Scripps Memorial Hospital Encinitas Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Scripps Memorial Hospital Encinitas, Encinitas, CA in 2024, from traditional Medicare claims. Back to the Scripps Memorial Hospital Encinitas profile, with quality ratings, finances and negotiated rates.
3,849
Medicare inpatient discharges
In 110 published DRGs
1.74
Case mix index
IPPS FY 2027
14%
Surgical stays
72%
Stays with complications
In DRGs with a CC or MCC
2,810
Medicare outpatient services
In 28 service groups
Inpatient stays by major diagnostic category
Infectious and parasitic diseases837 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 | 575 | $94,929 | $16,883 | $17,467 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 167 | $53,210 | $8,205 | $9,791 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 63 | $255,944 | $41,607 | $47,094 | 5.00 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 21 | $137,167 | $16,444 | $25,239 | 2.04 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 11 | $642,879 | $74,031 | $118,290 | 6.96 |
Circulatory system626 discharges in 19 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 207 | $66,617 | $10,928 | $12,257 | 1.28 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 49 | $70,058 | $13,565 | $12,891 | 1.59 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 46 | $143,947 | $15,816 | $26,486 | 1.82 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 36 | $43,783 | $5,958 | $8,056 | 0.74 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 28 | $210,366 | $23,518 | $38,707 | 2.87 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 26 | $67,239 | $7,165 | $12,372 | 0.91 |
| Syncope and collapseMS-DRG 312, medical | 26 | $51,065 | $7,327 | $9,396 | 0.86 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 24 | $56,187 | $10,053 | $10,338 | 1.20 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 20 | $108,821 | $8,434 | $20,023 | 1.08 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 19 | $132,228 | $18,467 | $24,330 | 2.09 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 19 | $49,454 | $8,292 | $9,099 | 0.97 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 18 | $46,945 | $8,408 | $8,638 | 1.07 |
| Hypertension without MCCMS-DRG 305, medical | 18 | $45,664 | $5,730 | $8,402 | 0.75 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 16 | $214,783 | $29,514 | $39,520 | 3.46 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 16 | $44,359 | $4,187 | $8,162 | 0.55 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 15 | $157,697 | $18,457 | $29,016 | 2.16 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 15 | $58,169 | $13,216 | $10,703 | 1.58 |
| Chest painMS-DRG 313, medical | 15 | $40,681 | $6,257 | $7,485 | 0.72 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 13 | $157,049 | $20,565 | $28,897 | 2.28 |
Musculoskeletal system and connective tissue485 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 | 65 | $162,843 | $16,505 | $29,963 | 1.88 |
| Medical back problems without MCCMS-DRG 552, medical | 65 | $54,695 | $7,689 | $10,064 | 0.97 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 55 | $130,284 | $18,071 | $23,972 | 2.07 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 51 | $48,798 | $8,647 | $8,979 | 1.09 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 30 | $182,586 | $18,345 | $33,596 | 2.11 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 29 | $190,177 | $24,830 | $34,993 | 2.95 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 22 | $41,963 | $7,169 | $7,721 | 0.90 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 21 | $148,479 | $18,638 | $27,320 | 2.04 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 16 | $241,559 | $22,612 | $44,447 | 2.48 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 15 | $96,042 | $14,540 | $17,672 | 1.82 |
| Medical back problems with MCCMS-DRG 551, medical | 15 | $61,309 | $13,250 | $11,281 | 1.70 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 15 | $40,704 | $6,722 | $7,490 | 0.82 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 14 | $180,363 | $17,698 | $33,187 | 1.97 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 13 | $258,778 | $31,223 | $47,615 | 3.49 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 12 | $146,368 | $20,359 | $26,932 | 2.40 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 12 | $123,197 | $13,395 | $22,668 | 1.49 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 12 | $37,536 | $6,282 | $6,907 | 0.79 |
| Tendonitis, myositis and bursitis without MCCMS-DRG 558, medical | 12 | $41,445 | $7,339 | $7,626 | 0.88 |
| Signs and symptoms of musculoskeletal system and connective tissue without MCCMS-DRG 556, medical | 11 | $47,877 | $6,763 | $8,809 | 0.82 |
Respiratory system475 discharges in 15 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 131 | $81,429 | $14,098 | $14,983 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 76 | $65,704 | $10,110 | $12,089 | 1.23 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 61 | $58,290 | $11,057 | $10,725 | 1.33 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 29 | $59,151 | $7,421 | $10,884 | 0.99 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 21 | $97,145 | $12,301 | $17,875 | 1.40 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 20 | $40,676 | $6,424 | $7,484 | 0.82 |
| Interstitial lung disease with MCCMS-DRG 196, medical | 20 | $97,031 | $16,801 | $17,854 | 1.90 |
| Major chest procedures with MCCMS-DRG 163, surgical | 17 | $301,186 | $40,646 | $55,418 | 4.71 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 17 | $92,211 | $15,792 | $16,967 | 1.74 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 16 | $55,234 | $8,190 | $10,163 | 0.96 |
| Major chest procedures with CCMS-DRG 164, surgical | 15 | $233,755 | $21,513 | $43,011 | 2.55 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 15 | $56,970 | $5,977 | $10,482 | 0.82 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 14 | $49,687 | $8,260 | $9,142 | 1.10 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 12 | $189,561 | $23,694 | $34,879 | 2.70 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 11 | $72,174 | $14,675 | $13,280 | 1.81 |
Digestive system431 discharges in 13 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 100 | $55,846 | $7,918 | $10,276 | 0.98 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 88 | $44,422 | $6,216 | $8,174 | 0.79 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 42 | $95,808 | $14,888 | $17,629 | 1.79 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 39 | $48,543 | $6,057 | $8,932 | 0.80 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 33 | $65,994 | $11,305 | $12,143 | 1.28 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 22 | $286,710 | $21,716 | $52,755 | 2.37 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 20 | $259,613 | $39,839 | $47,769 | 4.52 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 20 | $57,705 | $7,938 | $10,618 | 0.94 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 17 | $78,133 | $14,800 | $14,376 | 1.62 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 13 | $179,715 | $16,251 | $33,068 | 2.11 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 13 | $47,499 | $7,816 | $8,740 | 1.04 |
| Digestive malignancy with MCCMS-DRG 374, medical | 12 | $111,027 | $18,473 | $20,429 | 2.10 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 12 | $66,287 | $12,121 | $12,197 | 1.45 |
Nervous system331 discharges in 11 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 47 | $103,427 | $15,490 | $19,030 | 2.00 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 45 | $58,674 | $11,554 | $10,796 | 1.36 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 44 | $69,260 | $7,703 | $12,744 | 1.02 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 38 | $58,881 | $8,959 | $10,834 | 1.06 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 37 | $75,658 | $14,987 | $13,921 | 1.79 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 34 | $60,838 | $8,611 | $11,194 | 1.03 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 26 | $93,993 | $16,404 | $17,295 | 2.39 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 21 | $50,236 | $8,936 | $9,243 | 1.03 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 16 | $72,007 | $15,269 | $13,249 | 1.79 |
| Cranial and peripheral nerve disorders with MCCMS-DRG 073, medical | 12 | $57,348 | $14,528 | $10,552 | 1.51 |
| Seizures with MCCMS-DRG 100, medical | 11 | $116,344 | $16,285 | $21,407 | 1.98 |
Kidney and urinary tract245 discharges in 6 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 | 64 | $67,115 | $14,401 | $12,349 | 1.65 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 55 | $39,426 | $6,521 | $7,254 | 0.81 |
| Renal failure with CCMS-DRG 683, medical | 48 | $51,131 | $7,513 | $9,408 | 0.90 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 28 | $53,015 | $8,613 | $9,755 | 1.02 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 26 | $55,946 | $9,657 | $10,294 | 1.17 |
| Renal failure with MCCMS-DRG 682, medical | 24 | $61,358 | $12,895 | $11,290 | 1.50 |
Endocrine, nutritional and metabolic112 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Endocrine disorders with MCCMS-DRG 643, medical | 26 | $76,363 | $14,175 | $14,051 | 1.65 |
| Endocrine disorders with CCMS-DRG 644, medical | 26 | $56,599 | $8,965 | $10,414 | 1.06 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with MCCMS-DRG 640, medical | 24 | $84,242 | $12,504 | $15,501 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 22 | $47,450 | $5,882 | $8,731 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 14 | $35,288 | $7,606 | $6,493 | 0.90 |
Liver, gallbladder and pancreas82 discharges in 6 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 | 16 | $131,028 | $14,453 | $24,109 | 1.63 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 15 | $43,783 | $7,857 | $8,056 | 1.09 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 14 | $42,539 | $6,838 | $7,827 | 0.86 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 13 | $96,744 | $17,848 | $17,801 | 1.92 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 13 | $66,082 | $8,738 | $12,159 | 1.03 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 11 | $48,839 | $14,197 | $8,986 | 1.63 |
Skin, subcutaneous tissue and breast81 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 49 | $33,173 | $6,879 | $6,104 | 0.88 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 20 | $40,970 | $7,649 | $7,539 | 0.91 |
| Skin ulcers with CCMS-DRG 593, medical | 12 | $41,734 | $10,142 | $7,679 | 1.21 |
Blood and immune system49 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Coagulation disordersMS-DRG 813, medical | 19 | $91,121 | $13,208 | $16,766 | 1.56 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 15 | $68,421 | $12,053 | $12,590 | 1.40 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 15 | $51,731 | $7,122 | $9,518 | 0.90 |
Injuries, poisonings and toxic effects of drugs33 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 | 19 | $125,457 | $17,410 | $23,084 | 1.82 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 14 | $88,334 | $12,976 | $16,253 | 1.60 |
Mental diseases and disorders28 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 28 | $71,822 | $13,123 | $13,215 | 1.76 |
Alcohol and drug use20 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 | 20 | $60,169 | $7,099 | $11,071 | 0.86 |
Ear, nose, mouth and throat14 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| DysequilibriumMS-DRG 149, medical | 14 | $42,632 | $6,200 | $7,844 | 0.74 |
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 | 1,408 | 1,304 | $35,729 | $2,668 | $2,090 |
| Level 5 Urology and Related ServicesAPC 5375 | 173 | 167 | $53,678 | $5,068 | $3,918 |
| Level 4 Urology and Related ServicesAPC 5374 | 127 | 112 | $46,374 | $3,375 | $2,629 |
| Level 4 Airway EndoscopyAPC 5154 | 112 | 94 | $59,984 | $3,603 | $2,833 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 82 | 79 | $153,658 | $14,516 | $10,772 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 80 | 78 | $109,220 | $7,068 | $5,339 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 73 | 73 | $79,590 | $5,651 | $4,358 |
| Level 3 Airway EndoscopyAPC 5153 | 68 | 65 | $14,042 | $1,623 | $1,264 |
| Level 6 Urology and Related ServicesAPC 5376 | 66 | 66 | $116,651 | $9,534 | $7,291 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 63 | 62 | $39,473 | $3,384 | $2,636 |
| Level 2 Upper GI ProceduresAPC 5302 | 60 | 49 | $17,439 | $1,870 | $1,445 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 55 | 51 | $38,954 | $1,588 | $1,220 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 51 | 50 | $20,287 | $1,574 | $1,196 |
| Level 3 Vascular ProceduresAPC 5183 | 45 | 43 | $36,901 | $3,053 | $2,405 |
| Level 5 Airway EndoscopyAPC 5155 | 41 | 40 | $83,243 | $6,781 | $5,183 |
| Level 3 Urology and Related ServicesAPC 5373 | 32 | 26 | $43,292 | $1,962 | $1,516 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 31 | 30 | $46,376 | $2,783 | $2,141 |
| Level 1 Endovascular ProceduresAPC 5191 | 29 | 29 | $69,452 | $2,880 | $2,208 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 27 | 27 | $187,931 | $21,219 | $15,763 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 27 | 27 | $191,583 | $11,005 | $8,164 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 25 | 25 | $61,698 | $3,163 | $2,373 |
| Level 4 Gynecologic ProceduresAPC 5414 | 25 | 25 | $36,914 | $3,058 | $2,389 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 24 | 24 | $90,133 | $11,476 | $8,569 |
| Level 2 Vascular ProceduresAPC 5182 | 23 | 21 | $30,462 | $1,567 | $1,204 |
| Level 5 Gynecologic ProceduresAPC 5415 | 19 | 19 | $82,289 | $4,872 | $3,792 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 16 | 15 | $108,519 | $6,388 | $4,982 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 15 | 13 | $52,977 | $3,733 | $2,930 |
| Level 3 Endovascular ProceduresAPC 5193 | 13 | 13 | $110,192 | $11,871 | $8,874 |
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.