Ucsf Medical Center Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Ucsf Medical Center, San Francisco, CA in 2024, from traditional Medicare claims. Back to the Ucsf Medical Center profile, with quality ratings, finances and negotiated rates.
8,018
Medicare inpatient discharges
In 231 published DRGs
3.12
Case mix index
IPPS FY 2027
45%
Surgical stays
73%
Stays with complications
In DRGs with a CC or MCC
14,594
Medicare outpatient services
In 61 service groups
Inpatient stays by major diagnostic category
Musculoskeletal system and connective tissue1,370 discharges in 41 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 | 157 | $149,465 | $27,595 | $34,078 | 1.88 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 134 | $551,579 | $96,722 | $125,760 | 6.12 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 86 | $242,084 | $50,763 | $55,195 | 3.49 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 82 | $228,396 | $42,685 | $52,074 | 2.96 |
| Combined anterior and posterior spinal fusion with MCCMS-DRG 453, surgical | 73 | $709,251 | $138,783 | $161,709 | 8.86 |
| Spinal fusion except cervical with spinal curvature, malignancy, infection or extensiveMS-DRG 457, surgical | 54 | $552,042 | $89,951 | $125,866 | 6.08 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 51 | $295,555 | $53,855 | $67,386 | 3.66 |
| Spinal fusion except cervical with spinal curvature, malignancy, infection or extensiveMS-DRG 456, surgical | 47 | $783,179 | $142,757 | $178,565 | 8.43 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 40 | $186,236 | $28,944 | $42,462 | 2.07 |
| Major joint or limb reattachment procedures of upper extremitiesMS-DRG 483, surgical | 40 | $192,588 | $36,424 | $43,910 | 2.48 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 40 | $183,107 | $29,021 | $41,748 | 1.97 |
| Medical back problems without MCCMS-DRG 552, medical | 40 | $103,448 | $13,432 | $23,586 | 0.97 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 31 | $187,103 | $36,694 | $42,660 | 2.67 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 29 | $301,195 | $66,871 | $68,672 | 4.61 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 29 | $149,546 | $28,776 | $34,097 | 2.04 |
| Major hip and knee joint replacement or reattachment of lower extremity with MCC or totaMS-DRG 469, surgical | 28 | $231,593 | $49,937 | $52,803 | 3.33 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 26 | $351,879 | $48,181 | $80,229 | 3.00 |
| Cervical spinal fusion with MCCMS-DRG 471, surgical | 25 | $391,998 | $74,566 | $89,376 | 4.92 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 24 | $206,613 | $31,172 | $47,108 | 2.11 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 463, surgical | 21 | $555,035 | $96,263 | $126,548 | 5.66 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 21 | $94,368 | $12,534 | $21,516 | 0.90 |
| Connective tissue disorders with MCCMS-DRG 545, medical | 20 | $346,761 | $51,730 | $79,062 | 2.49 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 19 | $306,744 | $43,107 | $69,938 | 2.95 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 19 | $201,605 | $34,200 | $45,966 | 2.40 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 19 | $121,238 | $15,478 | $27,642 | 1.09 |
| Revision of hip or knee replacement with MCCMS-DRG 466, surgical | 18 | $372,095 | $74,710 | $84,838 | 5.19 |
| Knee procedures without principal diagnosis of infection without cc/mccMS-DRG 489, surgical | 17 | $100,097 | $16,096 | $22,822 | 1.24 |
| Medical back problems with MCCMS-DRG 551, medical | 16 | $173,914 | $28,305 | $39,652 | 1.70 |
| Soft tissue procedures with CCMS-DRG 501, surgical | 15 | $176,754 | $25,610 | $40,300 | 1.74 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 15 | $254,799 | $28,108 | $58,094 | 1.82 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 14 | $71,453 | $11,865 | $16,291 | 0.82 |
| Biopsies of musculoskeletal system and connective tissue with CCMS-DRG 478, surgical | 13 | $241,684 | $34,290 | $55,104 | 2.38 |
| Knee procedures with principal diagnosis of infection with CCMS-DRG 486, surgical | 13 | $185,479 | $28,412 | $42,289 | 2.01 |
| Local excision and removal of internal fixation devices except hip and femur with CCMS-DRG 496, surgical | 13 | $136,487 | $28,497 | $31,119 | 1.99 |
| Spinal fusion except cervical with MCCMS-DRG 459, surgical | 12 | $482,792 | $100,000 | $110,077 | 6.63 |
| Cervical spinal fusion without cc/mccMS-DRG 473, surgical | 12 | $165,398 | $36,024 | $37,711 | 2.46 |
| Other musculoskeletal system and connective tissue o.r. procedures with MCCMS-DRG 515, surgical | 12 | $317,728 | $50,437 | $72,442 | 3.16 |
| Other musculoskeletal system and connective tissue o.r. procedures without cc/mccMS-DRG 517, surgical | 12 | $131,392 | $21,661 | $29,957 | 1.49 |
| Bilateral or multiple major joint procedures of lower extremity without MCCMS-DRG 462, surgical | 11 | $220,039 | $43,517 | $50,169 | 2.85 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 11 | $314,333 | $46,035 | $71,668 | 2.99 |
| Signs and symptoms of musculoskeletal system and connective tissue without MCCMS-DRG 556, medical | 11 | $91,687 | $12,086 | $20,905 | 0.82 |
Circulatory system1,101 discharges in 32 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 159 | $217,031 | $27,807 | $49,483 | 1.59 |
| Heart failure and shock with MCCMS-DRG 291, medical | 142 | $156,962 | $20,195 | $35,787 | 1.28 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 77 | $245,802 | $72,100 | $56,043 | 4.88 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 44 | $66,234 | $10,476 | $15,101 | 0.74 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 44 | $242,280 | $35,186 | $55,240 | 2.09 |
| Other vascular procedures with CCMS-DRG 253, surgical | 43 | $206,517 | $38,261 | $47,086 | 2.55 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 41 | $589,149 | $113,420 | $134,326 | 7.71 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 40 | $702,024 | $127,481 | $160,061 | 6.25 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 38 | $292,838 | $33,982 | $66,767 | 2.16 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 35 | $102,495 | $13,423 | $23,369 | 0.91 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 30 | $313,077 | $52,651 | $71,381 | 3.35 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 30 | $96,608 | $16,255 | $22,027 | 1.20 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 29 | $136,110 | $13,823 | $31,033 | 0.97 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 28 | $47,562 | $7,337 | $10,844 | 0.55 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 27 | $101,229 | $14,869 | $23,080 | 1.07 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 27 | $398,789 | $55,883 | $90,924 | 2.87 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 27 | $214,819 | $25,414 | $48,979 | 1.82 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 26 | $543,165 | $85,685 | $123,842 | 5.06 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 26 | $189,535 | $17,735 | $43,214 | 1.08 |
| Syncope and collapseMS-DRG 312, medical | 20 | $84,432 | $12,698 | $19,250 | 0.86 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 19 | $439,432 | $85,288 | $100,190 | 5.88 |
| Aortic and heart assist procedures except pulsation balloon with MCCMS-DRG 268, surgical | 17 | $592,439 | $118,950 | $135,076 | 6.85 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 17 | $334,361 | $55,239 | $76,234 | 4.16 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 15 | $374,873 | $75,617 | $85,471 | 5.24 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 14 | $381,190 | $65,717 | $86,911 | 3.90 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 13 | $709,970 | $148,118 | $161,873 | 9.71 |
| Amputation for circulatory system disorders except upper limb and toe with MCCMS-DRG 239, surgical | 13 | $467,999 | $70,773 | $106,704 | 4.81 |
| Acute myocardial infarction, expired with MCCMS-DRG 283, medical | 13 | $323,589 | $39,633 | $73,778 | 1.97 |
| Other vascular procedures without cc/mccMS-DRG 254, surgical | 12 | $171,977 | $25,642 | $39,211 | 1.74 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 12 | $261,708 | $52,465 | $59,669 | 3.46 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 12 | $205,768 | $39,800 | $46,915 | 3.24 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 11 | $328,645 | $57,087 | $74,931 | 3.46 |
Nervous system952 discharges in 24 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 184 | $343,323 | $64,951 | $78,278 | 4.42 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 89 | $264,981 | $35,316 | $60,416 | 2.00 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 68 | $206,506 | $37,065 | $47,083 | 2.43 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 54 | $116,631 | $13,871 | $26,592 | 1.02 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 45 | $491,873 | $92,586 | $112,147 | 5.67 |
| Seizures with MCCMS-DRG 100, medical | 45 | $197,119 | $29,391 | $44,943 | 1.98 |
| Seizures without MCCMS-DRG 101, medical | 45 | $87,282 | $12,595 | $19,900 | 0.91 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 43 | $104,358 | $20,486 | $23,794 | 1.36 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 40 | $257,978 | $38,373 | $58,819 | 2.39 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 39 | $111,253 | $15,220 | $25,366 | 1.03 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 35 | $225,599 | $45,318 | $51,437 | 2.95 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 34 | $306,454 | $52,872 | $69,871 | 3.79 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 34 | $151,483 | $20,413 | $34,538 | 1.47 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 30 | $170,416 | $27,711 | $38,855 | 1.79 |
| Spinal procedures with CC or spinal neurostimulatorsMS-DRG 029, surgical | 28 | $280,938 | $48,531 | $64,054 | 3.43 |
| Intracranial vascular procedures with principal diagnosis hemorrhage with MCCMS-DRG 020, surgical | 24 | $662,321 | $140,146 | $151,009 | 8.45 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 23 | $206,746 | $29,769 | $47,138 | 1.79 |
| Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurMS-DRG 041, surgical | 17 | $196,570 | $33,561 | $44,818 | 2.23 |
| Spinal procedures with MCCMS-DRG 028, surgical | 13 | $311,701 | $84,702 | $71,068 | 6.03 |
| Ventricular shunt procedures with MCCMS-DRG 031, surgical | 13 | $359,516 | $60,528 | $81,970 | 4.12 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 13 | $128,463 | $14,389 | $29,290 | 1.03 |
| Peripheral, cranial nerve and other nervous system procedures with MCCMS-DRG 040, surgical | 12 | $417,663 | $58,979 | $95,227 | 3.85 |
| Cranial and peripheral nerve disorders with MCCMS-DRG 073, medical | 12 | $206,150 | $23,083 | $47,002 | 1.51 |
| Headaches without MCCMS-DRG 103, medical | 12 | $72,704 | $12,366 | $16,577 | 0.84 |
Infectious and parasitic diseases917 discharges in 11 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 | 558 | $245,418 | $34,605 | $55,955 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 96 | $622,968 | $101,317 | $142,037 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 69 | $101,710 | $14,520 | $23,190 | 1.03 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 55 | $148,520 | $27,485 | $33,863 | 1.84 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 27 | $63,668 | $14,735 | $14,516 | 1.01 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 27 | $743,720 | $123,533 | $169,568 | 6.96 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 25 | $477,904 | $66,369 | $108,962 | 4.43 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 18 | $227,172 | $32,594 | $51,795 | 2.14 |
| Infectious and parasitic diseases with o.r. procedures with CCMS-DRG 854, surgical | 17 | $209,114 | $36,451 | $47,678 | 2.04 |
| Fever and inflammatory conditionsMS-DRG 864, medical | 13 | $91,089 | $11,220 | $20,768 | 0.88 |
| Viral illness without MCCMS-DRG 866, medical | 12 | $91,332 | $10,357 | $20,824 | 0.92 |
Digestive system712 discharges in 23 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 90 | $196,440 | $33,904 | $44,788 | 2.37 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 66 | $77,476 | $11,335 | $17,665 | 0.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 49 | $477,108 | $74,892 | $108,781 | 4.52 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 48 | $175,589 | $26,334 | $40,034 | 1.79 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 44 | $100,687 | $13,975 | $22,957 | 0.94 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 42 | $220,507 | $25,600 | $50,276 | 1.62 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 41 | $89,951 | $11,177 | $20,509 | 0.80 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 38 | $95,500 | $14,179 | $21,774 | 0.98 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 35 | $196,697 | $35,532 | $44,847 | 2.50 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 35 | $122,994 | $18,138 | $28,043 | 1.28 |
| Digestive malignancy with MCCMS-DRG 374, medical | 30 | $288,801 | $38,644 | $65,847 | 2.10 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 28 | $473,790 | $83,929 | $108,024 | 5.08 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 23 | $150,224 | $22,411 | $34,251 | 1.67 |
| Hernia procedures except inguinal and femoral with CCMS-DRG 354, surgical | 21 | $190,475 | $25,184 | $43,428 | 1.72 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 19 | $213,274 | $26,648 | $48,626 | 1.45 |
| Digestive malignancy with CCMS-DRG 375, medical | 16 | $120,089 | $17,987 | $27,380 | 1.20 |
| Stomach, esophageal and duodenal procedures without cc/mccMS-DRG 328, surgical | 15 | $137,197 | $22,146 | $31,281 | 1.60 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 14 | $184,504 | $28,342 | $42,067 | 2.11 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 13 | $54,267 | $8,000 | $12,373 | 0.56 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 12 | $204,762 | $26,672 | $46,686 | 1.75 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 11 | $361,963 | $65,985 | $82,528 | 4.28 |
| Other digestive system o.r. procedures with CCMS-DRG 357, surgical | 11 | $169,540 | $29,911 | $38,655 | 2.20 |
| Complicated peptic ulcer with MCCMS-DRG 380, medical | 11 | $152,250 | $29,169 | $34,713 | 1.95 |
Kidney and urinary tract633 discharges in 17 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 123 | $109,999 | $14,451 | $25,080 | 1.02 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 105 | $180,258 | $25,384 | $41,099 | 1.65 |
| Kidney transplantMS-DRG 652, surgical | 53 | $565,559 | $46,022 | $128,947 | 3.00 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 38 | $147,244 | $20,931 | $33,572 | 1.35 |
| Renal failure with MCCMS-DRG 682, medical | 38 | $186,336 | $25,842 | $42,485 | 1.50 |
| Renal failure with CCMS-DRG 683, medical | 34 | $82,039 | $12,849 | $18,705 | 0.90 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 34 | $83,388 | $11,612 | $19,012 | 0.81 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 27 | $677,271 | $68,210 | $154,418 | 4.50 |
| Kidney and ureter procedures for neoplasm with CCMS-DRG 657, surgical | 25 | $141,633 | $27,287 | $32,292 | 1.84 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 24 | $104,936 | $21,724 | $23,925 | 1.48 |
| Major bladder procedures with CCMS-DRG 654, surgical | 23 | $238,281 | $41,566 | $54,328 | 2.74 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 23 | $346,969 | $54,247 | $79,109 | 2.59 |
| Kidney transplant with hemodialysis without MCCMS-DRG 651, surgical | 21 | $672,957 | $51,566 | $153,434 | 3.46 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 21 | $94,245 | $16,601 | $21,488 | 1.17 |
| Major bladder procedures without cc/mccMS-DRG 655, surgical | 16 | $194,011 | $29,114 | $44,234 | 2.11 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 16 | $454,385 | $72,752 | $103,600 | 3.70 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 12 | $133,270 | $35,097 | $30,386 | 2.38 |
Respiratory system517 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 | 111 | $187,931 | $26,583 | $42,848 | 1.70 |
| Major chest procedures with CCMS-DRG 164, surgical | 64 | $186,409 | $35,359 | $42,501 | 2.55 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 55 | $151,740 | $22,965 | $34,597 | 1.33 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 46 | $161,059 | $22,172 | $36,721 | 1.23 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 34 | $229,273 | $27,833 | $52,274 | 1.74 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 31 | $237,706 | $35,372 | $54,197 | 1.81 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 29 | $162,549 | $23,835 | $37,061 | 1.40 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 26 | $118,798 | $14,262 | $27,086 | 0.99 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 25 | $405,908 | $74,224 | $92,547 | 4.06 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 19 | $153,242 | $18,628 | $34,939 | 1.10 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 18 | $69,508 | $11,287 | $15,848 | 0.82 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 17 | $307,862 | $45,562 | $70,193 | 2.70 |
| Major chest procedures with MCCMS-DRG 163, surgical | 16 | $351,157 | $76,802 | $80,064 | 4.71 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 15 | $164,258 | $27,633 | $37,451 | 1.88 |
| Respiratory neoplasms with CCMS-DRG 181, medical | 11 | $144,197 | $15,233 | $32,877 | 1.10 |
Blood cancers and poorly differentiated neoplasms467 discharges in 11 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 | 168 | $131,010 | $19,145 | $29,870 | 1.21 |
| Chemotherapy without acute leukemia as secondary diagnosis with MCCMS-DRG 846, medical | 75 | $278,048 | $41,674 | $63,395 | 2.44 |
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 64 | $456,317 | $66,362 | $104,040 | 3.13 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 36 | $224,105 | $26,111 | $51,096 | 1.57 |
| Acute leukemia with MCCMS-DRG 834, medical | 28 | $674,493 | $114,023 | $153,784 | 5.60 |
| Myeloproliferative disorders or poorly differentiated neoplasms with major o.r. procedurMS-DRG 827, surgical | 20 | $202,337 | $31,160 | $46,133 | 2.32 |
| Myeloproliferative disorders or poorly differentiated neoplasms with other procedures wiMS-DRG 829, surgical | 20 | $283,470 | $52,624 | $64,631 | 3.15 |
| Other myeloproliferative disorders or poorly differentiated neoplastic diagnoses with mcMS-DRG 843, medical | 18 | $223,320 | $28,204 | $50,917 | 1.86 |
| Myeloproliferative disorders or poorly differentiated neoplasms with major o.r. procedurMS-DRG 826, surgical | 16 | $454,088 | $74,463 | $103,532 | 4.63 |
| Lymphoma and non-acute leukemia with other procedures with MCCMS-DRG 823, surgical | 11 | $598,745 | $106,066 | $136,514 | 4.50 |
| Acute leukemia with CCMS-DRG 835, medical | 11 | $237,986 | $34,545 | $54,261 | 2.24 |
Liver, gallbladder and pancreas258 discharges in 10 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 39 | $157,066 | $26,694 | $35,811 | 1.76 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 37 | $227,343 | $33,279 | $51,834 | 1.92 |
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 36 | $281,039 | $41,964 | $64,077 | 2.89 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 32 | $531,740 | $101,353 | $121,237 | 5.51 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 30 | $162,207 | $26,116 | $36,983 | 1.83 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 22 | $103,388 | $14,053 | $23,572 | 0.95 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 18 | $230,757 | $32,934 | $52,613 | 1.63 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 16 | $88,736 | $16,235 | $20,232 | 1.09 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 14 | $178,181 | $24,333 | $40,625 | 1.63 |
| Malignancy of hepatobiliary system or pancreas with CCMS-DRG 436, medical | 14 | $148,007 | $16,015 | $33,745 | 1.10 |
Transplants, ECMO and tracheostomy (pre-MDC)249 discharges in 9 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 | 49 | $2,193,031 | $404,294 | $500,011 | 21.32 |
| Chimeric antigen receptor (car) t-cell and other immunotherapiesMS-DRG 018, medical | 44 | $1,856,460 | $487,668 | $423,273 | 36.84 |
| Heart transplant or implant of heart assist system with MCCMS-DRG 001, surgical | 29 | $2,460,577 | $474,239 | $561,012 | 27.10 |
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 24 | $1,422,038 | $219,771 | $324,225 | 10.35 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 23 | $1,399,288 | $246,560 | $319,038 | 14.70 |
| Allogeneic bone marrow transplantMS-DRG 014, medical | 23 | $910,164 | $177,793 | $207,517 | 11.46 |
| Autologous bone marrow transplant with cc/mccMS-DRG 016, medical | 23 | $442,440 | $94,527 | $100,876 | 6.18 |
| Lung transplantMS-DRG 007, surgical | 19 | $1,602,213 | $189,859 | $365,305 | 12.27 |
| Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCCMS-DRG 011, surgical | 15 | $467,466 | $85,001 | $106,582 | 5.16 |
Endocrine, nutritional and metabolic225 discharges in 8 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 | 66 | $152,477 | $21,596 | $34,765 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 41 | $100,394 | $11,059 | $22,890 | 0.78 |
| Adrenal and pituitary procedures with cc/mccMS-DRG 614, surgical | 35 | $137,029 | $30,831 | $31,243 | 2.25 |
| Endocrine disorders with MCCMS-DRG 643, medical | 21 | $121,907 | $24,461 | $27,795 | 1.65 |
| Diabetes with MCCMS-DRG 637, medical | 19 | $151,019 | $20,727 | $34,432 | 1.45 |
| Endocrine disorders with CCMS-DRG 644, medical | 18 | $75,051 | $15,349 | $17,112 | 1.06 |
| Adrenal and pituitary procedures without cc/mccMS-DRG 615, surgical | 13 | $119,006 | $21,486 | $27,133 | 1.47 |
| Diabetes with CCMS-DRG 638, medical | 12 | $87,581 | $12,939 | $19,969 | 0.90 |
Other134 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Multiple level combined anterior and posterior spinal fusion except cervical with MCC orMS-DRG 426 | 31 | $896,415 | $170,077 | $204,383 | |
| Multiple level combined anterior and posterior spinal fusion except cervical with CCMS-DRG 427 | 29 | $616,872 | $105,927 | $140,647 | |
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 29 | $494,344 | $90,733 | $112,710 | 4.74 |
| Single level combined anterior and posterior spinal fusion except cervicalMS-DRG 402 | 16 | $303,306 | $58,245 | $69,154 | |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 16 | $162,697 | $33,918 | $37,095 | 2.49 |
| Multiple level spinal fusion except cervical without MCCMS-DRG 448 | 13 | $372,470 | $62,140 | $84,923 |
Injuries, poisonings and toxic effects of drugs117 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 49 | $141,441 | $26,417 | $32,249 | 1.82 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 27 | $500,603 | $81,585 | $114,137 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 22 | $153,018 | $27,486 | $34,888 | 2.00 |
| Complications of treatment with CCMS-DRG 920, medical | 19 | $107,928 | $15,699 | $24,608 | 1.03 |
Skin, subcutaneous tissue and breast104 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 44 | $75,865 | $12,362 | $17,297 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 19 | $126,651 | $22,365 | $28,876 | 1.49 |
| Minor skin disorders without MCCMS-DRG 607, medical | 15 | $111,676 | $13,286 | $25,462 | 0.89 |
| Other skin, subcutaneous tissue and breast procedures with CCMS-DRG 580, surgical | 14 | $163,851 | $25,626 | $37,358 | 1.75 |
| Skin graft for skin ulcer or cellulitis with CCMS-DRG 574, surgical | 12 | $172,790 | $44,796 | $39,396 | 3.41 |
Blood and immune system101 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Coagulation disordersMS-DRG 813, medical | 32 | $214,195 | $30,903 | $48,837 | 1.56 |
| Red blood cell disorders without MCCMS-DRG 812, medical | 21 | $95,400 | $13,462 | $21,751 | 0.90 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 16 | $202,040 | $32,869 | $46,065 | 2.19 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 16 | $248,179 | $37,353 | $56,585 | 1.20 |
| Reticuloendothelial and immunity disorders with MCCMS-DRG 814, medical | 16 | $392,479 | $56,092 | $89,485 | 2.13 |
Mental diseases and disorders56 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| PsychosesMS-DRG 885, medical | 25 | $211,933 | $24,123 | $48,321 | 1.37 |
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 18 | $163,774 | $26,601 | $37,341 | 1.76 |
| Acute adjustment reaction and psychosocial dysfunctionMS-DRG 880, medical | 13 | $63,898 | $13,760 | $14,569 | 0.95 |
Female reproductive system33 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Uterine and adnexa procedures for ovarian or adnexal malignancy with CCMS-DRG 737, surgical | 18 | $164,073 | $27,732 | $37,409 | 1.97 |
| Uterine and adnexa procedures for non-malignancy with cc/mccMS-DRG 742, surgical | 15 | $173,366 | $26,481 | $39,527 | 1.78 |
Ear, nose, mouth and throat25 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major head and neck procedures with CCMS-DRG 141, surgical | 14 | $149,904 | $29,002 | $34,178 | 2.07 |
| Major head and neck procedures without cc/mccMS-DRG 142, surgical | 11 | $125,151 | $22,973 | $28,534 | 1.54 |
HIV infections18 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| HIV with major related condition with MCCMS-DRG 974, medical | 18 | $209,111 | $47,483 | $47,677 | 2.92 |
Factors influencing health status17 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 | 17 | $81,121 | $11,293 | $18,496 | 0.80 |
Alcohol and drug use12 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 with MCCMS-DRG 896, medical | 12 | $157,664 | $24,897 | $35,947 | 1.78 |
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 | 2,215 | 1,042 | $5,723 | $759 | $502 |
| Level 3 Urology and Related ServicesAPC 5373 | 1,293 | 999 | $12,054 | $2,269 | $1,516 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 831 | 772 | $15,859 | $1,807 | $1,220 |
| Level 1 Intraocular ProceduresAPC 5491 | 795 | 542 | $34,541 | $2,601 | $1,752 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 699 | 574 | $26,258 | $3,173 | $2,141 |
| Comprehensive Observation ServicesAPC 8011 | 624 | 602 | $43,574 | $3,033 | $2,090 |
| Level 2 Upper GI ProceduresAPC 5302 | 485 | 398 | $20,460 | $2,128 | $1,445 |
| Level 5 Urology and Related ServicesAPC 5375 | 469 | 405 | $64,659 | $5,805 | $3,918 |
| Level 4 Airway EndoscopyAPC 5154 | 441 | 291 | $44,332 | $4,174 | $2,833 |
| Level 4 Urology and Related ServicesAPC 5374 | 396 | 330 | $35,648 | $3,899 | $2,629 |
| Level 1 Nerve ProceduresAPC 5431 | 388 | 351 | $23,118 | $2,149 | $1,407 |
| Level 3 Vascular ProceduresAPC 5183 | 379 | 351 | $26,893 | $3,548 | $2,405 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 340 | 331 | $62,172 | $8,359 | $5,339 |
| Level 1 Endovascular ProceduresAPC 5191 | 307 | 301 | $37,109 | $3,263 | $2,208 |
| Level 3 Airway EndoscopyAPC 5153 | 241 | 196 | $17,509 | $1,892 | $1,264 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 238 | 235 | $67,130 | $6,465 | $4,358 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 233 | 226 | $95,650 | $16,786 | $10,772 |
| Level 3 Endovascular ProceduresAPC 5193 | 230 | 196 | $105,026 | $13,768 | $8,874 |
| Level 4 Vascular ProceduresAPC 5184 | 215 | 166 | $44,150 | $4,875 | $3,946 |
| Level 5 ENT ProceduresAPC 5165 | 214 | 212 | $57,722 | $6,551 | $4,436 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 207 | 196 | $30,139 | $2,595 | $1,780 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 205 | 200 | $143,801 | $31,709 | $21,117 |
| Level 3 Lower GI ProceduresAPC 5313 | 201 | 190 | $27,043 | $3,147 | $2,176 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 200 | 129 | $30,401 | $3,862 | $2,636 |
| Level 2 Intraocular ProceduresAPC 5492 | 193 | 165 | $53,446 | $4,538 | $3,116 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 190 | 190 | $106,855 | $12,769 | $8,164 |
| Complex GI ProceduresAPC 5331 | 182 | 116 | $44,540 | $6,359 | $4,263 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 156 | 148 | $40,103 | $3,573 | $2,373 |
| Level 5 Airway EndoscopyAPC 5155 | 152 | 150 | $99,425 | $7,945 | $5,183 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 141 | 141 | $68,261 | $7,546 | $4,982 |
| Level 2 Vascular ProceduresAPC 5182 | 140 | 130 | $18,061 | $1,763 | $1,204 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 119 | 112 | $46,601 | $4,275 | $2,930 |
| Level 7 Radiation TherapyAPC 5627 | 113 | 107 | $104,004 | $9,322 | $6,121 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 112 | 110 | $24,197 | $1,802 | $1,196 |
| Level 2 Endovascular ProceduresAPC 5192 | 109 | 96 | $48,940 | $6,356 | $4,338 |
| Level 3 Upper GI ProceduresAPC 5303 | 104 | 92 | $31,063 | $4,214 | $2,888 |
| Level 3 ENT ProceduresAPC 5163 | 87 | 43 | $6,286 | $1,711 | $1,106 |
| Level 6 Urology and Related ServicesAPC 5376 | 83 | 79 | $65,203 | $11,320 | $7,291 |
| Level 3 Intraocular ProceduresAPC 5493 | 80 | 71 | $56,565 | $5,681 | $4,004 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 75 | 74 | $153,858 | $41,390 | $26,719 |
| Level 4 ENT ProceduresAPC 5164 | 66 | 58 | $37,316 | $3,555 | $2,217 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 59 | 59 | $77,736 | $13,376 | $8,569 |
| Level 4 Endovascular ProceduresAPC 5194 | 57 | 55 | $144,579 | $22,992 | $14,606 |
| Level 4 Gynecologic ProceduresAPC 5414 | 56 | 56 | $27,194 | $3,508 | $2,389 |
| Level 5 Gynecologic ProceduresAPC 5415 | 54 | 48 | $74,550 | $5,580 | $3,792 |
| Level 8 Urology and Related ServicesAPC 5378 | 48 | 44 | $100,393 | $25,578 | $17,428 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 40 | 40 | $131,348 | $23,927 | $15,763 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 40 | 39 | $113,734 | $29,080 | $18,465 |
| Level 4 Extraocular, Repair, and Plastic Eye ProceduresAPC 5504 | 40 | 39 | $57,632 | $4,338 | $2,969 |
| Cochlear Implant ProcedureAPC 5166 | 34 | 34 | $196,597 | $45,431 | $29,489 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 34 | 33 | $57,458 | $7,992 | $4,524 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 30 | 30 | $150,519 | $44,539 | $29,375 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 26 | 26 | $58,153 | $10,310 | $6,514 |
| Level 3 Neurostimulator and Related ProceduresAPC 5463 | 26 | 23 | $48,116 | $17,496 | $11,550 |
| Level 2 Nerve ProceduresAPC 5432 | 21 | 21 | $98,315 | $7,732 | $4,674 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 16 | 15 | $129,092 | $25,727 | $17,052 |
| Level 3 Breast/Lymphatic Surgery and Related ProceduresAPC 5093 | 15 | 15 | $103,312 | $11,621 | $7,546 |
| Level 6 Gynecologic ProceduresAPC 5416 | 15 | 14 | $98,251 | $8,998 | $5,836 |
| Level 1 Neurostimulator and Related ProceduresAPC 5461 | 13 | 11 | $45,059 | $3,524 | $2,547 |
| Implantation of Drug Infusion DeviceAPC 5471 | 11 | 11 | $116,639 | $23,412 | $14,829 |
| Level 4 Intraocular ProceduresAPC 5494 | 11 | 11 | $138,444 | $15,787 | $15,787 |
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.