Northwestern Memorial Hospital Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Northwestern Memorial Hospital, Chicago, IL in 2024, from traditional Medicare claims. Back to the Northwestern Memorial Hospital profile, with quality ratings, finances and negotiated rates.
9,081
Medicare inpatient discharges
In 226 published DRGs
2.78
Case mix index
IPPS FY 2027
35%
Surgical stays
73%
Stays with complications
In DRGs with a CC or MCC
13,205
Medicare outpatient services
In 61 service groups
Inpatient stays by major diagnostic category
Circulatory system2,242 discharges in 43 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 310 | $69,736 | $11,198 | $13,110 | 1.28 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 201 | $431,072 | $71,450 | $81,041 | 7.71 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 155 | $322,607 | $57,049 | $60,650 | 6.25 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 139 | $132,480 | $19,221 | $24,906 | 2.16 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 98 | $105,353 | $18,837 | $19,806 | 2.09 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 90 | $75,721 | $8,842 | $14,236 | 1.08 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 89 | $36,492 | $6,153 | $6,860 | 0.74 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 82 | $67,465 | $11,076 | $12,683 | 1.20 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 69 | $312,873 | $43,601 | $58,820 | 4.88 |
| Heart failure and shock with CCMS-DRG 292, medical | 67 | $59,068 | $6,969 | $11,105 | 0.86 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 63 | $348,952 | $50,568 | $65,603 | 5.88 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 59 | $184,848 | $28,830 | $34,751 | 3.24 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 49 | $213,378 | $32,688 | $40,115 | 3.35 |
| Syncope and collapseMS-DRG 312, medical | 49 | $46,937 | $7,462 | $8,824 | 0.86 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 47 | $290,259 | $48,180 | $54,569 | 5.06 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 46 | $100,509 | $14,003 | $18,896 | 1.59 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 43 | $40,494 | $9,244 | $7,613 | 1.07 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 43 | $133,752 | $15,912 | $25,145 | 1.82 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 42 | $83,728 | $14,047 | $15,741 | 1.58 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 42 | $50,960 | $8,372 | $9,580 | 0.97 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 35 | $283,078 | $39,736 | $53,219 | 4.16 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 28 | $113,980 | $20,267 | $21,428 | 2.28 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 26 | $445,147 | $62,649 | $83,688 | 7.80 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 25 | $179,115 | $25,326 | $33,674 | 2.87 |
| Other vascular procedures with CCMS-DRG 253, surgical | 24 | $156,203 | $21,330 | $29,366 | 2.55 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 24 | $215,379 | $32,120 | $40,491 | 3.46 |
| Hypertension with MCCMS-DRG 304, medical | 23 | $56,607 | $10,212 | $10,642 | 1.15 |
| Other cardiothoracic procedures with MCCMS-DRG 228, surgical | 22 | $310,257 | $46,308 | $58,328 | 5.04 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 22 | $210,665 | $38,047 | $39,605 | 3.90 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 21 | $261,697 | $43,025 | $49,199 | 4.81 |
| Cardiac congenital and valvular disorders with MCCMS-DRG 306, medical | 20 | $77,721 | $13,833 | $14,612 | 1.54 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 19 | $194,964 | $34,155 | $36,653 | 3.27 |
| Aortic and heart assist procedures except pulsation balloon with MCCMS-DRG 268, surgical | 19 | $500,008 | $74,406 | $94,001 | 6.85 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 18 | $378,664 | $57,086 | $71,189 | 5.24 |
| Hypertension without MCCMS-DRG 305, medical | 18 | $39,139 | $6,188 | $7,358 | 0.75 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 17 | $66,639 | $7,762 | $12,528 | 0.91 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 17 | $25,488 | $3,822 | $4,792 | 0.55 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 15 | $564,610 | $89,980 | $106,147 | 9.71 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 15 | $135,219 | $30,457 | $25,421 | 3.46 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 14 | $105,286 | $25,231 | $19,794 | 2.81 |
| Concomitant aortic and mitral valve proceduresMS-DRG 212, surgical | 13 | $590,545 | $103,652 | $111,022 | 10.77 |
| Atherosclerosis without MCCMS-DRG 303, medical | 12 | $42,744 | $5,231 | $8,036 | 0.66 |
| Chest painMS-DRG 313, medical | 12 | $37,840 | $6,335 | $7,114 | 0.72 |
Respiratory system960 discharges in 21 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 250 | $80,745 | $14,700 | $15,180 | 1.70 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 86 | $41,782 | $7,986 | $7,855 | 0.99 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 66 | $76,932 | $11,516 | $14,463 | 1.23 |
| Major chest procedures with CCMS-DRG 164, surgical | 64 | $162,569 | $22,000 | $30,563 | 2.55 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 64 | $133,840 | $16,176 | $25,162 | 1.88 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 52 | $111,082 | $16,211 | $20,883 | 1.81 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 43 | $79,669 | $12,405 | $14,978 | 1.40 |
| Major chest procedures with MCCMS-DRG 163, surgical | 41 | $281,257 | $46,054 | $52,876 | 4.71 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 36 | $91,956 | $16,430 | $17,288 | 1.74 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 30 | $47,122 | $8,283 | $8,859 | 0.96 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 29 | $168,643 | $24,566 | $31,705 | 2.70 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 25 | $36,358 | $7,340 | $6,835 | 0.85 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 23 | $164,845 | $33,133 | $30,991 | 4.06 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 22 | $55,579 | $10,894 | $10,449 | 1.33 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 22 | $146,504 | $21,204 | $27,543 | 1.90 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 21 | $42,024 | $9,559 | $7,901 | 1.10 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 19 | $52,666 | $6,351 | $9,901 | 0.82 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 19 | $400,896 | $75,558 | $75,368 | 6.91 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 17 | $35,027 | $6,638 | $6,585 | 0.82 |
| Other respiratory system o.r. procedures with CCMS-DRG 167, surgical | 16 | $109,565 | $15,295 | $20,598 | 1.82 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 15 | $46,157 | $7,651 | $8,678 | 0.91 |
Digestive system919 discharges in 23 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 | 112 | $41,538 | $6,589 | $7,809 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 92 | $55,410 | $8,262 | $10,417 | 0.98 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 86 | $81,901 | $15,094 | $15,397 | 1.62 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 80 | $138,695 | $20,581 | $26,075 | 2.37 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 66 | $89,855 | $16,363 | $16,893 | 1.79 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 65 | $66,472 | $11,050 | $12,497 | 1.28 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 60 | $49,579 | $8,130 | $9,321 | 0.94 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 59 | $274,066 | $46,269 | $51,524 | 4.52 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 32 | $32,524 | $6,404 | $6,115 | 0.80 |
| Digestive malignancy with MCCMS-DRG 374, medical | 30 | $116,932 | $18,579 | $21,983 | 2.10 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 25 | $77,143 | $14,564 | $14,503 | 1.75 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 24 | $223,711 | $42,920 | $42,058 | 5.08 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 24 | $80,788 | $12,923 | $15,188 | 1.45 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 21 | $201,067 | $22,325 | $37,801 | 2.50 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 18 | $100,098 | $14,405 | $18,818 | 1.67 |
| Peritoneal adhesiolysis with MCCMS-DRG 335, surgical | 17 | $259,882 | $35,771 | $48,858 | 3.58 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 17 | $46,564 | $9,295 | $8,754 | 1.04 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 16 | $125,333 | $15,708 | $23,563 | 2.11 |
| Hernia procedures except inguinal and femoral without cc/mccMS-DRG 355, surgical | 16 | $83,572 | $11,688 | $15,712 | 1.36 |
| Digestive malignancy with CCMS-DRG 375, medical | 16 | $66,233 | $10,531 | $12,452 | 1.20 |
| Complicated peptic ulcer with MCCMS-DRG 380, medical | 15 | $102,729 | $22,010 | $19,313 | 1.95 |
| Hernia procedures except inguinal and femoral with CCMS-DRG 354, surgical | 14 | $108,918 | $14,904 | $20,477 | 1.72 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 14 | $283,486 | $42,045 | $53,295 | 4.28 |
Nervous system890 discharges in 24 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 106 | $113,744 | $17,326 | $21,384 | 2.00 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 103 | $285,048 | $41,804 | $53,589 | 4.42 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 77 | $63,443 | $8,564 | $11,927 | 1.02 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 68 | $42,860 | $10,916 | $8,058 | 1.36 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 66 | $90,596 | $20,327 | $17,032 | 2.39 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 59 | $93,421 | $16,008 | $17,563 | 1.79 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 51 | $52,652 | $8,684 | $9,899 | 1.03 |
| Seizures without MCCMS-DRG 101, medical | 44 | $61,537 | $7,681 | $11,569 | 0.91 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 37 | $323,163 | $52,417 | $60,755 | 5.67 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 32 | $52,205 | $8,500 | $9,815 | 1.03 |
| Seizures with MCCMS-DRG 100, medical | 30 | $123,278 | $18,809 | $23,176 | 1.98 |
| Cranial and peripheral nerve disorders with MCCMS-DRG 073, medical | 29 | $74,163 | $12,728 | $13,943 | 1.51 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 22 | $121,626 | $14,541 | $22,866 | 1.47 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 21 | $196,998 | $26,896 | $37,036 | 2.95 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 21 | $163,218 | $22,500 | $30,685 | 2.43 |
| Headaches without MCCMS-DRG 103, medical | 18 | $49,400 | $6,012 | $9,287 | 0.84 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 16 | $87,390 | $15,149 | $16,429 | 1.79 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 15 | $303,547 | $35,320 | $57,067 | 3.79 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 14 | $52,570 | $5,465 | $9,883 | 0.69 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 14 | $117,711 | $21,852 | $22,130 | 2.28 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 13 | $56,842 | $9,476 | $10,686 | 1.06 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 12 | $115,973 | $20,588 | $21,803 | 2.27 |
| Intracranial vascular procedures with principal diagnosis hemorrhage with MCCMS-DRG 020, surgical | 11 | $422,534 | $77,081 | $79,436 | 8.45 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 11 | $79,585 | $11,030 | $14,962 | 1.36 |
Kidney and urinary tract868 discharges in 18 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 | 172 | $69,601 | $14,436 | $13,085 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 111 | $45,324 | $8,811 | $8,521 | 1.02 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 80 | $35,427 | $6,863 | $6,660 | 0.81 |
| Renal failure with MCCMS-DRG 682, medical | 72 | $80,113 | $13,323 | $15,061 | 1.50 |
| Kidney transplantMS-DRG 652, surgical | 66 | $299,200 | $26,201 | $56,250 | 3.00 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 62 | $52,577 | $10,346 | $9,885 | 1.17 |
| Renal failure with CCMS-DRG 683, medical | 56 | $44,500 | $7,538 | $8,366 | 0.90 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 47 | $121,222 | $11,189 | $22,790 | 1.35 |
| Major bladder procedures with CCMS-DRG 654, surgical | 32 | $240,283 | $25,132 | $45,173 | 2.74 |
| Kidney transplant with hemodialysis without MCCMS-DRG 651, surgical | 26 | $329,462 | $27,660 | $61,939 | 3.46 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 25 | $406,382 | $46,494 | $76,400 | 4.50 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 25 | $175,202 | $26,999 | $32,938 | 2.59 |
| Kidney and ureter procedures for neoplasm with CCMS-DRG 657, surgical | 21 | $142,194 | $16,303 | $26,732 | 1.84 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 21 | $258,181 | $39,571 | $48,538 | 3.70 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 15 | $104,315 | $17,034 | $19,611 | 2.38 |
| Major bladder procedures with MCCMS-DRG 653, surgical | 13 | $391,993 | $54,147 | $73,695 | 5.41 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 12 | $136,109 | $11,679 | $25,588 | 1.48 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 12 | $88,679 | $8,145 | $16,672 | 1.05 |
Infectious and parasitic diseases793 discharges in 11 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 | 466 | $123,617 | $19,123 | $23,240 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 90 | $47,094 | $8,442 | $8,854 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 88 | $289,452 | $48,836 | $54,417 | 5.00 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 31 | $405,502 | $66,858 | $76,234 | 6.96 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 25 | $78,910 | $16,875 | $14,835 | 1.84 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 21 | $100,002 | $18,152 | $18,800 | 2.04 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 17 | $36,438 | $7,817 | $6,850 | 1.01 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 15 | $133,322 | $17,010 | $25,065 | 2.14 |
| Viral illness without MCCMS-DRG 866, medical | 15 | $41,027 | $6,724 | $7,713 | 0.92 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 14 | $291,636 | $44,718 | $54,828 | 4.43 |
| Viral illness with MCCMS-DRG 865, medical | 11 | $57,790 | $13,897 | $10,864 | 1.64 |
Musculoskeletal system and connective tissue675 discharges in 22 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 | 145 | $113,969 | $16,311 | $21,426 | 1.88 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 60 | $180,770 | $27,641 | $33,985 | 3.49 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 49 | $353,725 | $54,407 | $66,500 | 6.12 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 43 | $128,985 | $17,756 | $24,249 | 2.07 |
| Medical back problems without MCCMS-DRG 552, medical | 38 | $43,737 | $7,745 | $8,222 | 0.97 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 37 | $57,283 | $8,103 | $10,769 | 1.09 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 31 | $108,749 | $15,178 | $20,445 | 1.82 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 26 | $154,792 | $17,665 | $29,101 | 2.11 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 24 | $171,074 | $24,039 | $32,162 | 2.96 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 23 | $215,128 | $31,011 | $40,444 | 3.66 |
| Connective tissue disorders with MCCMS-DRG 545, medical | 22 | $76,773 | $19,908 | $14,433 | 2.49 |
| Combined anterior and posterior spinal fusion with MCCMS-DRG 453, surgical | 21 | $493,734 | $84,396 | $92,822 | 8.86 |
| Spinal fusion except cervical with spinal curvature, malignancy, infection or extensiveMS-DRG 457, surgical | 20 | $322,853 | $55,289 | $60,696 | 6.08 |
| Major hip and knee joint replacement or reattachment of lower extremity with MCC or totaMS-DRG 469, surgical | 19 | $128,457 | $23,469 | $24,150 | 3.33 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 19 | $170,292 | $26,542 | $32,015 | 2.95 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 17 | $266,792 | $32,704 | $50,157 | 2.99 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 16 | $141,162 | $18,894 | $26,538 | 2.40 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 15 | $114,468 | $16,707 | $21,520 | 2.04 |
| Connective tissue disorders with CCMS-DRG 546, medical | 14 | $58,046 | $9,293 | $10,913 | 1.20 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 13 | $32,843 | $6,832 | $6,174 | 0.82 |
| Cervical spinal fusion with MCCMS-DRG 471, surgical | 12 | $215,205 | $39,851 | $40,459 | 4.92 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 11 | $176,969 | $28,357 | $33,270 | 3.00 |
Endocrine, nutritional and metabolic333 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 | 114 | $67,984 | $11,420 | $12,781 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 60 | $38,094 | $6,379 | $7,162 | 0.78 |
| Endocrine disorders with CCMS-DRG 644, medical | 40 | $42,916 | $8,877 | $8,068 | 1.06 |
| Diabetes with CCMS-DRG 638, medical | 36 | $45,722 | $7,427 | $8,596 | 0.90 |
| Endocrine disorders with MCCMS-DRG 643, medical | 33 | $66,507 | $14,780 | $12,503 | 1.65 |
| Diabetes with MCCMS-DRG 637, medical | 31 | $83,486 | $12,564 | $15,695 | 1.45 |
| Adrenal and pituitary procedures with cc/mccMS-DRG 614, surgical | 19 | $193,029 | $20,507 | $36,289 | 2.25 |
Blood cancers and poorly differentiated neoplasms282 discharges in 9 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 | 68 | $60,304 | $12,715 | $11,337 | 1.21 |
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 47 | $210,488 | $30,582 | $39,572 | 3.13 |
| Chemotherapy without acute leukemia as secondary diagnosis with MCCMS-DRG 846, medical | 39 | $88,683 | $23,313 | $16,672 | 2.44 |
| Acute leukemia with MCCMS-DRG 834, medical | 37 | $255,868 | $53,098 | $48,103 | 5.60 |
| Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy aMS-DRG 837, medical | 33 | $131,697 | $42,822 | $24,759 | 4.84 |
| Lymphoma and non-acute leukemia with other procedures with MCCMS-DRG 823, surgical | 18 | $332,370 | $47,136 | $62,486 | 4.50 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 18 | $87,157 | $14,666 | $16,385 | 1.57 |
| Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapMS-DRG 838, medical | 11 | $42,899 | $17,174 | $8,065 | 2.00 |
| Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with mcMS-DRG 843, medical | 11 | $97,466 | $17,219 | $18,324 | 1.86 |
Transplants, ECMO and tracheostomy (pre-MDC)267 discharges in 8 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 | $1,798,599 | $314,195 | $338,137 | 21.32 |
| Autologous bone marrow transplant with cc/mccMS-DRG 016, medical | 50 | $193,305 | $53,436 | $36,341 | 6.18 |
| Chimeric antigen receptor (car) t-cell and other immunotherapiesMS-DRG 018, medical | 36 | $3,326,965 | $580,958 | $625,469 | 36.84 |
| Heart transplant or implant of heart assist system with MCCMS-DRG 001, surgical | 31 | $1,647,696 | $292,035 | $309,767 | 27.10 |
| Lung transplantMS-DRG 007, surgical | 30 | $906,359 | $121,134 | $170,395 | 12.27 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 22 | $655,822 | $104,853 | $123,295 | 14.70 |
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 18 | $860,363 | $101,791 | $161,748 | 10.35 |
| Allogeneic bone marrow transplantMS-DRG 014, medical | 17 | $375,520 | $111,284 | $70,598 | 11.46 |
Liver, gallbladder and pancreas247 discharges in 10 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 43 | $87,682 | $15,373 | $16,484 | 1.83 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 29 | $122,312 | $14,424 | $22,995 | 1.63 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 29 | $99,360 | $15,011 | $18,680 | 1.76 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 26 | $84,023 | $17,622 | $15,796 | 1.92 |
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 25 | $208,468 | $24,403 | $39,192 | 2.89 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 25 | $124,544 | $17,641 | $23,414 | 1.63 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 22 | $44,713 | $6,896 | $8,406 | 0.95 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 17 | $71,506 | $15,153 | $13,443 | 1.67 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 16 | $288,752 | $51,049 | $54,285 | 5.51 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 15 | $169,218 | $22,171 | $31,813 | 2.32 |
Blood and immune system132 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 45 | $49,604 | $8,437 | $9,326 | 0.90 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 24 | $74,807 | $12,855 | $14,064 | 1.40 |
| Coagulation disordersMS-DRG 813, medical | 24 | $98,633 | $14,976 | $18,543 | 1.56 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 15 | $180,275 | $25,970 | $33,892 | 2.19 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 12 | $57,363 | $10,112 | $10,784 | 1.20 |
| Reticuloendothelial and immunity disorders with MCCMS-DRG 814, medical | 12 | $316,719 | $26,848 | $59,543 | 2.13 |
Injuries, poisonings and toxic effects of drugs118 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 | 38 | $176,792 | $29,912 | $33,237 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 27 | $39,353 | $9,389 | $7,398 | 1.03 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 20 | $317,487 | $45,946 | $59,687 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 18 | $103,941 | $16,553 | $19,541 | 2.00 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 15 | $62,696 | $14,341 | $11,787 | 1.60 |
Skin, subcutaneous tissue and breast110 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 47 | $32,628 | $7,169 | $6,134 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 27 | $54,461 | $11,733 | $10,239 | 1.49 |
| Other skin, subcutaneous tissue and breast procedures with CCMS-DRG 580, surgical | 13 | $124,744 | $11,161 | $23,452 | 1.75 |
| Minor skin disorders without MCCMS-DRG 607, medical | 12 | $37,740 | $6,948 | $7,095 | 0.89 |
| Other skin, subcutaneous tissue and breast procedures with MCCMS-DRG 579, surgical | 11 | $183,240 | $30,145 | $34,449 | 3.34 |
Other92 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 | 41 | $355,420 | $58,477 | $66,819 | 4.74 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 24 | $183,328 | $29,487 | $34,466 | 3.38 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 15 | $119,287 | $19,995 | $22,426 | 2.49 |
| Single level combined anterior and posterior spinal fusion except cervicalMS-DRG 402 | 12 | $213,484 | $35,796 | $40,135 |
Mental diseases and disorders46 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 29 | $66,937 | $13,476 | $12,584 | 1.76 |
| PsychosesMS-DRG 885, medical | 17 | $65,719 | $10,749 | $12,355 | 1.37 |
Factors influencing health status36 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 | 14 | $45,708 | $7,087 | $8,593 | 0.80 |
| Signs and symptoms with MCCMS-DRG 947, medical | 11 | $43,228 | $10,785 | $8,127 | 1.25 |
| Other factors influencing health statusMS-DRG 951, medical | 11 | $26,168 | $5,212 | $4,920 | 0.59 |
Male reproductive system29 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Transurethral prostatectomy with cc/mccMS-DRG 713, surgical | 15 | $99,889 | $15,055 | $18,779 | 1.45 |
| Major male pelvic procedures with cc/mccMS-DRG 707, surgical | 14 | $147,394 | $14,756 | $27,710 | 1.96 |
Alcohol and drug use26 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 | 13 | $61,784 | $14,925 | $11,615 | 1.78 |
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 13 | $35,358 | $7,888 | $6,647 | 0.86 |
Ear, nose, mouth and throat16 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major head and neck procedures with CCMS-DRG 141, surgical | 16 | $183,507 | $16,579 | $34,499 | 2.07 |
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 | 1,858 | 1,675 | $26,228 | $2,089 | $2,090 |
| Level 1 Intraocular ProceduresAPC 5491 | 1,330 | 958 | $21,161 | $1,793 | $1,752 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 989 | 930 | $14,457 | $1,237 | $1,220 |
| Level 2 Upper GI ProceduresAPC 5302 | 743 | 631 | $16,536 | $1,460 | $1,445 |
| Level 1 Endovascular ProceduresAPC 5191 | 568 | 550 | $29,876 | $2,258 | $2,208 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 534 | 515 | $99,559 | $11,024 | $10,772 |
| Level 5 Urology and Related ServicesAPC 5375 | 527 | 505 | $47,650 | $3,994 | $3,918 |
| Level 3 Urology and Related ServicesAPC 5373 | 428 | 300 | $23,993 | $1,559 | $1,516 |
| Level 3 Vascular ProceduresAPC 5183 | 425 | 399 | $27,384 | $2,440 | $2,405 |
| Level 4 Urology and Related ServicesAPC 5374 | 373 | 297 | $33,285 | $2,672 | $2,629 |
| Level 1 Nerve ProceduresAPC 5431 | 352 | 320 | $12,149 | $1,490 | $1,407 |
| Level 3 Endovascular ProceduresAPC 5193 | 340 | 316 | $78,754 | $9,029 | $8,874 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 300 | 296 | $71,678 | $4,426 | $4,358 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 297 | 288 | $163,686 | $21,334 | $21,117 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 285 | 284 | $106,420 | $8,341 | $8,164 |
| Level 4 Airway EndoscopyAPC 5154 | 276 | 218 | $39,447 | $2,859 | $2,833 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 263 | 237 | $29,201 | $2,150 | $2,141 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 236 | 227 | $61,832 | $5,426 | $5,339 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 169 | 163 | $42,823 | $2,954 | $2,930 |
| Level 2 Intraocular ProceduresAPC 5492 | 166 | 155 | $48,821 | $3,092 | $3,116 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 165 | 123 | $32,256 | $2,559 | $2,636 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 155 | 135 | $30,020 | $2,249 | $2,373 |
| Complex GI ProceduresAPC 5331 | 144 | 85 | $37,604 | $3,928 | $4,263 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 141 | 138 | $65,728 | $5,017 | $4,982 |
| Level 4 Vascular ProceduresAPC 5184 | 135 | 131 | $49,389 | $4,256 | $3,946 |
| Level 2 Vascular ProceduresAPC 5182 | 123 | 113 | $7,642 | $1,240 | $1,204 |
| Level 5 ENT ProceduresAPC 5165 | 116 | 115 | $72,688 | $4,459 | $4,436 |
| Level 5 Airway EndoscopyAPC 5155 | 113 | 108 | $69,131 | $5,304 | $5,183 |
| Level 3 Upper GI ProceduresAPC 5303 | 107 | 98 | $27,896 | $2,940 | $2,888 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 104 | 101 | $15,338 | $1,241 | $1,196 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 103 | 99 | $112,087 | $16,293 | $15,763 |
| Level 3 Lower GI ProceduresAPC 5313 | 103 | 98 | $18,827 | $2,181 | $2,176 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 103 | 99 | $25,073 | $1,791 | $1,780 |
| Level 4 Endovascular ProceduresAPC 5194 | 90 | 86 | $125,721 | $15,252 | $14,606 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 89 | 78 | $32,169 | $4,878 | $4,524 |
| Level 4 Gynecologic ProceduresAPC 5414 | 84 | 82 | $30,935 | $2,378 | $2,389 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 80 | 80 | $65,805 | $8,635 | $8,569 |
| Level 2 Endovascular ProceduresAPC 5192 | 68 | 64 | $52,362 | $4,429 | $4,338 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 67 | 67 | $45,558 | $6,624 | $6,514 |
| Level 3 Airway EndoscopyAPC 5153 | 57 | 53 | $20,790 | $1,315 | $1,264 |
| Level 6 Urology and Related ServicesAPC 5376 | 53 | 51 | $74,099 | $7,324 | $7,291 |
| Level 5 Gynecologic ProceduresAPC 5415 | 50 | 50 | $48,108 | $3,854 | $3,792 |
| Level 7 Radiation TherapyAPC 5627 | 49 | 45 | $212,289 | $5,811 | $6,121 |
| Level 3 Intraocular ProceduresAPC 5493 | 43 | 34 | $53,817 | $4,047 | $4,004 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 41 | 39 | $98,859 | $19,112 | $18,465 |
| Level 4 ENT ProceduresAPC 5164 | 40 | 38 | $42,713 | $2,433 | $2,217 |
| Level 8 Urology and Related ServicesAPC 5378 | 38 | 35 | $119,665 | $16,996 | $17,428 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 35 | 35 | $210,461 | $30,268 | $29,375 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 33 | 32 | $169,011 | $28,479 | $26,719 |
| Level 2 Urology and Related ServicesAPC 5372 | 30 | 29 | $28,649 | $529 | $502 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 24 | 24 | $70,385 | $7,532 | $7,546 |
| Level 4 Extraocular, Repair, and Plastic Eye ProceduresAPC 5504 | 23 | 21 | $53,410 | $2,858 | $2,969 |
| Level 4 Breast/Lymphatic Surgery and Related ProceduresAPC 5094 | 20 | 18 | $112,796 | $15,470 | $15,549 |
| Level 2 Nerve ProceduresAPC 5432 | 20 | 17 | $61,701 | $4,388 | $4,674 |
| Cochlear Implant ProcedureAPC 5166 | 17 | 16 | $154,603 | $30,883 | $29,489 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 15 | 15 | $146,251 | $17,275 | $17,052 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 15 | 15 | $129,761 | $21,233 | $21,011 |
| Level 6 Gynecologic ProceduresAPC 5416 | 15 | 15 | $84,531 | $5,856 | $5,836 |
| Level 1 Neurostimulator and Related ProceduresAPC 5461 | 14 | 14 | $37,126 | $2,637 | $2,547 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 13 | 13 | $58,325 | $5,787 | $5,682 |
| Implantation of Drug Infusion DeviceAPC 5471 | 11 | 11 | $104,035 | $15,676 | $14,829 |
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.