Novant Health Forsyth Medical Center Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Novant Health Forsyth Medical Center, Winston-Salem, NC in 2024, from traditional Medicare claims. Back to the Novant Health Forsyth Medical Center profile, with quality ratings, finances and negotiated rates.
6,272
Medicare inpatient discharges
In 155 published DRGs
1.95
Case mix index
IPPS FY 2027
27%
Surgical stays
66%
Stays with complications
In DRGs with a CC or MCC
6,132
Medicare outpatient services
In 45 service groups
Inpatient stays by major diagnostic category
Circulatory system1,348 discharges in 37 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 304 | $40,450 | $9,429 | $12,054 | 1.28 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 81 | $45,813 | $9,530 | $13,652 | 1.20 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 73 | $24,803 | $5,051 | $7,391 | 0.74 |
| Syncope and collapseMS-DRG 312, medical | 67 | $28,146 | $5,921 | $8,387 | 0.86 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 63 | $49,132 | $11,078 | $14,641 | 1.59 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 59 | $56,389 | $11,986 | $16,804 | 1.82 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 53 | $111,462 | $20,975 | $33,216 | 3.24 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 46 | $40,092 | $6,747 | $11,947 | 1.08 |
| Hypertension without MCCMS-DRG 305, medical | 43 | $24,074 | $4,650 | $7,174 | 0.75 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 40 | $149,886 | $32,971 | $44,666 | 4.88 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 38 | $67,692 | $14,700 | $20,172 | 2.16 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 35 | $80,556 | $13,824 | $24,006 | 2.09 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 33 | $174,853 | $32,468 | $52,106 | 5.20 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 31 | $137,686 | $27,589 | $41,030 | 4.04 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 30 | $82,766 | $15,051 | $24,664 | 2.28 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 29 | $30,661 | $6,024 | $9,137 | 0.91 |
| Other vascular procedures with CCMS-DRG 253, surgical | 26 | $71,189 | $16,110 | $21,214 | 2.55 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 24 | $16,337 | $3,633 | $4,868 | 0.55 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 23 | $97,633 | $19,715 | $29,095 | 2.87 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 19 | $141,946 | $27,619 | $42,300 | 4.16 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 18 | $114,639 | $22,016 | $34,162 | 3.35 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 16 | $190,842 | $33,669 | $56,871 | 5.06 |
| Chest painMS-DRG 313, medical | 16 | $23,408 | $4,662 | $6,975 | 0.72 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 15 | $97,826 | $19,610 | $29,152 | 3.46 |
| Hypertension with MCCMS-DRG 304, medical | 15 | $47,937 | $8,998 | $14,285 | 1.15 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 15 | $30,565 | $6,744 | $9,108 | 0.97 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 14 | $159,893 | $33,131 | $47,648 | 5.24 |
| Other vascular procedures without cc/mccMS-DRG 254, surgical | 14 | $63,645 | $10,746 | $18,966 | 1.74 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 14 | $144,537 | $27,687 | $43,072 | 3.90 |
| Heart failure and shock with CCMS-DRG 292, medical | 13 | $31,500 | $6,250 | $9,387 | 0.86 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 12 | $293,360 | $62,537 | $87,421 | 7.71 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 12 | $87,647 | $23,334 | $26,119 | 3.46 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 12 | $26,302 | $4,390 | $7,838 | 0.72 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 12 | $43,392 | $10,280 | $12,931 | 1.58 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 11 | $222,059 | $54,627 | $66,174 | 7.80 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 11 | $73,715 | $11,253 | $21,967 | 1.83 |
| Other major cardiovascular procedures without cc/mccMS-DRG 272, surgical | 11 | $71,719 | $13,399 | $21,372 | 2.44 |
Respiratory system958 discharges in 16 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 201 | $37,780 | $8,760 | $11,259 | 1.33 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 186 | $39,295 | $11,236 | $11,710 | 1.70 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 127 | $29,988 | $7,479 | $8,936 | 1.10 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 98 | $38,342 | $8,619 | $11,426 | 1.23 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 62 | $39,419 | $9,459 | $11,747 | 1.40 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 53 | $26,896 | $5,590 | $8,015 | 0.82 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 41 | $26,197 | $6,841 | $7,807 | 0.99 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 35 | $25,071 | $6,271 | $7,471 | 0.96 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 32 | $28,033 | $5,547 | $8,354 | 0.82 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 25 | $77,568 | $18,047 | $23,115 | 2.70 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 23 | $22,715 | $5,309 | $6,769 | 0.85 |
| Major chest procedures with CCMS-DRG 164, surgical | 21 | $113,731 | $18,277 | $33,892 | 2.55 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 15 | $63,365 | $13,590 | $18,883 | 1.74 |
| Pleural effusion with MCCMS-DRG 186, medical | 14 | $49,803 | $11,316 | $14,841 | 1.55 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 14 | $134,914 | $44,188 | $40,204 | 6.91 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 11 | $57,253 | $13,761 | $17,061 | 1.90 |
Musculoskeletal system and connective tissue741 discharges in 19 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 | 310 | $56,862 | $12,484 | $16,945 | 1.88 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 54 | $59,454 | $14,222 | $17,717 | 2.07 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 53 | $67,735 | $14,036 | $20,185 | 2.11 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 32 | $210,973 | $48,271 | $62,870 | 6.12 |
| Medical back problems without MCCMS-DRG 552, medical | 29 | $27,972 | $6,418 | $8,336 | 0.97 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 27 | $122,129 | $23,231 | $36,394 | 3.66 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 27 | $85,643 | $19,021 | $25,522 | 2.95 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 26 | $52,511 | $13,453 | $15,648 | 2.04 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 25 | $189,136 | $36,318 | $56,363 | 4.61 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 24 | $102,907 | $21,817 | $30,666 | 3.49 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 21 | $20,982 | $4,961 | $6,253 | 0.79 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 20 | $21,180 | $6,079 | $6,312 | 0.90 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 18 | $88,987 | $18,798 | $26,518 | 2.99 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 16 | $90,355 | $18,572 | $26,926 | 2.96 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 14 | $60,231 | $13,304 | $17,949 | 1.97 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 12 | $61,852 | $18,789 | $18,432 | 3.00 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 11 | $86,338 | $16,679 | $25,729 | 2.48 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 11 | $41,205 | $9,107 | $12,279 | 1.49 |
| Medical back problems with MCCMS-DRG 551, medical | 11 | $27,539 | $11,397 | $8,207 | 1.70 |
Infectious and parasitic diseases684 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 | 463 | $58,674 | $13,384 | $17,485 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 110 | $36,279 | $6,980 | $10,811 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 73 | $144,200 | $38,952 | $42,971 | 5.00 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 19 | $49,904 | $12,363 | $14,871 | 2.04 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 19 | $202,489 | $45,628 | $60,342 | 6.96 |
Digestive system626 discharges in 15 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 | 125 | $26,180 | $5,310 | $7,802 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 103 | $31,759 | $6,842 | $9,464 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 65 | $53,015 | $12,262 | $15,798 | 1.79 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 56 | $44,712 | $8,840 | $13,324 | 1.28 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 53 | $71,209 | $15,684 | $21,220 | 2.37 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 39 | $51,117 | $9,817 | $15,233 | 1.67 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 31 | $30,900 | $7,484 | $9,208 | 1.04 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 29 | $123,765 | $29,402 | $36,882 | 4.52 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 29 | $21,701 | $5,446 | $6,467 | 0.80 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 26 | $27,258 | $6,564 | $8,123 | 0.94 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 17 | $52,771 | $12,445 | $15,726 | 1.75 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 16 | $14,363 | $3,413 | $4,280 | 0.56 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 14 | $42,225 | $11,290 | $12,583 | 1.62 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 12 | $188,120 | $40,748 | $56,060 | 5.08 |
| Digestive malignancy with MCCMS-DRG 374, medical | 11 | $94,433 | $12,776 | $28,141 | 2.10 |
Nervous system573 discharges in 22 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 | 104 | $35,634 | $6,669 | $10,619 | 1.02 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 80 | $66,843 | $13,280 | $19,919 | 2.00 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 37 | $28,134 | $5,281 | $8,384 | 0.80 |
| Seizures with MCCMS-DRG 100, medical | 34 | $78,198 | $15,866 | $23,303 | 1.98 |
| Seizures without MCCMS-DRG 101, medical | 30 | $34,223 | $6,244 | $10,198 | 0.91 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 28 | $190,931 | $39,380 | $56,898 | 5.67 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 26 | $112,206 | $30,252 | $33,437 | 4.42 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 26 | $33,511 | $9,016 | $9,986 | 1.32 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 22 | $31,020 | $7,285 | $9,244 | 1.03 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 19 | $40,099 | $7,867 | $11,949 | 1.14 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 17 | $58,565 | $12,994 | $17,452 | 1.81 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 16 | $26,839 | $4,191 | $7,998 | 0.69 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 16 | $56,869 | $12,899 | $16,947 | 1.79 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 15 | $63,979 | $9,712 | $19,066 | 1.47 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 15 | $37,267 | $8,896 | $11,106 | 1.36 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 14 | $28,427 | $7,115 | $8,471 | 1.06 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 14 | $76,960 | $16,568 | $22,934 | 2.27 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 13 | $78,427 | $14,038 | $23,371 | 2.43 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 13 | $56,620 | $16,995 | $16,873 | 2.39 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 12 | $131,640 | $23,951 | $39,229 | 3.79 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 11 | $73,783 | $19,481 | $21,987 | 2.95 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 11 | $77,514 | $16,105 | $23,099 | 2.28 |
Kidney and urinary tract484 discharges in 10 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 112 | $22,386 | $5,601 | $6,671 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 106 | $33,068 | $8,124 | $9,854 | 1.17 |
| Renal failure with MCCMS-DRG 682, medical | 67 | $45,556 | $10,595 | $13,576 | 1.50 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 56 | $41,574 | $10,962 | $12,389 | 1.65 |
| Renal failure with CCMS-DRG 683, medical | 50 | $24,739 | $6,353 | $7,372 | 0.90 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 29 | $25,606 | $7,459 | $7,631 | 1.02 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 21 | $91,626 | $23,948 | $27,304 | 3.70 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 18 | $41,543 | $7,531 | $12,380 | 1.35 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 14 | $113,663 | $19,129 | $33,871 | 2.59 |
| Renal failure without cc/mccMS-DRG 684, medical | 11 | $19,105 | $3,953 | $5,693 | 0.61 |
Endocrine, nutritional and metabolic264 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 89 | $24,658 | $5,484 | $7,348 | 0.78 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 82 | $30,498 | $9,068 | $9,088 | 1.32 |
| Diabetes with CCMS-DRG 638, medical | 34 | $20,881 | $6,101 | $6,223 | 0.90 |
| Amputation of lower limb for endocrine, nutritional and metabolic disorders with CCMS-DRG 617, surgical | 30 | $56,326 | $12,913 | $16,785 | 1.98 |
| Diabetes with MCCMS-DRG 637, medical | 29 | $38,259 | $8,291 | $11,401 | 1.45 |
Liver, gallbladder and pancreas182 discharges in 10 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 28 | $66,656 | $11,092 | $19,863 | 1.63 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 27 | $32,665 | $5,876 | $9,734 | 0.86 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 22 | $53,710 | $7,202 | $16,006 | 1.09 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 20 | $48,147 | $11,119 | $14,348 | 1.63 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 17 | $76,912 | $14,883 | $22,920 | 2.32 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 15 | $60,306 | $11,521 | $17,971 | 1.76 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 14 | $70,300 | $13,987 | $20,950 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 14 | $60,963 | $13,292 | $18,167 | 1.83 |
| Laparoscopic cholecystectomy without C.D.E. without cc/mccMS-DRG 419, surgical | 13 | $48,465 | $8,200 | $14,442 | 1.31 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 12 | $44,233 | $11,427 | $13,181 | 1.67 |
Mental diseases and disorders82 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| PsychosesMS-DRG 885, medical | 71 | $32,597 | $9,599 | $9,714 | 1.37 |
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 11 | $28,768 | $10,969 | $8,573 | 1.76 |
Skin, subcutaneous tissue and breast72 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 72 | $24,316 | $6,108 | $7,246 | 0.88 |
Blood and immune system69 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 38 | $27,508 | $5,746 | $8,197 | 0.90 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 31 | $43,093 | $9,426 | $12,842 | 1.40 |
Other61 discharges in 3 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 | 34 | $162,557 | $33,048 | $48,442 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 14 | $87,072 | $15,476 | $25,947 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 13 | $98,625 | $24,471 | $29,390 | 3.38 |
Factors influencing health status50 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other factors influencing health statusMS-DRG 951, medical | 37 | $19,016 | $4,209 | $5,667 | 0.59 |
| Signs and symptoms without MCCMS-DRG 948, medical | 13 | $24,884 | $5,485 | $7,415 | 0.80 |
Blood cancers and poorly differentiated neoplasms33 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 11 | $102,037 | $23,437 | $30,407 | 3.13 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 11 | $60,329 | $11,104 | $17,978 | 1.57 |
| Chemotherapy without acute leukemia as secondary diagnosis with CCMS-DRG 847, medical | 11 | $42,272 | $9,417 | $12,597 | 1.21 |
Injuries, poisonings and toxic effects of drugs26 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 13 | $84,206 | $14,806 | $25,093 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 13 | $24,459 | $6,615 | $7,289 | 1.03 |
Alcohol and drug use19 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 19 | $29,970 | $5,828 | $8,931 | 0.86 |
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 1 Intraocular ProceduresAPC 5491 | 642 | 406 | $6,462 | $1,676 | $1,752 |
| Level 2 Urology and Related ServicesAPC 5372 | 618 | 463 | $950 | $436 | $502 |
| Comprehensive Observation ServicesAPC 8011 | 591 | 555 | $15,494 | $1,943 | $2,090 |
| Level 3 Urology and Related ServicesAPC 5373 | 438 | 305 | $4,407 | $1,329 | $1,516 |
| Level 1 Endovascular ProceduresAPC 5191 | 412 | 412 | $19,120 | $2,073 | $2,208 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 354 | 306 | $7,242 | $1,149 | $1,220 |
| Level 1 Nerve ProceduresAPC 5431 | 306 | 207 | $4,446 | $1,379 | $1,407 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 241 | 236 | $106,238 | $19,795 | $21,117 |
| Level 3 Vascular ProceduresAPC 5183 | 194 | 178 | $12,181 | $2,292 | $2,405 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 193 | 189 | $52,054 | $9,973 | $10,772 |
| Level 2 Upper GI ProceduresAPC 5302 | 187 | 164 | $10,026 | $1,339 | $1,445 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 184 | 179 | $27,522 | $5,138 | $5,339 |
| Level 2 Intraocular ProceduresAPC 5492 | 147 | 103 | $12,312 | $2,930 | $3,116 |
| Level 4 Urology and Related ServicesAPC 5374 | 119 | 109 | $12,526 | $2,508 | $2,629 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 99 | 95 | $27,257 | $4,148 | $4,358 |
| Level 2 Vascular ProceduresAPC 5182 | 95 | 90 | $8,576 | $1,144 | $1,204 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 93 | 85 | $11,296 | $2,275 | $2,373 |
| Level 3 Endovascular ProceduresAPC 5193 | 90 | 88 | $51,550 | $7,726 | $8,874 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 83 | 83 | $48,131 | $8,089 | $8,569 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 80 | 77 | $78,347 | $15,318 | $15,763 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 79 | 77 | $13,774 | $1,764 | $2,141 |
| Level 4 Vascular ProceduresAPC 5184 | 76 | 55 | $18,770 | $3,098 | $3,946 |
| Level 4 Airway EndoscopyAPC 5154 | 57 | 55 | $22,750 | $2,720 | $2,833 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 55 | 55 | $28,573 | $6,167 | $6,514 |
| Level 3 Lower GI ProceduresAPC 5313 | 51 | 46 | $10,235 | $1,999 | $2,176 |
| Level 5 Urology and Related ServicesAPC 5375 | 51 | 51 | $25,474 | $3,610 | $3,918 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 51 | 51 | $96,535 | $26,068 | $26,719 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 50 | 50 | $19,171 | $4,967 | $4,524 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 47 | 46 | $45,667 | $7,579 | $8,164 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 46 | 33 | $12,306 | $2,509 | $2,636 |
| Level 4 Gynecologic ProceduresAPC 5414 | 40 | 40 | $11,942 | $2,180 | $2,389 |
| Level 2 Endovascular ProceduresAPC 5192 | 39 | 36 | $40,497 | $4,151 | $4,338 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 39 | 39 | $90,765 | $27,542 | $29,375 |
| Level 4 Endovascular ProceduresAPC 5194 | 33 | 31 | $89,624 | $13,878 | $14,606 |
| Level 3 Upper GI ProceduresAPC 5303 | 31 | 29 | $16,429 | $2,692 | $2,888 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 30 | 29 | $6,391 | $1,167 | $1,196 |
| Level 3 Airway EndoscopyAPC 5153 | 30 | 30 | $9,008 | $1,231 | $1,264 |
| Level 5 Airway EndoscopyAPC 5155 | 30 | 29 | $29,976 | $4,971 | $5,183 |
| Level 5 Gynecologic ProceduresAPC 5415 | 25 | 25 | $17,040 | $3,396 | $3,792 |
| Level 3 Intraocular ProceduresAPC 5493 | 23 | 16 | $16,650 | $3,796 | $4,004 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 21 | 21 | $71,658 | $16,520 | $18,465 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 20 | 16 | $6,066 | $1,683 | $1,780 |
| Complex GI ProceduresAPC 5331 | 17 | 14 | $25,468 | $4,139 | $4,263 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 13 | 13 | $25,189 | $4,736 | $4,982 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 12 | 12 | $73,695 | $16,089 | $17,052 |
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.