Piedmont Hospital Inc. Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Piedmont Hospital Inc., Atlanta, GA in 2024, from traditional Medicare claims. Back to the Piedmont Hospital Inc. profile, with quality ratings, finances and negotiated rates.
5,535
Medicare inpatient discharges
In 161 published DRGs
2.80
Case mix index
IPPS FY 2027
43%
Surgical stays
70%
Stays with complications
In DRGs with a CC or MCC
5,474
Medicare outpatient services
In 45 service groups
Inpatient stays by major diagnostic category
Circulatory system2,007 discharges in 42 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 255 | $59,152 | $8,112 | $10,647 | 1.28 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 211 | $317,527 | $42,667 | $57,155 | 6.25 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 153 | $269,894 | $31,216 | $48,581 | 4.88 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 144 | $157,021 | $19,717 | $28,264 | 3.24 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 129 | $106,988 | $14,533 | $19,258 | 2.16 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 71 | $27,648 | $3,835 | $4,977 | 0.74 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 61 | $246,723 | $24,301 | $44,410 | 4.04 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 61 | $73,990 | $9,510 | $13,318 | 1.59 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 56 | $61,620 | $6,063 | $11,092 | 1.08 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 51 | $133,930 | $11,419 | $24,107 | 1.82 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 50 | $106,151 | $15,656 | $19,107 | 2.09 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 49 | $19,500 | $2,456 | $3,510 | 0.55 |
| Syncope and collapseMS-DRG 312, medical | 49 | $34,882 | $4,810 | $6,279 | 0.86 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 45 | $69,451 | $9,739 | $12,501 | 1.20 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 40 | $199,776 | $18,149 | $35,960 | 2.87 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 37 | $276,370 | $33,771 | $49,747 | 5.06 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 32 | $316,862 | $33,212 | $57,035 | 5.24 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 31 | $432,583 | $60,728 | $77,865 | 7.71 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 31 | $173,136 | $23,834 | $31,164 | 3.46 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 29 | $301,630 | $39,166 | $54,293 | 5.88 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 29 | $52,585 | $5,180 | $9,465 | 0.91 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 28 | $221,603 | $24,070 | $39,889 | 3.35 |
| Other vascular procedures with CCMS-DRG 253, surgical | 28 | $160,182 | $14,180 | $28,833 | 2.55 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 27 | $117,434 | $14,469 | $21,138 | 2.28 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 24 | $290,429 | $34,077 | $52,277 | 5.20 |
| Permanent cardiac pacemaker implant without cc/mccMS-DRG 244, surgical | 24 | $91,166 | $11,627 | $16,410 | 1.83 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 24 | $174,263 | $17,465 | $31,367 | 3.46 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 22 | $275,351 | $29,041 | $49,563 | 4.16 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 21 | $42,655 | $5,145 | $7,678 | 0.97 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 19 | $378,569 | $54,355 | $68,142 | 7.80 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 19 | $36,107 | $6,363 | $6,499 | 1.07 |
| Hypertension without MCCMS-DRG 305, medical | 18 | $37,898 | $4,045 | $6,822 | 0.75 |
| Cardiac congenital and valvular disorders with MCCMS-DRG 306, medical | 17 | $52,118 | $9,720 | $9,381 | 1.54 |
| Chest painMS-DRG 313, medical | 17 | $32,646 | $4,070 | $5,876 | 0.72 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 16 | $190,233 | $25,089 | $34,242 | 3.90 |
| Cardiac defibrillator implant with MCC or carotid sinus neurostimulatorMS-DRG 276, surgical | 15 | $237,776 | $42,406 | $42,800 | 6.21 |
| Heart failure and shock with CCMS-DRG 292, medical | 13 | $47,581 | $5,288 | $8,565 | 0.86 |
| Atherosclerosis without MCCMS-DRG 303, medical | 13 | $28,736 | $3,516 | $5,172 | 0.66 |
| Cardiac congenital and valvular disorders without MCCMS-DRG 307, medical | 13 | $60,577 | $4,979 | $10,904 | 0.94 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 12 | $465,235 | $64,116 | $83,742 | 9.71 |
| Hypertension with MCCMS-DRG 304, medical | 12 | $51,778 | $6,578 | $9,320 | 1.15 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 11 | $61,404 | $10,409 | $11,053 | 1.58 |
Infectious and parasitic diseases636 discharges in 8 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 | 362 | $96,100 | $12,182 | $17,298 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 103 | $45,220 | $5,765 | $8,140 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 84 | $264,517 | $36,264 | $47,613 | 5.00 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 23 | $456,319 | $54,155 | $82,137 | 6.96 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 20 | $82,589 | $11,114 | $14,866 | 1.84 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 17 | $177,787 | $13,428 | $32,002 | 2.04 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 15 | $32,006 | $5,531 | $5,761 | 1.01 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 12 | $157,875 | $22,644 | $28,417 | 4.43 |
Digestive system532 discharges in 16 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 | 97 | $38,328 | $4,458 | $6,899 | 0.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 71 | $122,656 | $13,947 | $22,078 | 2.37 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 60 | $46,967 | $5,366 | $8,454 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 42 | $70,931 | $11,642 | $12,768 | 1.79 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 41 | $87,388 | $8,719 | $15,730 | 1.67 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 34 | $167,949 | $25,942 | $30,231 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 30 | $51,216 | $7,805 | $9,219 | 1.28 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 28 | $32,940 | $5,839 | $5,929 | 0.94 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 21 | $223,247 | $33,311 | $40,184 | 5.08 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 18 | $123,627 | $15,121 | $22,253 | 2.50 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 18 | $37,289 | $4,176 | $6,712 | 0.80 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 18 | $59,684 | $10,456 | $10,743 | 1.62 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 17 | $55,361 | $9,758 | $9,965 | 1.75 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 13 | $47,861 | $6,317 | $8,615 | 1.04 |
| Digestive malignancy with CCMS-DRG 375, medical | 13 | $67,650 | $6,829 | $12,177 | 1.20 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 11 | $79,645 | $6,711 | $14,336 | 1.45 |
Kidney and urinary tract480 discharges in 13 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 | 82 | $68,600 | $10,743 | $12,348 | 1.65 |
| Kidney transplantMS-DRG 652, surgical | 76 | $385,651 | $14,649 | $69,417 | 3.00 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 62 | $59,515 | $5,939 | $10,713 | 1.02 |
| Renal failure with CCMS-DRG 683, medical | 59 | $41,120 | $5,128 | $7,402 | 0.90 |
| Renal failure with MCCMS-DRG 682, medical | 47 | $67,622 | $9,815 | $12,172 | 1.50 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 34 | $37,730 | $4,289 | $6,791 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 25 | $48,420 | $7,088 | $8,716 | 1.17 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 22 | $513,181 | $28,960 | $92,373 | 4.50 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 19 | $100,748 | $8,248 | $18,135 | 1.35 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 18 | $265,699 | $34,674 | $47,826 | 3.70 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 13 | $131,290 | $15,831 | $23,632 | 2.59 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 12 | $103,109 | $14,437 | $18,560 | 2.38 |
| Kidney and ureter procedures for neoplasm with MCCMS-DRG 656, surgical | 11 | $108,222 | $20,955 | $19,480 | 3.14 |
Nervous system444 discharges in 17 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 67 | $206,826 | $26,360 | $37,229 | 4.42 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 67 | $54,802 | $5,645 | $9,864 | 1.02 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 58 | $87,128 | $10,993 | $15,683 | 2.00 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 32 | $301,451 | $41,143 | $54,261 | 5.67 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 25 | $44,380 | $4,184 | $7,988 | 0.80 |
| Extracranial procedures without cc/mccMS-DRG 039, surgical | 24 | $72,255 | $6,375 | $13,006 | 1.14 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 23 | $41,356 | $6,083 | $7,444 | 1.03 |
| Seizures with MCCMS-DRG 100, medical | 21 | $130,133 | $13,654 | $23,424 | 1.98 |
| Extracranial procedures with CCMS-DRG 038, surgical | 18 | $93,216 | $8,792 | $16,779 | 1.60 |
| Seizures without MCCMS-DRG 101, medical | 17 | $49,753 | $5,609 | $8,956 | 0.91 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 16 | $51,788 | $5,922 | $9,322 | 1.06 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 16 | $95,097 | $14,863 | $17,117 | 2.28 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 15 | $77,445 | $11,442 | $13,940 | 1.79 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 12 | $82,567 | $9,471 | $14,862 | 1.47 |
| Ventricular shunt procedures without cc/mccMS-DRG 033, surgical | 11 | $107,440 | $7,925 | $19,339 | 1.62 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 11 | $44,528 | $3,887 | $8,015 | 0.69 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 11 | $121,747 | $12,433 | $21,915 | 1.79 |
Musculoskeletal system and connective tissue392 discharges in 18 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cervical spinal fusion with CCMS-DRG 472, surgical | 46 | $159,675 | $17,800 | $28,741 | 2.96 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 39 | $255,777 | $29,782 | $46,040 | 4.61 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 31 | $435,643 | $56,114 | $78,416 | 6.12 |
| Medical back problems without MCCMS-DRG 552, medical | 31 | $43,096 | $5,605 | $7,757 | 0.97 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 30 | $199,407 | $23,797 | $35,893 | 3.66 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 25 | $114,679 | $12,843 | $20,642 | 2.11 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 24 | $121,570 | $12,605 | $21,883 | 2.07 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 23 | $90,785 | $12,562 | $16,341 | 2.04 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 19 | $110,530 | $10,716 | $19,895 | 1.88 |
| Cervical spinal fusion without cc/mccMS-DRG 473, surgical | 18 | $145,259 | $13,729 | $26,147 | 2.46 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 16 | $173,879 | $21,513 | $31,298 | 3.49 |
| Combined anterior and posterior spinal fusion with MCCMS-DRG 453, surgical | 14 | $610,781 | $76,624 | $109,941 | 8.86 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 14 | $108,848 | $16,833 | $19,593 | 2.67 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 14 | $108,153 | $12,230 | $19,467 | 1.97 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 13 | $147,970 | $18,858 | $26,635 | 2.95 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 12 | $156,362 | $15,924 | $28,145 | 2.48 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 12 | $81,554 | $9,214 | $14,680 | 1.49 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 11 | $33,288 | $5,138 | $5,992 | 0.90 |
Respiratory system324 discharges in 13 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 44 | $66,244 | $10,426 | $11,924 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 44 | $47,130 | $8,141 | $8,483 | 1.33 |
| Major chest procedures with CCMS-DRG 164, surgical | 41 | $113,817 | $15,037 | $20,487 | 2.55 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 33 | $61,577 | $7,422 | $11,084 | 1.23 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 25 | $61,096 | $6,802 | $10,997 | 1.10 |
| Major chest procedures with MCCMS-DRG 163, surgical | 24 | $189,511 | $29,451 | $34,112 | 4.71 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 20 | $30,934 | $4,286 | $5,568 | 0.82 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 20 | $48,655 | $5,760 | $8,758 | 0.96 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 18 | $60,241 | $9,077 | $10,843 | 1.40 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 17 | $97,726 | $11,202 | $17,591 | 1.88 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 15 | $79,537 | $11,806 | $14,317 | 1.74 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 12 | $40,767 | $4,696 | $7,338 | 0.99 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 11 | $51,323 | $5,053 | $9,238 | 0.85 |
Liver, gallbladder and pancreas215 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 34 | $154,155 | $17,917 | $27,748 | 2.89 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 33 | $239,250 | $32,295 | $43,065 | 5.51 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 21 | $88,638 | $10,438 | $15,955 | 1.83 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 21 | $62,869 | $6,595 | $11,316 | 1.09 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 20 | $82,226 | $9,902 | $14,801 | 1.76 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 17 | $42,455 | $4,915 | $7,642 | 0.95 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 15 | $111,228 | $12,476 | $20,021 | 1.92 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 14 | $94,396 | $10,750 | $16,991 | 1.63 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 14 | $65,845 | $11,213 | $11,852 | 1.67 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 13 | $41,359 | $4,630 | $7,445 | 0.86 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 13 | $53,100 | $7,894 | $9,558 | 1.63 |
Endocrine, nutritional and metabolic155 discharges in 6 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 | 60 | $60,107 | $7,847 | $10,819 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 27 | $38,964 | $4,415 | $7,014 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 21 | $29,534 | $4,602 | $5,316 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 17 | $50,528 | $8,488 | $9,095 | 1.45 |
| Adrenal and pituitary procedures with cc/mccMS-DRG 614, surgical | 15 | $127,049 | $13,294 | $22,869 | 2.25 |
| Endocrine disorders with CCMS-DRG 644, medical | 15 | $48,267 | $6,713 | $8,688 | 1.06 |
Transplants, ECMO and tracheostomy (pre-MDC)90 discharges in 3 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 | 44 | $887,029 | $141,248 | $159,665 | 21.32 |
| Heart transplant or implant of heart assist system with MCCMS-DRG 001, surgical | 24 | $1,717,574 | $196,373 | $309,163 | 27.10 |
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 22 | $695,118 | $60,696 | $125,121 | 10.35 |
Injuries, poisonings and toxic effects of drugs64 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 27 | $81,940 | $11,162 | $14,749 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 19 | $40,801 | $6,519 | $7,344 | 1.03 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 18 | $218,930 | $33,511 | $39,407 | 3.72 |
Skin, subcutaneous tissue and breast54 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 42 | $33,021 | $4,780 | $5,944 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 12 | $53,128 | $8,817 | $9,563 | 1.49 |
Other50 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 | 27 | $425,884 | $29,668 | $76,659 | 4.74 |
| Multiple level combined anterior and posterior spinal fusion except cervical with CCMS-DRG 427 | 12 | $644,546 | $85,072 | $116,018 | |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 11 | $115,669 | $15,929 | $20,820 | 2.49 |
Blood and immune system43 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders with MCCMS-DRG 811, medical | 16 | $69,254 | $7,244 | $12,466 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 16 | $41,405 | $5,381 | $7,453 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 11 | $60,229 | $9,796 | $10,841 | 1.56 |
Ear, nose, mouth and throat19 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 19 | $41,514 | $3,822 | $7,472 | 0.74 |
Blood cancers and poorly differentiated neoplasms15 discharges in 1 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 | 15 | $55,778 | $7,687 | $10,040 | 1.21 |
Factors influencing health status15 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 | 15 | $35,987 | $4,648 | $6,478 | 0.80 |
Source: CMS Medicare Inpatient Hospitals by Provider and Service (2024 data, released 2026-04-10), traditional Medicare only; CMS omits DRGs with fewer than 11 discharges. Estimated cost is average charges times the hospital's Medicare cost-to-charge ratio from the IPPS Impact File. Weights are the MS-DRG relative weights for the same year.
Outpatient services
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Comprehensive Observation ServicesAPC 8011 | 499 | 478 | $22,046 | $1,937 | $2,090 |
| Level 1 Endovascular ProceduresAPC 5191 | 432 | 430 | $30,051 | $2,123 | $2,208 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 419 | 406 | $93,221 | $9,929 | $10,772 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 369 | 359 | $137,291 | $19,690 | $21,117 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 341 | 320 | $15,570 | $1,157 | $1,220 |
| Level 3 Endovascular ProceduresAPC 5193 | 220 | 200 | $92,329 | $8,500 | $8,874 |
| Level 5 Urology and Related ServicesAPC 5375 | 214 | 197 | $36,732 | $3,724 | $3,918 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 195 | 192 | $49,353 | $4,132 | $4,358 |
| Level 2 Upper GI ProceduresAPC 5302 | 190 | 167 | $15,230 | $1,389 | $1,445 |
| Level 3 Vascular ProceduresAPC 5183 | 172 | 151 | $22,732 | $2,338 | $2,405 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 151 | 148 | $63,563 | $4,469 | $5,339 |
| Level 4 Urology and Related ServicesAPC 5374 | 139 | 116 | $31,311 | $2,538 | $2,629 |
| Level 2 Endovascular ProceduresAPC 5192 | 130 | 125 | $49,924 | $3,996 | $4,338 |
| Level 4 Airway EndoscopyAPC 5154 | 128 | 124 | $37,342 | $2,674 | $2,833 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 128 | 126 | $79,794 | $7,600 | $8,164 |
| Level 4 Vascular ProceduresAPC 5184 | 118 | 86 | $43,059 | $2,991 | $3,946 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 112 | 108 | $24,438 | $944 | $1,780 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 105 | 105 | $29,715 | $2,065 | $2,141 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 105 | 92 | $30,412 | $2,134 | $2,636 |
| Level 4 Endovascular ProceduresAPC 5194 | 97 | 93 | $126,871 | $14,301 | $14,606 |
| Level 1 Nerve ProceduresAPC 5431 | 94 | 89 | $18,877 | $1,285 | $1,407 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 86 | 86 | $67,177 | $8,174 | $8,569 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 84 | 83 | $118,960 | $15,253 | $15,763 |
| Level 3 Lower GI ProceduresAPC 5313 | 80 | 77 | $24,617 | $1,841 | $2,176 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 75 | 70 | $39,666 | $2,758 | $2,930 |
| Level 2 Vascular ProceduresAPC 5182 | 70 | 68 | $10,124 | $1,149 | $1,204 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 69 | 65 | $38,959 | $1,758 | $2,373 |
| Level 3 Urology and Related ServicesAPC 5373 | 68 | 42 | $19,176 | $1,440 | $1,516 |
| Level 5 Airway EndoscopyAPC 5155 | 63 | 62 | $70,032 | $4,049 | $5,183 |
| Complex GI ProceduresAPC 5331 | 57 | 45 | $33,830 | $3,992 | $4,263 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 56 | 56 | $60,754 | $4,615 | $4,982 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 52 | 52 | $146,092 | $27,698 | $29,375 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 48 | 43 | $19,349 | $915 | $1,196 |
| Level 4 Gynecologic ProceduresAPC 5414 | 46 | 46 | $36,324 | $2,280 | $2,389 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 38 | 38 | $40,538 | $6,116 | $6,514 |
| Level 3 Upper GI ProceduresAPC 5303 | 38 | 35 | $26,059 | $2,683 | $2,888 |
| Level 7 Radiation TherapyAPC 5627 | 35 | 25 | $104,313 | $5,758 | $6,121 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 27 | 27 | $68,911 | $16,409 | $17,052 |
| Level 5 ENT ProceduresAPC 5165 | 25 | 25 | $61,968 | $3,499 | $4,436 |
| Level 3 Airway EndoscopyAPC 5153 | 24 | 24 | $19,624 | $1,224 | $1,264 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 22 | 20 | $112,504 | $16,963 | $18,465 |
| Level 2 Electrophysiologic ProceduresAPC 5212 | 14 | 14 | $48,900 | $5,522 | $5,682 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 13 | 12 | $70,936 | $5,783 | $7,546 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 13 | 13 | $91,556 | $20,167 | $21,011 |
| Level 4 Extraocular, Repair, and Plastic Eye ProceduresAPC 5504 | 13 | 13 | $34,389 | $2,331 | $2,969 |
Source: CMS Medicare Outpatient Hospitals by Provider and Service (2024 data, released 2026-06-24), comprehensive APCs for traditional Medicare; CMS omits services with fewer than 11 claims. The US average weights every hospital by its services.