562, medical | 22 | $148,062 | $15,604 | $22,950 | 1.52 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 21 | $136,689 | $23,126 | $21,187 | 2.48 |
| Other musculoskeletal system and connective tissue diagnoses with CCMS-DRG 565, medical | 21 | $80,720 | $9,261 | $12,512 | 1.00 |
| Fractures of hip and pelvis with MCCMS-DRG 535, medical | 20 | $88,471 | $12,566 | $13,713 | 1.30 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 18 | $196,935 | $32,403 | $30,525 | 3.49 |
| Connective tissue disorders with MCCMS-DRG 545, medical | 16 | $182,887 | $22,524 | $28,347 | 2.49 |
| Connective tissue disorders with CCMS-DRG 546, medical | 14 | $144,297 | $9,898 | $22,366 | 1.20 |
| Spinal fusion except cervical with spinal curvature, malignancy, infection or extensiveMS-DRG 457, surgical | 13 | $396,274 | $57,535 | $61,423 | 6.08 |
| Osteomyelitis with MCCMS-DRG 539, medical | 13 | $149,784 | $18,875 | $23,217 | 1.98 |
| Other musculoskeletal system and connective tissue diagnoses with MCCMS-DRG 564, medical | 13 | $107,684 | $15,465 | $16,691 | 1.56 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 12 | $221,555 | $46,116 | $34,341 | 4.61 |
| Bone diseases and arthropathies with MCCMS-DRG 553, medical | 12 | $84,149 | $11,883 | $13,043 | 1.35 |
| Tendonitis, myositis and bursitis with MCCMS-DRG 557, medical | 12 | $154,659 | $14,264 | $23,972 | 1.56 |
| Tendonitis, myositis and bursitis without MCCMS-DRG 558, medical | 11 | $84,252 | $8,129 | $13,059 | 0.88 |
| Aftercare, musculoskeletal system and connective tissue with CCMS-DRG 560, medical | 11 | $77,340 | $10,191 | $11,988 | 1.13 |
Respiratory system1,242 discharges in 24 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 286 | $154,010 | $16,550 | $23,872 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 137 | $112,788 | $12,389 | $17,482 | 1.33 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 108 | $158,699 | $13,370 | $24,598 | 1.23 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 85 | $171,935 | $14,160 | $26,650 | 1.40 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 74 | $80,488 | $7,342 | $12,476 | 0.82 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 66 | $145,131 | $10,981 | $22,495 | 1.10 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 64 | $92,820 | $8,621 | $14,387 | 0.99 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 59 | $99,882 | $8,274 | $15,482 | 0.96 |
| Major chest trauma with CCMS-DRG 184, medical | 41 | $80,660 | $9,330 | $12,502 | 1.05 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 33 | $189,758 | $15,995 | $29,413 | 1.74 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 33 | $260,325 | $30,333 | $40,350 | 2.70 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 30 | $87,911 | $7,056 | $13,626 | 0.82 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 28 | $216,072 | $21,195 | $33,491 | 1.90 |
| Major chest trauma with MCCMS-DRG 183, medical | 27 | $87,220 | $14,775 | $13,519 | 1.57 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 24 | $135,522 | $16,257 | $21,006 | 1.81 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 23 | $88,120 | $8,789 | $13,659 | 0.91 |
| Respiratory signs and symptomsMS-DRG 204, medical | 20 | $82,373 | $7,432 | $12,768 | 0.82 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 18 | $382,111 | $46,148 | $59,227 | 4.06 |
| Pleural effusion with MCCMS-DRG 186, medical | 18 | $121,771 | $14,597 | $18,874 | 1.55 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 18 | $80,238 | $7,496 | $12,437 | 0.85 |
| Simple pneumonia and pleurisy without cc/mccMS-DRG 195, medical | 13 | $52,908 | $4,982 | $8,201 | 0.63 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 13 | $615,654 | $66,926 | $95,426 | 6.91 |
| Respiratory infections and inflammations without cc/mccMS-DRG 179, medical | 12 | $69,929 | $6,732 | $10,839 | 0.76 |
| Major chest trauma without cc/mccMS-DRG 185, medical | 12 | $48,821 | $5,952 | $7,567 | 0.76 |
Digestive system1,155 discharges in 21 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 | 202 | $69,362 | $6,938 | $10,751 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 145 | $87,413 | $8,919 | $13,549 | 0.98 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 101 | $123,371 | $12,618 | $19,123 | 1.28 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 94 | $131,763 | $22,961 | $20,423 | 2.37 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 89 | $148,246 | $17,961 | $22,978 | 1.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 80 | $316,010 | $47,510 | $48,982 | 4.52 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 69 | $83,027 | $8,247 | $12,869 | 0.94 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 59 | $143,644 | $16,262 | $22,265 | 1.62 |
| Digestive malignancy with MCCMS-DRG 374, medical | 42 | $178,179 | $22,275 | $27,618 | 2.10 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 39 | $74,396 | $7,144 | $11,531 | 0.80 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 33 | $83,528 | $15,812 | $12,947 | 1.67 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 32 | $96,231 | $9,450 | $14,916 | 1.04 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 31 | $147,210 | $15,652 | $22,818 | 1.45 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 23 | $165,617 | $16,808 | $25,671 | 1.75 |
| Digestive malignancy with CCMS-DRG 375, medical | 23 | $108,955 | $11,773 | $16,888 | 1.20 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 23 | $47,953 | $4,012 | $7,433 | 0.56 |
| Gastrointestinal hemorrhage without cc/mccMS-DRG 379, medical | 19 | $52,466 | $5,200 | $8,132 | 0.63 |
| Major gastrointestinal disorders and peritoneal infections without cc/mccMS-DRG 373, medical | 15 | $62,146 | $5,495 | $9,633 | 0.72 |
| Inflammatory bowel disease with CCMS-DRG 386, medical | 14 | $60,475 | $8,639 | $9,374 | 0.97 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 11 | $389,187 | $51,250 | $60,324 | 5.08 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 11 | $119,951 | $18,842 | $18,592 | 2.11 |
Kidney and urinary tract1,060 discharges in 14 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 212 | $81,954 | $7,039 | $12,703 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 194 | $113,073 | $10,997 | $17,526 | 1.17 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 174 | $152,840 | $16,275 | $23,690 | 1.65 |
| Renal failure with MCCMS-DRG 682, medical | 121 | $167,706 | $15,656 | $25,994 | 1.50 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 103 | $104,585 | $9,508 | $16,211 | 1.02 |
| Renal failure with CCMS-DRG 683, medical | 81 | $102,963 | $8,741 | $15,959 | 0.90 |
| Kidney transplantMS-DRG 652, surgical | 35 | $377,951 | $29,656 | $58,582 | 3.00 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 35 | $108,585 | $12,593 | $16,831 | 1.35 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 23 | $264,776 | $29,324 | $41,040 | 2.59 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 21 | $372,329 | $41,361 | $57,711 | 3.70 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 20 | $477,887 | $47,337 | $74,073 | 4.50 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 15 | $79,988 | $9,900 | $12,398 | 1.05 |
| Urinary stones without MCCMS-DRG 694, medical | 15 | $62,306 | $6,280 | $9,657 | 0.78 |
| Kidney and urinary tract signs and symptoms without MCCMS-DRG 696, medical | 11 | $66,172 | $6,542 | $10,257 | 0.69 |
Nervous system1,034 discharges in 30 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 122 | $198,683 | $20,068 | $30,796 | 2.00 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 87 | $114,887 | $12,544 | $17,807 | 1.36 |
| Seizures without MCCMS-DRG 101, medical | 80 | $145,203 | $8,963 | $22,507 | 0.91 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 71 | $387,966 | $48,528 | $60,135 | 4.42 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 66 | $169,764 | $25,484 | $26,313 | 2.39 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 61 | $95,128 | $9,553 | $14,745 | 1.03 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 60 | $108,477 | $9,556 | $16,814 | 1.02 |
| Seizures with MCCMS-DRG 100, medical | 37 | $245,181 | $22,883 | $38,003 | 1.98 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 32 | $91,261 | $11,748 | $14,145 | 1.32 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 31 | $246,602 | $27,701 | $38,223 | 1.79 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 30 | $175,789 | $21,025 | $27,247 | 2.43 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 29 | $68,598 | $6,790 | $10,633 | 0.80 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 29 | $217,096 | $25,425 | $33,650 | 2.28 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 26 | $199,816 | $21,757 | $30,971 | 2.27 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 25 | $365,695 | $53,192 | $56,683 | 5.67 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 24 | $117,077 | $10,691 | $18,147 | 1.06 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 20 | $134,357 | $16,139 | $20,825 | 1.79 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 19 | $199,752 | $25,341 | $30,962 | 2.95 |
| Peripheral, cranial nerve and other nervous system procedures with MCCMS-DRG 040, surgical | 19 | $273,872 | $35,890 | $42,450 | 3.85 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 19 | $165,029 | $14,250 | $25,580 | 1.47 |
| Headaches without MCCMS-DRG 103, medical | 19 | $82,883 | $7,417 | $12,847 | 0.84 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 18 | $68,700 | $6,106 | $10,649 | 0.69 |
| Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurMS-DRG 041, surgical | 17 | $157,324 | $22,844 | $24,385 | 2.23 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 17 | $110,935 | $8,819 | $17,195 | 1.03 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 16 | $102,843 | $12,694 | $15,941 | 1.36 |
| Ventricular shunt procedures without cc/mccMS-DRG 033, surgical | 13 | $94,530 | $15,657 | $14,652 | 1.62 |
| Extracranial procedures with CCMS-DRG 038, surgical | 13 | $132,800 | $14,933 | $20,584 | 1.60 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 12 | $70,208 | $9,872 | $10,882 | 1.14 |
| Intracranial vascular procedures with principal diagnosis hemorrhage with MCCMS-DRG 020, surgical | 11 | $376,801 | $86,625 | $58,404 | 8.45 |
| Other disorders of nervous system without cc/mccMS-DRG 093, medical | 11 | $72,011 | $6,654 | $11,162 | 0.77 |
Endocrine, nutritional and metabolic371 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 | 113 | $136,988 | $12,874 | $21,233 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 105 | $68,483 | $7,047 | $10,615 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 51 | $117,814 | $9,439 | $18,261 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 37 | $136,725 | $13,883 | $21,192 | 1.45 |
| Endocrine disorders with MCCMS-DRG 643, medical | 31 | $117,693 | $16,203 | $18,242 | 1.65 |
| Endocrine disorders with CCMS-DRG 644, medical | 22 | $115,993 | $9,947 | $17,979 | 1.06 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 12 | $153,940 | $14,994 | $23,861 | 1.98 |
Liver, gallbladder and pancreas294 discharges in 12 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 | 40 | $190,141 | $17,721 | $29,472 | 1.76 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 38 | $96,629 | $10,122 | $14,977 | 1.09 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 37 | $391,729 | $35,797 | $60,718 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 33 | $223,237 | $20,737 | $34,602 | 1.83 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 33 | $123,171 | $16,517 | $19,091 | 1.63 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 20 | $115,754 | $9,358 | $17,942 | 1.03 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 19 | $65,967 | $7,987 | $10,225 | 0.86 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 19 | $101,839 | $8,889 | $15,785 | 0.95 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 17 | $130,241 | $14,942 | $20,187 | 1.63 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 14 | $123,599 | $15,924 | $19,158 | 1.67 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 13 | $94,584 | $11,172 | $14,661 | 1.31 |
| Malignancy of hepatobiliary system or pancreas with CCMS-DRG 436, medical | 11 | $111,046 | $10,543 | $17,212 | 1.10 |
Skin, subcutaneous tissue and breast265 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 136 | $75,725 | $7,740 | $11,737 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 45 | $121,029 | $14,943 | $18,759 | 1.49 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 40 | $75,406 | $8,527 | $11,688 | 0.91 |
| Skin ulcers with MCCMS-DRG 592, medical | 18 | $158,724 | $16,214 | $24,602 | 2.09 |
| Minor skin disorders without MCCMS-DRG 607, medical | 15 | $73,813 | $8,291 | $11,441 | 0.89 |
| Other skin, subcutaneous tissue and breast procedures with MCCMS-DRG 579, surgical | 11 | $322,286 | $39,903 | $49,954 | 3.34 |
Blood and immune system155 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders with MCCMS-DRG 811, medical | 53 | $137,570 | $16,054 | $21,323 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 51 | $81,324 | $8,787 | $12,605 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 35 | $138,801 | $15,638 | $21,514 | 1.56 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 16 | $203,521 | $10,181 | $31,546 | 1.20 |
Blood cancers and poorly differentiated neoplasms112 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 32 | $320,315 | $30,727 | $49,649 | 3.13 |
| Acute leukemia with MCCMS-DRG 834, medical | 27 | $520,256 | $69,177 | $80,640 | 5.60 |
| Chemotherapy without acute leukemia as secondary diagnosis with CCMS-DRG 847, medical | 24 | $88,962 | $12,824 | $13,789 | 1.21 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 17 | $135,816 | $14,809 | $21,051 | 1.57 |
| Lymphoma and non-acute leukemia with other procedures with MCCMS-DRG 823, surgical | 12 | $308,099 | $47,125 | $47,755 | 4.50 |
Injuries, poisonings and toxic effects of drugs111 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 34 | $212,934 | $24,391 | $33,005 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 22 | $80,876 | $10,152 | $12,536 | 1.03 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 18 | $175,737 | $16,676 | $27,239 | 1.60 |
| Poisoning and toxic effects of drugs without MCCMS-DRG 918, medical | 14 | $60,194 | $8,181 | $9,330 | 0.86 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 12 | $425,684 | $47,400 | $65,981 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 11 | $100,651 | $18,088 | $15,601 | 2.00 |
Mental diseases and disorders106 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 | 80 | $114,559 | $16,401 | $17,757 | 1.76 |
| PsychosesMS-DRG 885, medical | 14 | $134,827 | $13,870 | $20,898 | 1.37 |
| Acute adjustment reaction and psychosocial dysfunctionMS-DRG 880, medical | 12 | $94,129 | $9,322 | $14,590 | 0.95 |
Other104 discharges in 4 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 | 57 | $356,689 | $50,700 | $55,287 | 4.74 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 19 | $398,804 | $48,212 | $61,815 | 3.38 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 15 | $207,380 | $23,660 | $32,144 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 988, surgical | 13 | $134,278 | $14,380 | $20,813 | 1.70 |
Factors influencing health status103 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other factors influencing health statusMS-DRG 951, medical | 52 | $91,894 | $5,663 | $14,244 | 0.59 |
| Signs and symptoms without MCCMS-DRG 948, medical | 39 | $73,505 | $7,373 | $11,393 | 0.80 |
| Signs and symptoms with MCCMS-DRG 947, medical | 12 | $136,507 | $13,040 | $21,159 | 1.25 |
Transplants, ECMO and tracheostomy (pre-MDC)83 discharges in 5 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 | 33 | $2,340,880 | $279,696 | $362,836 | 21.32 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 15 | $1,700,384 | $172,468 | $263,560 | 14.70 |
| Heart transplant or implant of heart assist system with MCCMS-DRG 001, surgical | 12 | $2,735,305 | $347,236 | $423,972 | 27.10 |
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 12 | $953,330 | $105,933 | $147,766 | 10.35 |
| Allogeneic bone marrow transplantMS-DRG 014, medical | 11 | $856,443 | $132,113 | $132,749 | 11.46 |
Ear, nose, mouth and throat52 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 52 | $67,180 | $6,208 | $10,413 | 0.74 |
Multiple significant trauma31 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Limb reattachment, hip and femur procedures for multiple significant traumaMS-DRG 956, surgical | 19 | $243,284 | $36,409 | $37,709 | 3.88 |
| Other multiple significant trauma with CCMS-DRG 964, medical | 12 | $116,393 | $14,433 | $18,041 | 1.50 |
Alcohol and drug use31 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 with MCCMS-DRG 896, medical | 16 | $168,228 | $16,337 | $26,075 | 1.78 |
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 15 | $82,387 | $8,264 | $12,770 | 0.86 |
Eye17 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 | 17 | $67,628 | $6,528 | $10,482 | 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 | 1,623 | 988 | $4,078 | $591 | $502 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 1,154 | 1,029 | $10,266 | $1,398 | $1,220 |
| Level 1 Endovascular ProceduresAPC 5191 | 669 | 666 | $17,737 | $2,531 | $2,208 |
| Level 3 Urology and Related ServicesAPC 5373 | 651 | 566 | $8,981 | $1,784 | $1,516 |
| Level 3 Endovascular ProceduresAPC 5193 | 388 | 372 | $58,780 | $10,175 | $8,874 |
| Level 2 Intraocular ProceduresAPC 5492 | 374 | 360 | $19,615 | $3,448 | $3,116 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 320 | 311 | $57,623 | $12,370 | $10,772 |
| Comprehensive Observation ServicesAPC 8011 | 304 | 301 | $30,671 | $2,380 | $2,090 |
| Level 2 Upper GI ProceduresAPC 5302 | 273 | 240 | $14,082 | $1,656 | $1,445 |
| Level 4 Urology and Related ServicesAPC 5374 | 222 | 186 | $22,223 | $3,085 | $2,629 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 192 | 158 | $21,334 | $2,939 | $2,636 |
| Level 1 Nerve ProceduresAPC 5431 | 174 | 162 | $16,579 | $1,656 | $1,407 |
| Level 5 Urology and Related ServicesAPC 5375 | 173 | 162 | $31,754 | $4,570 | $3,918 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 172 | 171 | $36,660 | $6,068 | $5,339 |
| Level 3 Vascular ProceduresAPC 5183 | 171 | 152 | $19,324 | $2,802 | $2,405 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 170 | 168 | $200,246 | $24,166 | $21,117 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 160 | 154 | $16,851 | $1,393 | $1,196 |
| Level 4 Gynecologic ProceduresAPC 5414 | 158 | 156 | $21,429 | $2,626 | $2,389 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 126 | 123 | $23,807 | $2,847 | $2,373 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 124 | 124 | $32,069 | $4,915 | $4,358 |
| Level 4 Vascular ProceduresAPC 5184 | 111 | 107 | $41,099 | $4,403 | $3,946 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 110 | 107 | $19,019 | $2,492 | $2,141 |
| Level 1 Intraocular ProceduresAPC 5491 | 100 | 81 | $17,499 | $2,060 | $1,752 |
| Level 3 Lower GI ProceduresAPC 5313 | 85 | 81 | $19,333 | $2,489 | $2,176 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 75 | 75 | $63,134 | $10,091 | $8,569 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 70 | 70 | $55,630 | $7,512 | $6,514 |
| Level 3 Upper GI ProceduresAPC 5303 | 60 | 57 | $20,490 | $3,411 | $2,888 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 58 | 57 | $19,300 | $2,088 | $1,780 |
| Level 2 Endovascular ProceduresAPC 5192 | 50 | 48 | $38,063 | $4,858 | $4,338 |
| Level 2 Vascular ProceduresAPC 5182 | 45 | 44 | $7,869 | $1,359 | $1,204 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 44 | 40 | $121,930 | $31,544 | $26,719 |
| Complex GI ProceduresAPC 5331 | 43 | 36 | $28,541 | $4,991 | $4,263 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 42 | 39 | $106,691 | $21,609 | $18,465 |
| Level 5 Gynecologic ProceduresAPC 5415 | 41 | 41 | $33,862 | $4,329 | $3,792 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 39 | 39 | $60,367 | $9,071 | $8,164 |
| Level 4 Airway EndoscopyAPC 5154 | 34 | 13 | $25,446 | $3,338 | $2,833 |
| Level 4 Endovascular ProceduresAPC 5194 | 34 | 33 | $92,597 | $17,204 | $14,606 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 31 | 30 | $23,317 | $5,895 | $4,524 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 28 | 28 | $176,496 | $33,510 | $29,375 |
| Level 3 Neurostimulator and Related ProceduresAPC 5463 | 25 | 25 | $42,199 | $12,247 | $11,550 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 22 | 22 | $38,818 | $5,741 | $4,982 |
| Level 3 Intraocular ProceduresAPC 5493 | 22 | 19 | $27,357 | $4,686 | $4,004 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 21 | 21 | $80,017 | $17,451 | $15,763 |
| Implantation Wireless PA Pressure MonitorAPC 5200 | 17 | 17 | $111,405 | $30,972 | $26,955 |
| Level 6 Urology and Related ServicesAPC 5376 | 16 | 15 | $37,947 | $8,189 | $7,291 |
| Level 8 Urology and Related ServicesAPC 5378 | 15 | 15 | $88,059 | $18,208 | $17,428 |
| Level 5 Airway EndoscopyAPC 5155 | 14 | 14 | $32,054 | $5,260 | $5,183 |
| Level 4 ENT ProceduresAPC 5164 | 13 | 13 | $22,108 | $2,887 | $2,217 |
| Level 4 Extraocular, Repair, and Plastic Eye ProceduresAPC 5504 | 11 | 11 | $21,056 | $3,467 | $2,969 |
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.