Riley Hospital For Children At Iu Health Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Riley Hospital For Children At Iu Health, Indianapolis, IN in 2024, from traditional Medicare claims. Back to the Riley Hospital For Children At Iu Health profile, with quality ratings, finances and negotiated rates.
6,193
Medicare inpatient discharges
In 201 published DRGs
2.44
Case mix index
IPPS FY 2027
38%
Surgical stays
71%
Stays with complications
In DRGs with a CC or MCC
5,827
Medicare outpatient services
In 48 service groups
Inpatient stays by major diagnostic category
Circulatory system929 discharges in 28 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 129 | $68,429 | $11,523 | $14,507 | 1.28 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 71 | $153,559 | $27,780 | $32,555 | 3.24 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 57 | $148,660 | $20,747 | $31,516 | 2.16 |
| Syncope and collapseMS-DRG 312, medical | 57 | $45,090 | $7,628 | $9,559 | 0.86 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 48 | $200,455 | $42,269 | $42,496 | 4.88 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 45 | $129,413 | $18,003 | $27,436 | 2.09 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 42 | $38,695 | $6,224 | $8,203 | 0.74 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 40 | $377,440 | $44,975 | $80,017 | 4.16 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 36 | $349,253 | $55,265 | $74,042 | 5.24 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 32 | $47,021 | $9,198 | $9,968 | 1.07 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 31 | $221,229 | $30,717 | $46,901 | 3.46 |
| Other vascular procedures with CCMS-DRG 253, surgical | 30 | $142,189 | $22,370 | $30,144 | 2.55 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 28 | $225,593 | $33,580 | $47,826 | 3.35 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 27 | $507,643 | $84,492 | $107,620 | 7.71 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 27 | $133,450 | $14,671 | $28,291 | 1.82 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 26 | $299,941 | $50,085 | $63,587 | 5.06 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 22 | $46,140 | $8,379 | $9,782 | 0.97 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 21 | $258,316 | $34,823 | $54,763 | 4.04 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 20 | $94,127 | $13,174 | $19,955 | 1.59 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 20 | $56,300 | $9,956 | $11,936 | 1.20 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 19 | $81,859 | $13,836 | $17,354 | 1.58 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 18 | $263,229 | $53,044 | $55,804 | 6.25 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 16 | $113,884 | $8,772 | $24,143 | 1.08 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 16 | $23,242 | $4,558 | $4,927 | 0.55 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 14 | $146,044 | $21,944 | $30,961 | 2.28 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 13 | $48,600 | $7,882 | $10,303 | 0.91 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 13 | $192,801 | $22,766 | $40,874 | 2.87 |
| Hypertension with MCCMS-DRG 304, medical | 11 | $70,393 | $9,708 | $14,923 | 1.15 |
Nervous system725 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 | 82 | $113,527 | $17,113 | $24,068 | 2.00 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 64 | $237,657 | $40,551 | $50,383 | 4.42 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 64 | $57,221 | $8,687 | $12,131 | 1.02 |
| Seizures without MCCMS-DRG 101, medical | 60 | $46,900 | $7,602 | $9,943 | 0.91 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 40 | $282,171 | $48,508 | $59,820 | 5.67 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 38 | $77,107 | $11,677 | $16,347 | 1.36 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 34 | $45,747 | $11,470 | $9,698 | 1.36 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 32 | $52,170 | $9,187 | $11,060 | 1.03 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 27 | $203,153 | $28,838 | $43,068 | 2.95 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 27 | $164,211 | $21,374 | $34,813 | 2.43 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 26 | $60,184 | $11,281 | $12,759 | 1.32 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 26 | $85,351 | $15,818 | $18,094 | 1.79 |
| Seizures with MCCMS-DRG 100, medical | 26 | $101,095 | $17,623 | $21,432 | 1.98 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 25 | $133,640 | $21,237 | $28,332 | 2.28 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 22 | $120,529 | $19,009 | $25,552 | 2.39 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 18 | $82,207 | $17,868 | $17,428 | 2.27 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 17 | $190,145 | $32,045 | $40,311 | 3.79 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 17 | $81,217 | $15,856 | $17,218 | 1.79 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 15 | $34,681 | $6,806 | $7,352 | 0.80 |
| Carotid artery stent procedures without cc/mccMS-DRG 036, surgical | 14 | $116,449 | $16,192 | $24,687 | 1.81 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 14 | $33,336 | $5,812 | $7,067 | 0.69 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 13 | $62,870 | $10,949 | $13,328 | 1.47 |
| Intracranial vascular procedures with principal diagnosis hemorrhage with CCMS-DRG 021, surgical | 12 | $242,560 | $52,845 | $51,423 | 6.14 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 12 | $51,571 | $9,191 | $10,933 | 1.06 |
Digestive system700 discharges in 22 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 | 67 | $44,800 | $7,020 | $9,498 | 0.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 60 | $119,629 | $20,078 | $25,361 | 2.37 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 58 | $56,034 | $8,915 | $11,879 | 0.98 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 55 | $58,904 | $10,399 | $12,488 | 0.94 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 44 | $62,046 | $11,031 | $13,154 | 1.28 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 40 | $239,464 | $43,911 | $50,766 | 4.52 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 40 | $110,251 | $16,948 | $23,373 | 1.79 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 40 | $73,378 | $14,425 | $15,556 | 1.62 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 39 | $267,981 | $48,688 | $56,812 | 5.08 |
| Hernia procedures except inguinal and femoral with CCMS-DRG 354, surgical | 32 | $115,778 | $14,725 | $24,545 | 1.72 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 31 | $146,861 | $22,270 | $31,134 | 2.50 |
| Stomach, esophageal and duodenal procedures without cc/mccMS-DRG 328, surgical | 28 | $107,435 | $13,589 | $22,776 | 1.60 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 25 | $31,489 | $7,089 | $6,676 | 0.80 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 24 | $88,000 | $14,695 | $18,656 | 1.67 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 22 | $55,999 | $8,597 | $11,872 | 1.04 |
| Other digestive system o.r. procedures with CCMS-DRG 357, surgical | 16 | $119,225 | $17,972 | $25,276 | 2.20 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 16 | $54,631 | $12,112 | $11,582 | 1.45 |
| Hernia procedures except inguinal and femoral without cc/mccMS-DRG 355, surgical | 15 | $78,987 | $11,252 | $16,745 | 1.36 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 13 | $24,215 | $4,325 | $5,134 | 0.56 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 12 | $85,923 | $16,885 | $18,216 | 1.75 |
| Digestive malignancy with MCCMS-DRG 374, medical | 12 | $101,247 | $18,110 | $21,464 | 2.10 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 11 | $277,859 | $43,609 | $58,906 | 4.28 |
Kidney and urinary tract647 discharges in 17 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 72 | $36,100 | $7,022 | $7,653 | 0.81 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 68 | $64,111 | $13,611 | $13,591 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 66 | $51,179 | $9,023 | $10,850 | 1.02 |
| Kidney transplantMS-DRG 652, surgical | 62 | $354,850 | $29,451 | $75,228 | 3.00 |
| Renal failure with CCMS-DRG 683, medical | 58 | $39,889 | $7,828 | $8,456 | 0.90 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 49 | $53,074 | $10,106 | $11,252 | 1.17 |
| Renal failure with MCCMS-DRG 682, medical | 47 | $78,622 | $13,880 | $16,668 | 1.50 |
| Kidney and ureter procedures for neoplasm with CCMS-DRG 657, surgical | 42 | $100,002 | $15,341 | $21,200 | 1.84 |
| Major bladder procedures with CCMS-DRG 654, surgical | 34 | $156,038 | $23,693 | $33,080 | 2.74 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 28 | $82,014 | $11,572 | $17,387 | 1.35 |
| Major bladder procedures with MCCMS-DRG 653, surgical | 23 | $235,071 | $47,558 | $49,835 | 5.41 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 21 | $75,533 | $8,354 | $16,013 | 1.05 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 19 | $168,241 | $22,774 | $35,667 | 2.59 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 17 | $235,227 | $40,331 | $49,868 | 3.70 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 15 | $80,917 | $12,473 | $17,155 | 1.48 |
| Major bladder procedures without cc/mccMS-DRG 655, surgical | 14 | $142,808 | $17,971 | $30,275 | 2.11 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 12 | $405,065 | $41,919 | $85,874 | 4.50 |
Infectious and parasitic diseases630 discharges in 10 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 | 347 | $86,208 | $17,033 | $18,276 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 88 | $294,856 | $49,965 | $62,509 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 66 | $49,939 | $8,875 | $10,587 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 33 | $317,614 | $56,559 | $67,334 | 6.96 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 24 | $62,234 | $16,195 | $13,194 | 1.84 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 19 | $107,649 | $17,822 | $22,821 | 2.04 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 16 | $115,258 | $19,432 | $24,435 | 2.14 |
| Fever and inflammatory conditionsMS-DRG 864, medical | 14 | $51,104 | $8,094 | $10,834 | 0.88 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 12 | $149,722 | $36,373 | $31,741 | 4.43 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 11 | $37,364 | $9,022 | $7,921 | 1.01 |
Respiratory system576 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 | 77 | $69,602 | $14,216 | $14,756 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 64 | $56,276 | $10,490 | $11,930 | 1.33 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 40 | $46,016 | $8,708 | $9,755 | 1.10 |
| Major chest procedures with MCCMS-DRG 163, surgical | 37 | $193,903 | $40,779 | $41,108 | 4.71 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 33 | $79,775 | $15,459 | $16,912 | 1.81 |
| Major chest trauma with CCMS-DRG 184, medical | 31 | $54,649 | $8,212 | $11,586 | 1.05 |
| Major chest procedures with CCMS-DRG 164, surgical | 30 | $136,565 | $21,252 | $28,952 | 2.55 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 24 | $33,019 | $8,237 | $7,000 | 0.99 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 24 | $58,551 | $10,629 | $12,413 | 1.23 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 24 | $38,562 | $7,019 | $8,175 | 0.82 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 23 | $158,739 | $23,558 | $33,653 | 2.70 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 21 | $106,104 | $16,051 | $22,494 | 1.88 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 20 | $65,504 | $12,135 | $13,887 | 1.40 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 20 | $233,646 | $48,990 | $49,533 | 6.91 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 19 | $35,793 | $6,976 | $7,588 | 0.82 |
| Major chest trauma with MCCMS-DRG 183, medical | 19 | $80,231 | $12,925 | $17,009 | 1.57 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 17 | $120,966 | $13,424 | $25,645 | 0.91 |
| Pneumothorax with MCCMS-DRG 199, medical | 16 | $108,842 | $14,393 | $23,075 | 1.77 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 14 | $78,683 | $15,297 | $16,681 | 1.74 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 12 | $41,800 | $7,753 | $8,862 | 0.96 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 11 | $161,230 | $34,223 | $34,181 | 4.06 |
Musculoskeletal system and connective tissue568 discharges in 21 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 | 91 | $158,865 | $17,957 | $33,679 | 2.07 |
| Medical back problems without MCCMS-DRG 552, medical | 61 | $45,816 | $7,972 | $9,713 | 0.97 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 41 | $201,389 | $25,745 | $42,695 | 2.95 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 40 | $225,580 | $30,754 | $47,823 | 3.49 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 35 | $148,017 | $15,609 | $31,380 | 1.88 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 32 | $143,240 | $20,533 | $30,367 | 2.40 |
| Medical back problems with MCCMS-DRG 551, medical | 32 | $75,304 | $14,172 | $15,964 | 1.70 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 26 | $398,071 | $39,636 | $84,391 | 3.66 |
| Lower extremity and humerus procedures except hip, foot and femur without cc/mccMS-DRG 494, surgical | 22 | $137,522 | $14,619 | $29,155 | 1.87 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 22 | $149,684 | $16,666 | $31,733 | 2.11 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 20 | $46,631 | $7,784 | $9,886 | 0.90 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 19 | $270,689 | $28,785 | $57,386 | 2.96 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 463, surgical | 18 | $259,359 | $41,260 | $54,984 | 5.66 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 17 | $198,974 | $28,185 | $42,182 | 2.99 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 16 | $489,689 | $68,544 | $103,814 | 6.12 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 15 | $242,073 | $34,669 | $51,320 | 3.00 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 14 | $127,438 | $13,008 | $27,017 | 1.59 |
| Lower extremity and humerus procedures except hip, foot and femur with MCCMS-DRG 492, surgical | 13 | $169,922 | $29,084 | $36,023 | 3.46 |
| Revision of hip or knee replacement with MCCMS-DRG 466, surgical | 12 | $339,870 | $43,258 | $72,052 | 5.19 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 11 | $224,522 | $25,384 | $47,599 | 2.67 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 11 | $116,790 | $16,697 | $24,760 | 2.04 |
Liver, gallbladder and pancreas460 discharges in 16 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 59 | $154,243 | $24,642 | $32,700 | 2.89 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 47 | $272,960 | $51,487 | $57,867 | 5.51 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 47 | $56,327 | $9,471 | $11,941 | 1.09 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 31 | $103,612 | $16,210 | $21,966 | 1.67 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 31 | $90,864 | $17,480 | $19,263 | 1.83 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 30 | $129,824 | $19,694 | $27,523 | 1.92 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 29 | $65,520 | $14,230 | $13,890 | 1.63 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 28 | $83,306 | $16,269 | $17,661 | 1.76 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 27 | $56,217 | $7,508 | $11,918 | 0.86 |
| Pancreas, liver and shunt procedures without cc/mccMS-DRG 407, surgical | 26 | $99,046 | $18,504 | $20,998 | 2.15 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 26 | $49,699 | $7,934 | $10,536 | 0.95 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 25 | $89,902 | $13,636 | $19,059 | 1.63 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 16 | $54,519 | $9,258 | $11,558 | 1.03 |
| Disorders of pancreas except malignancy without cc/mccMS-DRG 440, medical | 16 | $41,849 | $5,798 | $8,872 | 0.62 |
| Laparoscopic cholecystectomy without C.D.E. with MCCMS-DRG 417, surgical | 11 | $134,046 | $22,898 | $28,418 | 2.32 |
| Disorders of the biliary tract without cc/mccMS-DRG 446, medical | 11 | $52,493 | $6,808 | $11,129 | 0.80 |
Endocrine, nutritional and metabolic189 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 | 71 | $75,258 | $12,787 | $15,955 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 44 | $46,692 | $6,907 | $9,899 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 29 | $39,401 | $7,764 | $8,353 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 19 | $60,865 | $12,684 | $12,903 | 1.45 |
| Adrenal and pituitary procedures with cc/mccMS-DRG 614, surgical | 13 | $124,814 | $19,390 | $26,461 | 2.25 |
| Endocrine disorders with CCMS-DRG 644, medical | 13 | $44,594 | $8,548 | $9,454 | 1.06 |
Transplants, ECMO and tracheostomy (pre-MDC)144 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 | 29 | $842,330 | $181,539 | $178,574 | 21.32 |
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 25 | $614,020 | $108,711 | $130,172 | 10.35 |
| Autologous bone marrow transplant with cc/mccMS-DRG 016, medical | 23 | $256,545 | $54,389 | $54,388 | 6.18 |
| Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCCMS-DRG 011, surgical | 15 | $262,696 | $46,623 | $55,692 | 5.16 |
| Heart transplant or implant of heart assist system with MCCMS-DRG 001, surgical | 14 | $1,100,452 | $246,322 | $233,296 | 27.10 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 14 | $479,233 | $99,822 | $101,597 | 14.70 |
| Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CCMS-DRG 012, surgical | 13 | $227,310 | $34,359 | $48,190 | 4.00 |
| Liver transplant without MCCMS-DRG 006, surgical | 11 | $389,604 | $43,592 | $82,596 | 4.84 |
Blood and immune system135 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 70 | $46,839 | $7,989 | $9,930 | 0.90 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 25 | $99,040 | $14,421 | $20,996 | 1.20 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 25 | $77,702 | $13,121 | $16,473 | 1.40 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 15 | $140,217 | $21,385 | $29,726 | 2.19 |
Blood cancers and poorly differentiated neoplasms113 discharges in 5 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 | 66 | $89,148 | $13,117 | $18,899 | 1.21 |
| Acute leukemia with MCCMS-DRG 834, medical | 12 | $557,019 | $93,673 | $118,088 | 5.60 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 12 | $121,966 | $14,402 | $25,857 | 1.57 |
| Chemotherapy without acute leukemia as secondary diagnosis with MCCMS-DRG 846, medical | 12 | $144,289 | $24,822 | $30,589 | 2.44 |
| Myeloproliferative disorders or poorly differentiated neoplasms with major o.r. procedurMS-DRG 827, surgical | 11 | $142,022 | $20,768 | $30,109 | 2.32 |
Injuries, poisonings and toxic effects of drugs106 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with CCMS-DRG 920, medical | 31 | $61,420 | $9,399 | $13,021 | 1.03 |
| Complications of treatment with MCCMS-DRG 919, medical | 22 | $106,685 | $19,257 | $22,617 | 1.82 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 20 | $212,235 | $35,572 | $44,994 | 3.72 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 18 | $59,128 | $12,653 | $12,535 | 1.60 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 15 | $121,959 | $18,966 | $25,855 | 2.00 |
Other65 discharges in 2 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 | 45 | $238,197 | $40,922 | $50,498 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 20 | $195,432 | $24,298 | $41,432 | 2.49 |
Multiple significant trauma58 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other o.r. procedures for multiple significant trauma with MCCMS-DRG 957, surgical | 22 | $512,947 | $83,122 | $108,745 | 7.23 |
| Other multiple significant trauma with CCMS-DRG 964, medical | 21 | $64,555 | $13,063 | $13,686 | 1.50 |
| Limb reattachment, hip and femur procedures for multiple significant traumaMS-DRG 956, surgical | 15 | $254,384 | $37,051 | $53,929 | 3.88 |
Skin, subcutaneous tissue and breast47 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 36 | $47,484 | $7,544 | $10,067 | 0.88 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 11 | $81,829 | $8,019 | $17,348 | 0.91 |
Mental diseases and disorders31 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 | 18 | $81,550 | $13,721 | $17,289 | 1.76 |
| Acute adjustment reaction and psychosocial dysfunctionMS-DRG 880, medical | 13 | $48,503 | $8,404 | $10,283 | 0.95 |
Ear, nose, mouth and throat26 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Dental and oral diseases with CCMS-DRG 158, medical | 14 | $45,717 | $7,138 | $9,692 | 0.94 |
| Other ear, nose, mouth and throat o.r. procedures with CCMS-DRG 144, surgical | 12 | $120,415 | $15,701 | $25,528 | 1.73 |
Factors influencing health status21 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 | 21 | $44,047 | $6,422 | $9,338 | 0.80 |
Eye12 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other disorders of the eye without MCCMS-DRG 125, medical | 12 | $40,405 | $6,781 | $8,566 | 0.80 |
Alcohol and drug use11 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 | 11 | $37,178 | $8,422 | $7,882 | 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 2 Urology and Related ServicesAPC 5372 | 741 | 348 | $3,156 | $490 | $502 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 437 | 410 | $13,484 | $1,168 | $1,220 |
| Level 3 Urology and Related ServicesAPC 5373 | 317 | 278 | $11,158 | $1,457 | $1,516 |
| Level 1 Endovascular ProceduresAPC 5191 | 313 | 305 | $41,958 | $2,100 | $2,208 |
| Level 2 Upper GI ProceduresAPC 5302 | 250 | 217 | $21,596 | $1,381 | $1,445 |
| Comprehensive Observation ServicesAPC 8011 | 248 | 239 | $21,099 | $1,923 | $2,090 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 226 | 191 | $20,039 | $2,051 | $2,141 |
| Level 5 Urology and Related ServicesAPC 5375 | 226 | 215 | $39,452 | $3,738 | $3,918 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 210 | 204 | $111,474 | $10,146 | $10,772 |
| Level 3 Vascular ProceduresAPC 5183 | 196 | 170 | $32,754 | $2,277 | $2,405 |
| Complex GI ProceduresAPC 5331 | 194 | 163 | $44,148 | $4,094 | $4,263 |
| Level 4 Airway EndoscopyAPC 5154 | 189 | 143 | $23,629 | $2,690 | $2,833 |
| Level 4 Urology and Related ServicesAPC 5374 | 179 | 152 | $27,179 | $2,513 | $2,629 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 177 | 174 | $228,750 | $19,840 | $21,117 |
| Level 3 Upper GI ProceduresAPC 5303 | 167 | 159 | $29,652 | $2,763 | $2,888 |
| Level 3 Endovascular ProceduresAPC 5193 | 155 | 138 | $102,132 | $8,382 | $8,874 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 149 | 149 | $49,863 | $4,186 | $4,358 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 148 | 147 | $75,124 | $7,654 | $8,164 |
| Level 4 Vascular ProceduresAPC 5184 | 133 | 125 | $50,959 | $3,807 | $3,946 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 108 | 71 | $22,002 | $2,509 | $2,636 |
| Level 5 ENT ProceduresAPC 5165 | 98 | 95 | $53,293 | $4,074 | $4,436 |
| Level 2 Endovascular ProceduresAPC 5192 | 80 | 76 | $64,014 | $4,149 | $4,338 |
| Level 3 Airway EndoscopyAPC 5153 | 72 | 63 | $17,472 | $1,232 | $1,264 |
| Level 5 Airway EndoscopyAPC 5155 | 69 | 68 | $46,785 | $4,966 | $5,183 |
| Level 4 ENT ProceduresAPC 5164 | 67 | 67 | $25,938 | $2,269 | $2,217 |
| Level 2 Vascular ProceduresAPC 5182 | 67 | 52 | $17,667 | $1,141 | $1,204 |
| Level 6 Urology and Related ServicesAPC 5376 | 54 | 54 | $62,459 | $6,569 | $7,291 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 49 | 49 | $64,731 | $5,117 | $5,339 |
| Level 4 Endovascular ProceduresAPC 5194 | 48 | 45 | $138,506 | $14,014 | $14,606 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 47 | 47 | $64,593 | $8,090 | $8,569 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 38 | 36 | $35,960 | $2,340 | $2,373 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 37 | 36 | $32,590 | $2,767 | $2,930 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 35 | 34 | $55,134 | $4,731 | $4,982 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 31 | 31 | $115,394 | $28,255 | $29,375 |
| Level 4 Gynecologic ProceduresAPC 5414 | 28 | 27 | $24,321 | $2,270 | $2,389 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 27 | 26 | $147,619 | $26,579 | $26,719 |
| Level 7 Radiation TherapyAPC 5627 | 27 | 23 | $142,740 | $5,653 | $6,121 |
| Level 8 Urology and Related ServicesAPC 5378 | 25 | 25 | $146,840 | $15,514 | $17,428 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 25 | 25 | $135,514 | $15,374 | $18,465 |
| Cochlear Implant ProcedureAPC 5166 | 22 | 22 | $120,755 | $27,511 | $29,489 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 20 | 20 | $14,924 | $1,157 | $1,196 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 18 | 18 | $194,967 | $15,312 | $15,763 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 17 | 16 | $121,023 | $16,083 | $17,052 |
| Level 3 ENT ProceduresAPC 5163 | 14 | 13 | $9,336 | $1,080 | $1,106 |
| Level 5 Gynecologic ProceduresAPC 5415 | 14 | 11 | $42,887 | $3,611 | $3,792 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 12 | 12 | $39,123 | $6,157 | $6,514 |
| Level 1 Nerve ProceduresAPC 5431 | 12 | 12 | $27,818 | $1,386 | $1,407 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 11 | 11 | $71,023 | $19,786 | $21,011 |
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.