Northeast Georgia Medical Center Gainesville Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Northeast Georgia Medical Center Gainesville, Gainesville, GA in 2024, from traditional Medicare claims. Back to the Northeast Georgia Medical Center Gainesville profile, with quality ratings, finances and negotiated rates.
7,885
Medicare inpatient discharges
In 188 published DRGs
2.07
Case mix index
IPPS FY 2027
30%
Surgical stays
71%
Stays with complications
In DRGs with a CC or MCC
8,327
Medicare outpatient services
In 46 service groups
Inpatient stays by major diagnostic category
Circulatory system1,931 discharges in 40 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 382 | $52,081 | $10,144 | $9,427 | 1.28 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 109 | $86,328 | $13,030 | $15,625 | 1.59 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 102 | $201,317 | $25,165 | $36,438 | 3.24 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 100 | $312,365 | $38,155 | $56,538 | 4.88 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 92 | $136,239 | $13,413 | $24,659 | 1.82 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 91 | $39,643 | $5,926 | $7,175 | 0.74 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 81 | $56,785 | $9,312 | $10,278 | 1.20 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 79 | $176,886 | $22,356 | $32,016 | 2.87 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 78 | $117,782 | $17,457 | $21,319 | 2.16 |
| Syncope and collapseMS-DRG 312, medical | 67 | $45,656 | $6,996 | $8,264 | 0.86 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 63 | $56,928 | $6,963 | $10,304 | 0.91 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 50 | $65,456 | $8,475 | $11,847 | 1.08 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 42 | $432,649 | $55,733 | $78,309 | 6.25 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 41 | $93,955 | $17,059 | $17,006 | 2.28 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 41 | $88,367 | $16,022 | $15,994 | 2.09 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 40 | $350,546 | $43,253 | $63,449 | 5.20 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 29 | $316,499 | $45,699 | $57,286 | 5.06 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 27 | $198,987 | $28,674 | $36,017 | 3.35 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 27 | $247,962 | $28,999 | $44,881 | 4.16 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 27 | $31,455 | $4,292 | $5,693 | 0.55 |
| Other vascular procedures with CCMS-DRG 253, surgical | 26 | $164,361 | $19,732 | $29,749 | 2.55 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 26 | $176,172 | $24,779 | $31,887 | 3.46 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 25 | $417,685 | $52,043 | $75,601 | 5.24 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 25 | $135,747 | $26,997 | $24,570 | 3.46 |
| Coronary intravascular lithotripsy with intraluminal device without MCCMS-DRG 324, surgical | 24 | $240,328 | $24,045 | $43,499 | 2.97 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 21 | $77,721 | $14,219 | $14,067 | 1.83 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 21 | $46,028 | $8,921 | $8,331 | 1.07 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 20 | $381,232 | $61,418 | $69,003 | 7.80 |
| Coronary intravascular lithotripsy with intraluminal device with MCCMS-DRG 323, surgical | 19 | $315,432 | $29,949 | $57,093 | 4.14 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 18 | $37,452 | $7,654 | $6,779 | 0.97 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 17 | $250,173 | $31,372 | $45,281 | 4.04 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 16 | $490,845 | $54,690 | $88,843 | 7.71 |
| Hypertension without MCCMS-DRG 305, medical | 16 | $46,490 | $6,075 | $8,415 | 0.75 |
| Chest painMS-DRG 313, medical | 16 | $33,166 | $5,684 | $6,003 | 0.72 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 14 | $65,025 | $11,611 | $11,770 | 1.58 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 13 | $223,078 | $28,406 | $40,377 | 3.27 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 12 | $153,258 | $21,368 | $27,740 | 2.81 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 12 | $49,870 | $5,752 | $9,027 | 0.72 |
| Acute myocardial infarction, expired with MCCMS-DRG 283, medical | 11 | $180,238 | $17,631 | $32,623 | 1.97 |
| Hypertension with MCCMS-DRG 304, medical | 11 | $51,585 | $9,397 | $9,337 | 1.15 |
Respiratory system1,133 discharges in 20 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 265 | $64,034 | $10,026 | $11,590 | 1.33 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 198 | $77,469 | $12,519 | $14,022 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 102 | $47,151 | $9,816 | $8,534 | 1.23 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 98 | $45,682 | $8,980 | $8,268 | 1.10 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 90 | $44,901 | $6,586 | $8,127 | 0.82 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 67 | $71,197 | $11,075 | $12,887 | 1.40 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 52 | $128,488 | $19,789 | $23,256 | 2.70 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 37 | $45,794 | $7,379 | $8,289 | 0.99 |
| Major chest procedures with CCMS-DRG 164, surgical | 31 | $166,772 | $20,193 | $30,186 | 2.55 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 31 | $44,380 | $6,387 | $8,033 | 0.82 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 23 | $39,750 | $6,848 | $7,195 | 0.85 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 22 | $101,883 | $13,834 | $18,441 | 1.74 |
| Simple pneumonia and pleurisy without cc/mccMS-DRG 195, medical | 20 | $36,949 | $4,922 | $6,688 | 0.63 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 20 | $281,181 | $43,198 | $50,894 | 6.91 |
| Pneumothorax with CCMS-DRG 200, medical | 17 | $39,685 | $7,196 | $7,183 | 1.08 |
| Major chest trauma with CCMS-DRG 184, medical | 14 | $47,734 | $7,684 | $8,640 | 1.05 |
| Pleural effusion with MCCMS-DRG 186, medical | 12 | $88,827 | $10,587 | $16,078 | 1.55 |
| Pneumothorax with MCCMS-DRG 199, medical | 12 | $60,565 | $13,977 | $10,962 | 1.77 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 11 | $125,349 | $20,312 | $22,688 | 4.06 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 11 | $47,600 | $5,336 | $8,616 | 0.96 |
Digestive system837 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 | 133 | $39,255 | $6,287 | $7,105 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 117 | $52,076 | $7,415 | $9,426 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 73 | $94,400 | $12,801 | $17,086 | 1.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 64 | $152,243 | $17,645 | $27,556 | 2.37 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 57 | $258,121 | $34,530 | $46,720 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 53 | $67,908 | $10,015 | $12,291 | 1.28 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 47 | $31,660 | $5,839 | $5,731 | 0.80 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 45 | $110,127 | $12,581 | $19,933 | 1.67 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 39 | $39,727 | $7,446 | $7,191 | 0.94 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 26 | $48,562 | $8,578 | $8,790 | 1.04 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 25 | $27,340 | $3,852 | $4,949 | 0.56 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 23 | $63,991 | $11,329 | $11,582 | 1.45 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 20 | $73,484 | $13,781 | $13,301 | 1.75 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 20 | $85,268 | $13,081 | $15,434 | 1.62 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 19 | $248,727 | $37,857 | $45,020 | 5.08 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 17 | $106,737 | $18,328 | $19,319 | 2.50 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 13 | $173,867 | $33,430 | $31,470 | 4.28 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 12 | $92,468 | $16,394 | $16,737 | 2.11 |
| Hernia procedures except inguinal and femoral without cc/mccMS-DRG 355, surgical | 12 | $64,354 | $10,532 | $11,648 | 1.36 |
| Peritoneal adhesiolysis without cc/mccMS-DRG 337, surgical | 11 | $110,414 | $9,228 | $19,985 | 1.50 |
| Gastrointestinal hemorrhage without cc/mccMS-DRG 379, medical | 11 | $36,211 | $5,061 | $6,554 | 0.63 |
Nervous system832 discharges in 26 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 | 119 | $54,180 | $7,513 | $9,807 | 1.02 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 116 | $94,721 | $15,612 | $17,144 | 2.00 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 45 | $233,727 | $34,240 | $42,305 | 4.42 |
| Seizures with MCCMS-DRG 100, medical | 39 | $118,730 | $14,117 | $21,490 | 1.98 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 35 | $65,019 | $9,878 | $11,768 | 1.36 |
| Extracranial procedures with CCMS-DRG 038, surgical | 32 | $85,483 | $12,187 | $15,472 | 1.60 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 32 | $41,083 | $5,047 | $7,436 | 0.69 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 32 | $83,545 | $13,408 | $15,122 | 1.79 |
| Seizures without MCCMS-DRG 101, medical | 32 | $53,958 | $6,705 | $9,766 | 0.91 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 31 | $48,088 | $8,187 | $8,704 | 1.03 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 29 | $77,650 | $8,726 | $14,055 | 1.14 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 29 | $79,611 | $13,983 | $14,410 | 1.79 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 28 | $41,337 | $8,498 | $7,482 | 1.06 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 25 | $249,805 | $39,277 | $45,215 | 5.67 |
| Ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent witMS-DRG 062, medical | 22 | $84,689 | $13,658 | $15,329 | 1.87 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 21 | $47,403 | $6,431 | $8,580 | 0.80 |
| Carotid artery stent procedures with CCMS-DRG 035, surgical | 19 | $188,224 | $18,346 | $34,069 | 2.30 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 19 | $105,217 | $17,941 | $19,044 | 2.28 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 18 | $154,332 | $13,501 | $27,934 | 1.81 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 17 | $195,918 | $29,469 | $35,461 | 3.79 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 17 | $58,646 | $11,525 | $10,615 | 1.47 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 17 | $66,331 | $9,581 | $12,006 | 1.36 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 17 | $56,021 | $10,136 | $10,140 | 1.32 |
| Traumatic stupor and coma >1 hour without cc/mccMS-DRG 084, medical | 16 | $49,108 | $7,292 | $8,889 | 0.92 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 14 | $107,377 | $19,055 | $19,435 | 2.39 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 11 | $202,368 | $24,212 | $36,629 | 2.43 |
Musculoskeletal system and connective tissue756 discharges in 23 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 | 168 | $132,053 | $15,827 | $23,902 | 2.07 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 96 | $124,121 | $15,694 | $22,466 | 2.11 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 63 | $155,987 | $22,553 | $28,234 | 2.95 |
| Medical back problems without MCCMS-DRG 552, medical | 56 | $48,559 | $7,091 | $8,789 | 0.97 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 30 | $107,454 | $11,731 | $19,449 | 1.59 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 30 | $143,613 | $16,448 | $25,994 | 2.40 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 30 | $48,979 | $7,112 | $8,865 | 0.90 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 29 | $364,505 | $38,446 | $65,975 | 4.61 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 29 | $196,010 | $21,561 | $35,478 | 2.96 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 25 | $35,284 | $5,994 | $6,386 | 0.79 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 23 | $221,816 | $26,696 | $40,149 | 3.66 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 21 | $217,015 | $26,827 | $39,280 | 3.49 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 20 | $146,608 | $22,829 | $26,536 | 2.99 |
| Cervical spinal fusion without cc/mccMS-DRG 473, surgical | 17 | $147,395 | $17,917 | $26,678 | 2.46 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 17 | $198,935 | $22,142 | $36,007 | 2.48 |
| Medical back problems with MCCMS-DRG 551, medical | 16 | $73,953 | $13,955 | $13,386 | 1.70 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 15 | $409,312 | $46,256 | $74,086 | 6.12 |
| Biopsies of musculoskeletal system and connective tissue with CCMS-DRG 478, surgical | 13 | $139,038 | $16,685 | $25,166 | 2.38 |
| Other musculoskeletal system and connective tissue diagnoses with CCMS-DRG 565, medical | 13 | $45,386 | $8,052 | $8,215 | 1.00 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 12 | $39,381 | $8,389 | $7,128 | 1.09 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 11 | $152,086 | $14,889 | $27,528 | 1.88 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 11 | $121,494 | $15,728 | $21,990 | 2.04 |
| Fractures of hip and pelvis with MCCMS-DRG 535, medical | 11 | $69,707 | $10,059 | $12,617 | 1.30 |
Kidney and urinary tract750 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 148 | $41,074 | $6,334 | $7,434 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 126 | $55,313 | $9,062 | $10,012 | 1.17 |
| Renal failure with CCMS-DRG 683, medical | 122 | $40,663 | $6,867 | $7,360 | 0.90 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 95 | $76,957 | $12,463 | $13,929 | 1.65 |
| Renal failure with MCCMS-DRG 682, medical | 86 | $74,125 | $11,785 | $13,417 | 1.50 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 60 | $38,799 | $7,744 | $7,023 | 1.02 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 47 | $73,579 | $10,358 | $13,318 | 1.35 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 29 | $169,719 | $30,970 | $30,719 | 3.70 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 13 | $127,430 | $18,794 | $23,065 | 2.38 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 12 | $107,128 | $19,428 | $19,390 | 2.59 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 12 | $58,846 | $8,121 | $10,651 | 1.05 |
Infectious and parasitic diseases620 discharges in 5 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 | 437 | $101,618 | $14,858 | $18,393 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 88 | $319,687 | $44,072 | $57,863 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 46 | $56,949 | $8,300 | $10,308 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 35 | $369,977 | $58,589 | $66,966 | 6.96 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 14 | $256,947 | $35,064 | $46,507 | 4.43 |
Endocrine, nutritional and metabolic328 discharges in 9 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 | 104 | $59,675 | $10,368 | $10,801 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 85 | $42,020 | $6,262 | $7,606 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 27 | $45,532 | $6,964 | $8,241 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 24 | $75,766 | $9,743 | $13,714 | 1.45 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 22 | $77,802 | $13,631 | $14,082 | 1.98 |
| Endocrine disorders with CCMS-DRG 644, medical | 22 | $43,587 | $7,639 | $7,889 | 1.06 |
| Endocrine disorders with MCCMS-DRG 643, medical | 21 | $76,270 | $13,373 | $13,805 | 1.65 |
| O.r. procedures for obesity without cc/mccMS-DRG 621, surgical | 12 | $105,398 | $10,679 | $19,077 | 1.52 |
| Other endocrine, nutritional and metabolic o.r. procedures with CCMS-DRG 629, surgical | 11 | $156,459 | $16,160 | $28,319 | 2.26 |
Liver, gallbladder and pancreas210 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 27 | $109,798 | $16,539 | $19,874 | 1.92 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 26 | $156,656 | $19,623 | $28,355 | 2.32 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 21 | $116,405 | $13,996 | $21,069 | 1.76 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 20 | $96,738 | $8,597 | $17,510 | 1.83 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 19 | $109,586 | $12,474 | $19,835 | 1.63 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 19 | $75,167 | $8,676 | $13,605 | 1.09 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 18 | $90,105 | $9,558 | $16,309 | 1.31 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 17 | $43,814 | $8,282 | $7,930 | 0.95 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 15 | $46,087 | $7,294 | $8,342 | 1.03 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 14 | $38,384 | $6,394 | $6,947 | 0.86 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 14 | $114,415 | $13,044 | $20,709 | 1.63 |
Skin, subcutaneous tissue and breast135 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 85 | $38,276 | $6,722 | $6,928 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 31 | $66,927 | $11,383 | $12,114 | 1.49 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 19 | $62,697 | $6,718 | $11,348 | 0.91 |
Blood and immune system96 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 32 | $47,665 | $6,736 | $8,627 | 0.90 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 25 | $66,474 | $11,520 | $12,032 | 1.40 |
| Coagulation disordersMS-DRG 813, medical | 15 | $76,978 | $12,579 | $13,933 | 1.56 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 13 | $47,444 | $8,341 | $8,587 | 1.20 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 11 | $82,916 | $17,064 | $15,008 | 2.19 |
Other78 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 | 35 | $274,392 | $39,810 | $49,665 | 4.74 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 19 | $181,209 | $28,411 | $32,799 | 3.38 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 13 | $89,614 | $19,686 | $16,220 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 988, surgical | 11 | $91,202 | $13,189 | $16,508 | 1.70 |
Injuries, poisonings and toxic effects of drugs52 discharges in 2 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 | 37 | $51,749 | $11,787 | $9,367 | 1.60 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 15 | $198,730 | $30,143 | $35,970 | 3.72 |
Transplants, ECMO and tracheostomy (pre-MDC)42 discharges in 2 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 | 22 | $1,085,610 | $171,163 | $196,495 | 21.32 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 20 | $535,575 | $96,029 | $96,939 | 14.70 |
Alcohol and drug use28 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 | 16 | $54,174 | $6,351 | $9,805 | 0.86 |
| Alcohol, drug abuse or dependence without rehabilitation therapy with MCCMS-DRG 896, medical | 12 | $68,532 | $12,537 | $12,404 | 1.78 |
Multiple significant trauma16 discharges in 1 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 | 16 | $198,320 | $33,401 | $35,896 | 3.88 |
Ear, nose, mouth and throat14 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 14 | $39,059 | $5,998 | $7,070 | 0.74 |
Factors influencing health status14 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 | 14 | $48,380 | $5,804 | $8,757 | 0.80 |
Mental diseases and disorders13 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 13 | $101,880 | $17,778 | $18,440 | 1.76 |
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 | 2,366 | 2,142 | $24,165 | $1,945 | $2,090 |
| Level 1 Endovascular ProceduresAPC 5191 | 485 | 480 | $28,797 | $2,087 | $2,208 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 480 | 475 | $56,187 | $4,058 | $4,358 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 446 | 419 | $14,238 | $1,142 | $1,220 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 333 | 321 | $106,615 | $10,030 | $10,772 |
| Level 5 Urology and Related ServicesAPC 5375 | 317 | 289 | $54,571 | $3,652 | $3,918 |
| Level 3 Vascular ProceduresAPC 5183 | 296 | 272 | $29,583 | $2,267 | $2,405 |
| Level 2 Upper GI ProceduresAPC 5302 | 280 | 249 | $17,848 | $1,371 | $1,445 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 273 | 266 | $76,908 | $5,159 | $5,339 |
| Level 3 Urology and Related ServicesAPC 5373 | 256 | 156 | $19,501 | $1,466 | $1,516 |
| Level 4 Urology and Related ServicesAPC 5374 | 250 | 220 | $40,842 | $2,492 | $2,629 |
| Level 3 Endovascular ProceduresAPC 5193 | 229 | 218 | $104,097 | $8,243 | $8,874 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 204 | 202 | $85,668 | $7,593 | $8,164 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 174 | 168 | $27,221 | $2,004 | $2,141 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 124 | 124 | $53,481 | $8,011 | $8,569 |
| Level 2 Endovascular ProceduresAPC 5192 | 122 | 107 | $44,546 | $4,116 | $4,338 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 117 | 115 | $38,021 | $2,291 | $2,373 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 114 | 113 | $186,597 | $19,616 | $21,117 |
| Level 4 Endovascular ProceduresAPC 5194 | 112 | 106 | $178,380 | $14,323 | $14,606 |
| Level 4 Vascular ProceduresAPC 5184 | 107 | 102 | $51,505 | $3,880 | $3,946 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 90 | 89 | $55,315 | $4,632 | $4,982 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 84 | 81 | $44,913 | $2,513 | $2,636 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 82 | 82 | $17,166 | $1,137 | $1,196 |
| Level 6 Urology and Related ServicesAPC 5376 | 81 | 79 | $69,797 | $6,652 | $7,291 |
| Level 2 Vascular ProceduresAPC 5182 | 79 | 76 | $11,544 | $1,102 | $1,204 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 72 | 67 | $33,865 | $2,577 | $2,930 |
| Level 5 ENT ProceduresAPC 5165 | 61 | 61 | $62,881 | $4,045 | $4,436 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 61 | 60 | $148,929 | $28,274 | $29,375 |
| Level 4 Gynecologic ProceduresAPC 5414 | 61 | 59 | $31,962 | $2,197 | $2,389 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 60 | 59 | $154,916 | $14,556 | $15,763 |
| Level 4 Airway EndoscopyAPC 5154 | 57 | 56 | $50,574 | $2,673 | $2,833 |
| Level 2 Urology and Related ServicesAPC 5372 | 56 | 29 | $7,114 | $470 | $502 |
| Level 1 Nerve ProceduresAPC 5431 | 52 | 47 | $26,755 | $1,322 | $1,407 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 49 | 49 | $34,992 | $6,042 | $6,514 |
| Level 5 Airway EndoscopyAPC 5155 | 45 | 44 | $74,970 | $4,972 | $5,183 |
| Level 5 Gynecologic ProceduresAPC 5415 | 38 | 37 | $51,471 | $3,613 | $3,792 |
| Level 3 Lower GI ProceduresAPC 5313 | 37 | 36 | $28,260 | $2,047 | $2,176 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 33 | 32 | $103,034 | $16,094 | $17,052 |
| Level 3 Airway EndoscopyAPC 5153 | 26 | 26 | $22,455 | $1,233 | $1,264 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 24 | 23 | $231,174 | $26,597 | $26,719 |
| Level 3 Upper GI ProceduresAPC 5303 | 22 | 21 | $38,183 | $2,656 | $2,888 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 21 | 19 | $143,264 | $18,264 | $18,465 |
| Level 7 Radiation TherapyAPC 5627 | 14 | 13 | $51,697 | $5,657 | $6,121 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 13 | 12 | $70,297 | $6,942 | $7,546 |
| Complex GI ProceduresAPC 5331 | 13 | 12 | $64,377 | $4,140 | $4,263 |
| Level 6 Gynecologic ProceduresAPC 5416 | 11 | 11 | $61,074 | $5,472 | $5,836 |
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.