Pikeville Medical Center Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Pikeville Medical Center, Pikeville, KY in 2024, from traditional Medicare claims. Back to the Pikeville Medical Center profile, with quality ratings, finances and negotiated rates.
1,916
Medicare inpatient discharges
In 58 published DRGs
1.89
Case mix index
IPPS FY 2027
14%
Surgical stays
71%
Stays with complications
In DRGs with a CC or MCC
2,485
Medicare outpatient services
In 33 service groups
Inpatient stays by major diagnostic category
Circulatory system541 discharges in 18 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 142 | $62,685 | $10,549 | $13,289 | 1.28 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 54 | $79,688 | $13,003 | $16,894 | 1.59 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 41 | $103,286 | $26,221 | $21,897 | 3.24 |
| Chest painMS-DRG 313, medical | 40 | $36,323 | $5,017 | $7,700 | 0.72 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 31 | $113,538 | $14,029 | $24,070 | 1.82 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 29 | $32,977 | $5,406 | $6,991 | 0.74 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 28 | $76,769 | $9,811 | $16,275 | 1.20 |
| Syncope and collapseMS-DRG 312, medical | 26 | $41,775 | $6,303 | $8,856 | 0.86 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 25 | $72,051 | $7,914 | $15,275 | 1.08 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 18 | $28,239 | $3,449 | $5,987 | 0.55 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 16 | $147,297 | $32,114 | $31,227 | 4.04 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 16 | $167,420 | $22,251 | $35,493 | 2.87 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 15 | $46,547 | $6,647 | $9,868 | 0.91 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 14 | $98,420 | $17,880 | $20,865 | 2.16 |
| Hypertension without MCCMS-DRG 305, medical | 13 | $34,916 | $5,241 | $7,402 | 0.75 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 11 | $344,523 | $54,802 | $73,039 | 7.80 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 11 | $123,470 | $33,932 | $26,176 | 4.88 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 11 | $106,703 | $17,819 | $22,621 | 2.09 |
Infectious and parasitic diseases432 discharges in 4 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 | 298 | $81,227 | $16,455 | $17,220 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 54 | $39,212 | $7,729 | $8,313 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 45 | $238,011 | $47,265 | $50,458 | 5.00 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 35 | $328,331 | $61,211 | $69,606 | 6.96 |
Respiratory system332 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 102 | $58,205 | $10,426 | $12,339 | 1.33 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 62 | $85,863 | $13,591 | $18,203 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 40 | $49,049 | $9,603 | $10,398 | 1.23 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 35 | $37,672 | $8,721 | $7,987 | 1.10 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 32 | $32,390 | $5,895 | $6,867 | 0.82 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 24 | $146,890 | $22,533 | $31,141 | 2.70 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 15 | $30,517 | $6,607 | $6,470 | 0.85 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 11 | $70,344 | $11,312 | $14,913 | 1.40 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 11 | $47,097 | $7,799 | $9,984 | 0.99 |
Kidney and urinary tract203 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 52 | $47,134 | $9,165 | $9,992 | 1.17 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 43 | $29,074 | $5,894 | $6,164 | 0.81 |
| Renal failure with MCCMS-DRG 682, medical | 34 | $56,372 | $11,948 | $11,951 | 1.50 |
| Renal failure with CCMS-DRG 683, medical | 33 | $40,136 | $6,435 | $8,509 | 0.90 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 26 | $86,504 | $14,876 | $18,339 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 15 | $36,496 | $7,819 | $7,737 | 1.02 |
Digestive system108 discharges in 4 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 | 42 | $32,251 | $5,550 | $6,837 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 36 | $42,699 | $7,410 | $9,052 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 19 | $80,629 | $15,002 | $17,093 | 1.79 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 11 | $37,685 | $7,042 | $7,989 | 0.94 |
Musculoskeletal system and connective tissue78 discharges in 3 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 | 39 | $76,347 | $16,012 | $16,185 | 2.07 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 24 | $68,263 | $16,296 | $14,472 | 2.11 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 15 | $117,901 | $24,527 | $24,995 | 2.95 |
Nervous system76 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 24 | $76,058 | $15,727 | $16,124 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 21 | $43,534 | $7,669 | $9,229 | 1.02 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 20 | $38,099 | $5,652 | $8,077 | 0.80 |
| Seizures with MCCMS-DRG 100, medical | 11 | $83,634 | $16,093 | $17,730 | 1.98 |
Endocrine, nutritional and metabolic63 discharges in 4 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 | 20 | $65,458 | $11,142 | $13,877 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 17 | $31,196 | $5,826 | $6,613 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 15 | $36,437 | $6,321 | $7,725 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 11 | $48,664 | $10,959 | $10,317 | 1.45 |
Liver, gallbladder and pancreas36 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 14 | $70,425 | $11,557 | $14,930 | 1.63 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 11 | $67,977 | $11,595 | $14,411 | 1.63 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 11 | $62,912 | $13,269 | $13,337 | 1.92 |
Skin, subcutaneous tissue and breast20 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 20 | $32,151 | $6,564 | $6,816 | 0.88 |
Blood and immune system16 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 16 | $32,383 | $6,916 | $6,865 | 0.90 |
Other11 discharges in 1 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 | 11 | $155,850 | $36,810 | $33,040 | 4.74 |
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 | 383 | 359 | $22,986 | $1,924 | $2,090 |
| Level 1 Intraocular ProceduresAPC 5491 | 299 | 178 | $8,748 | $1,655 | $1,752 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 216 | 208 | $58,461 | $10,163 | $10,772 |
| Level 2 Urology and Related ServicesAPC 5372 | 181 | 141 | $3,654 | $485 | $502 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 162 | 148 | $11,421 | $1,142 | $1,220 |
| Level 1 Endovascular ProceduresAPC 5191 | 150 | 150 | $28,727 | $2,028 | $2,208 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 106 | 104 | $37,286 | $5,031 | $5,339 |
| Level 3 Urology and Related ServicesAPC 5373 | 100 | 72 | $10,632 | $1,472 | $1,516 |
| Level 3 Vascular ProceduresAPC 5183 | 92 | 86 | $21,130 | $2,254 | $2,405 |
| Level 2 Upper GI ProceduresAPC 5302 | 74 | 56 | $11,101 | $1,340 | $1,445 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 59 | 57 | $19,126 | $2,341 | $2,373 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 56 | 42 | $19,887 | $2,498 | $2,636 |
| Level 4 Urology and Related ServicesAPC 5374 | 56 | 48 | $12,266 | $2,523 | $2,629 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 53 | 52 | $32,565 | $3,939 | $4,358 |
| Level 5 Urology and Related ServicesAPC 5375 | 50 | 50 | $15,799 | $3,744 | $3,918 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 44 | 42 | $11,840 | $1,137 | $1,196 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 42 | 40 | $17,012 | $2,054 | $2,141 |
| Level 3 Endovascular ProceduresAPC 5193 | 40 | 39 | $72,689 | $8,143 | $8,874 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 38 | 38 | $73,084 | $8,060 | $8,569 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 35 | 34 | $12,326 | $1,691 | $1,780 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 31 | 31 | $114,514 | $19,879 | $21,117 |
| Level 4 Airway EndoscopyAPC 5154 | 28 | 26 | $18,787 | $2,710 | $2,833 |
| Level 2 Vascular ProceduresAPC 5182 | 25 | 23 | $15,591 | $1,159 | $1,204 |
| Level 2 Intraocular ProceduresAPC 5492 | 24 | 22 | $18,951 | $2,842 | $3,116 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 23 | 23 | $278,054 | $26,931 | $29,375 |
| Level 3 ENT ProceduresAPC 5163 | 19 | 19 | $10,143 | $1,042 | $1,106 |
| Level 6 Urology and Related ServicesAPC 5376 | 19 | 19 | $30,789 | $6,379 | $7,291 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 15 | 14 | $24,599 | $2,574 | $2,930 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 15 | 15 | $118,112 | $14,943 | $17,052 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 15 | 15 | $46,849 | $7,712 | $8,164 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 13 | 13 | $31,678 | $4,719 | $4,982 |
| Level 4 Vascular ProceduresAPC 5184 | 11 | 11 | $29,650 | $3,960 | $3,946 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 11 | 11 | $33,917 | $6,147 | $6,514 |
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.