Upmc Shadyside Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Upmc Shadyside, Pittsburgh, PA in 2024, from traditional Medicare claims. Back to the Upmc Shadyside profile, with quality ratings, finances and negotiated rates.
6,147
Medicare inpatient discharges
In 197 published DRGs
2.63
Case mix index
IPPS FY 2027
36%
Surgical stays
74%
Stays with complications
In DRGs with a CC or MCC
4,201
Medicare outpatient services
In 43 service groups
Inpatient stays by major diagnostic category
Circulatory system1,143 discharges in 33 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 177 | $128,276 | $10,368 | $10,519 | 1.28 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 74 | $257,287 | $21,461 | $21,097 | 2.09 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 60 | $842,515 | $62,945 | $69,086 | 7.71 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 50 | $170,170 | $13,573 | $13,954 | 1.59 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 49 | $351,489 | $52,670 | $28,822 | 6.25 |
| Syncope and collapseMS-DRG 312, medical | 41 | $89,522 | $6,799 | $7,341 | 0.86 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 41 | $287,441 | $23,133 | $23,570 | 2.87 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 40 | $253,695 | $41,890 | $20,803 | 4.88 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 40 | $98,632 | $7,066 | $8,088 | 0.97 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 39 | $723,350 | $48,298 | $59,315 | 5.88 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 39 | $179,679 | $13,955 | $14,734 | 1.82 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 38 | $67,764 | $5,095 | $5,557 | 0.74 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 37 | $315,280 | $30,206 | $25,853 | 3.35 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 37 | $300,488 | $17,044 | $24,640 | 2.16 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 37 | $40,731 | $3,465 | $3,340 | 0.55 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 29 | $265,105 | $25,443 | $21,739 | 3.24 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 29 | $102,178 | $8,416 | $8,379 | 1.20 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 26 | $471,353 | $32,065 | $38,651 | 3.46 |
| Other vascular procedures with CCMS-DRG 253, surgical | 26 | $270,358 | $19,322 | $22,169 | 2.55 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 25 | $580,321 | $46,017 | $47,586 | 5.06 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 25 | $73,305 | $6,878 | $6,011 | 0.91 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 24 | $101,435 | $8,361 | $8,318 | 1.07 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 20 | $99,368 | $8,716 | $8,148 | 1.08 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 18 | $253,331 | $17,612 | $20,773 | 2.28 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 17 | $246,369 | $26,133 | $20,202 | 3.46 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 16 | $101,210 | $13,069 | $8,299 | 1.58 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 15 | $1,013,650 | $67,037 | $83,119 | 7.80 |
| Acute myocardial infarction, expired with MCCMS-DRG 283, medical | 14 | $346,079 | $13,316 | $28,378 | 1.97 |
| Cardiac valve and other major cardiothoracic procedures with cardiac catheterization witMS-DRG 216, surgical | 13 | $1,028,155 | $77,454 | $84,309 | 9.71 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 12 | $409,593 | $22,302 | $33,587 | 3.27 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 12 | $274,431 | $35,915 | $22,503 | 4.16 |
| Hypertension without MCCMS-DRG 305, medical | 12 | $81,373 | $5,661 | $6,673 | 0.75 |
| Chest painMS-DRG 313, medical | 11 | $43,258 | $5,548 | $3,547 | 0.72 |
Digestive system719 discharges in 20 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 | 85 | $82,618 | $5,884 | $6,775 | 0.79 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 76 | $243,067 | $17,594 | $19,931 | 2.37 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 67 | $115,974 | $6,948 | $9,510 | 0.94 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 54 | $552,341 | $40,557 | $45,292 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 51 | $134,154 | $9,601 | $11,001 | 1.28 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 47 | $80,504 | $5,770 | $6,601 | 0.80 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 42 | $278,939 | $20,425 | $22,873 | 2.50 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 41 | $82,360 | $7,745 | $6,754 | 0.98 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 40 | $147,738 | $13,682 | $12,114 | 1.62 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 31 | $588,301 | $39,177 | $48,241 | 5.08 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 31 | $179,199 | $14,615 | $14,694 | 1.79 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 23 | $158,319 | $10,981 | $12,982 | 1.67 |
| Gastrointestinal obstruction with MCCMS-DRG 388, medical | 21 | $286,801 | $15,852 | $23,518 | 1.45 |
| Digestive malignancy with MCCMS-DRG 374, medical | 20 | $191,807 | $14,596 | $15,728 | 2.10 |
| Major gastrointestinal disorders and peritoneal infections with CCMS-DRG 372, medical | 19 | $147,873 | $7,749 | $12,126 | 1.04 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 18 | $442,936 | $31,260 | $36,321 | 4.28 |
| Digestive malignancy with CCMS-DRG 375, medical | 16 | $116,357 | $8,540 | $9,541 | 1.20 |
| Peritoneal adhesiolysis with CCMS-DRG 336, surgical | 14 | $214,281 | $17,531 | $17,571 | 2.11 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 12 | $47,310 | $3,183 | $3,879 | 0.56 |
| Other digestive system o.r. procedures with CCMS-DRG 357, surgical | 11 | $236,171 | $17,439 | $19,366 | 2.20 |
Nervous system668 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 | 104 | $394,623 | $35,474 | $32,359 | 4.42 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 75 | $199,632 | $15,186 | $16,370 | 2.00 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 49 | $156,528 | $11,470 | $12,835 | 1.47 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 47 | $150,231 | $8,068 | $12,319 | 1.02 |
| Seizures without MCCMS-DRG 101, medical | 41 | $86,005 | $6,361 | $7,052 | 0.91 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 36 | $520,013 | $46,958 | $42,641 | 5.67 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 29 | $295,462 | $24,373 | $24,228 | 2.95 |
| Seizures with MCCMS-DRG 100, medical | 28 | $211,751 | $16,815 | $17,364 | 1.98 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 26 | $145,150 | $9,888 | $11,902 | 1.36 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 26 | $112,584 | $7,714 | $9,232 | 1.03 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 22 | $357,639 | $28,158 | $29,326 | 2.39 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 17 | $248,492 | $19,297 | $20,376 | 2.43 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 17 | $152,220 | $6,910 | $12,482 | 1.03 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 17 | $132,643 | $10,073 | $10,877 | 1.32 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 16 | $309,795 | $22,079 | $25,403 | 2.27 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 15 | $338,012 | $17,855 | $27,717 | 1.79 |
| Headaches without MCCMS-DRG 103, medical | 14 | $123,650 | $5,303 | $10,139 | 0.84 |
| Spinal procedures with CC or spinal neurostimulatorsMS-DRG 029, surgical | 13 | $350,268 | $22,727 | $28,722 | 3.43 |
| Peripheral, cranial nerve and other nervous system procedures with MCCMS-DRG 040, surgical | 13 | $295,395 | $32,233 | $24,222 | 3.85 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 13 | $88,347 | $6,067 | $7,244 | 0.80 |
| Other cerebrovascular disorders with CCMS-DRG 071, medical | 13 | $111,547 | $8,482 | $9,147 | 1.06 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 13 | $156,864 | $10,157 | $12,863 | 1.36 |
| Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurMS-DRG 041, surgical | 12 | $189,544 | $17,547 | $15,543 | 2.23 |
| Cranial and peripheral nerve disorders with MCCMS-DRG 073, medical | 12 | $185,916 | $11,731 | $15,245 | 1.51 |
Musculoskeletal system and connective tissue616 discharges in 21 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 | 68 | $126,828 | $14,834 | $10,400 | 1.88 |
| Medical back problems without MCCMS-DRG 552, medical | 67 | $91,435 | $6,886 | $7,498 | 0.97 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 55 | $255,373 | $30,231 | $20,941 | 3.66 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 44 | $218,577 | $16,651 | $17,923 | 2.07 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 37 | $380,287 | $50,314 | $31,184 | 6.12 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 37 | $209,996 | $23,002 | $17,220 | 2.96 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 35 | $248,280 | $27,623 | $20,359 | 3.49 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 30 | $220,896 | $17,270 | $18,113 | 2.40 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 26 | $187,092 | $21,458 | $15,342 | 2.67 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 23 | $370,230 | $24,245 | $30,359 | 2.95 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 23 | $131,040 | $7,355 | $10,745 | 1.09 |
| Medical back problems with MCCMS-DRG 551, medical | 23 | $177,110 | $13,312 | $14,523 | 1.70 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 23 | $73,804 | $6,748 | $6,052 | 0.90 |
| Spinal fusion except cervical with spinal curvature, malignancy, infection or extensiveMS-DRG 457, surgical | 22 | $437,957 | $53,704 | $35,912 | 6.08 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with MCCMS-DRG 542, medical | 20 | $190,844 | $15,504 | $15,649 | 1.82 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 17 | $322,801 | $39,411 | $26,470 | 4.61 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 16 | $147,991 | $16,620 | $12,135 | 2.04 |
| Bone diseases and arthropathies without MCCMS-DRG 554, medical | 15 | $68,372 | $6,149 | $5,606 | 0.82 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 13 | $183,687 | $17,707 | $15,062 | 2.11 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 463, surgical | 11 | $952,871 | $61,024 | $78,135 | 5.66 |
| Connective tissue disorders with MCCMS-DRG 545, medical | 11 | $360,504 | $30,281 | $29,561 | 2.49 |
Respiratory system550 discharges in 18 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 103 | $177,336 | $14,576 | $14,542 | 1.70 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 64 | $157,287 | $9,009 | $12,898 | 1.23 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 54 | $147,118 | $9,762 | $12,064 | 1.33 |
| Other respiratory system diagnoses with MCCMS-DRG 205, medical | 48 | $281,584 | $17,530 | $23,090 | 1.81 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 31 | $175,831 | $10,667 | $14,418 | 1.40 |
| Major chest procedures with CCMS-DRG 164, surgical | 24 | $211,826 | $20,411 | $17,370 | 2.55 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 24 | $93,971 | $5,894 | $7,706 | 0.82 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 23 | $97,910 | $7,302 | $8,029 | 0.99 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 23 | $339,475 | $22,139 | $27,837 | 2.70 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 21 | $132,912 | $7,386 | $10,899 | 1.10 |
| Major chest trauma with CCMS-DRG 184, medical | 20 | $95,655 | $8,388 | $7,844 | 1.05 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 19 | $67,982 | $5,872 | $5,574 | 0.82 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 19 | $126,856 | $6,840 | $10,402 | 0.91 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 18 | $382,498 | $26,575 | $31,365 | 4.06 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 18 | $282,061 | $13,994 | $23,129 | 1.74 |
| Major chest procedures with MCCMS-DRG 163, surgical | 16 | $570,492 | $46,518 | $46,780 | 4.71 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 13 | $203,912 | $14,250 | $16,721 | 1.88 |
| Respiratory system diagnosis with ventilator support >96 hoursMS-DRG 207, medical | 12 | $776,592 | $63,744 | $63,681 | 6.91 |
Infectious and parasitic diseases534 discharges in 9 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 | 306 | $233,517 | $16,970 | $19,148 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 70 | $681,523 | $45,781 | $55,885 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 44 | $104,517 | $8,452 | $8,570 | 1.03 |
| Postoperative or post-traumatic infections with o.r. procedures with MCCMS-DRG 856, surgical | 21 | $519,947 | $42,172 | $42,636 | 4.43 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 21 | $317,994 | $17,540 | $26,075 | 2.14 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 21 | $899,911 | $54,240 | $73,793 | 6.96 |
| Postoperative and post-traumatic infections with MCCMS-DRG 862, medical | 20 | $186,408 | $13,691 | $15,285 | 1.84 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 18 | $112,376 | $8,140 | $9,215 | 1.01 |
| Fever and inflammatory conditionsMS-DRG 864, medical | 13 | $65,609 | $6,993 | $5,380 | 0.88 |
Kidney and urinary tract498 discharges in 15 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 | 70 | $74,167 | $7,583 | $6,082 | 1.02 |
| Renal failure with CCMS-DRG 683, medical | 66 | $83,690 | $6,746 | $6,863 | 0.90 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 65 | $164,519 | $13,136 | $13,491 | 1.65 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 59 | $90,135 | $6,079 | $7,391 | 0.81 |
| Renal failure with MCCMS-DRG 682, medical | 54 | $140,076 | $11,911 | $11,486 | 1.50 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 31 | $111,439 | $9,419 | $9,138 | 1.17 |
| Kidney transplantMS-DRG 652, surgical | 28 | $423,983 | $22,892 | $34,767 | 3.00 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 22 | $129,027 | $10,010 | $10,580 | 1.35 |
| Kidney and ureter procedures for neoplasm with CCMS-DRG 657, surgical | 21 | $172,190 | $15,344 | $14,120 | 1.84 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 19 | $322,260 | $32,790 | $26,425 | 3.70 |
| Major bladder procedures with CCMS-DRG 654, surgical | 14 | $226,823 | $21,845 | $18,600 | 2.74 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 13 | $237,552 | $20,390 | $19,479 | 2.38 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 12 | $1,063,368 | $75,317 | $87,196 | 4.50 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 12 | $122,231 | $11,184 | $10,023 | 1.48 |
| Kidney and ureter procedures for non-neoplasm with MCCMS-DRG 659, surgical | 12 | $209,184 | $18,117 | $17,153 | 2.59 |
Liver, gallbladder and pancreas355 discharges in 12 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 45 | $267,843 | $24,567 | $21,963 | 2.89 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 45 | $192,876 | $14,241 | $15,816 | 1.76 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 45 | $105,811 | $8,557 | $8,676 | 1.09 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 39 | $170,740 | $14,730 | $14,001 | 1.83 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 33 | $100,493 | $6,502 | $8,240 | 0.86 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 29 | $148,158 | $14,013 | $12,149 | 1.63 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 28 | $470,113 | $43,114 | $38,549 | 5.51 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 28 | $151,988 | $12,531 | $12,463 | 1.67 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 23 | $100,009 | $7,457 | $8,201 | 0.95 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 18 | $264,481 | $14,136 | $21,687 | 1.92 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 11 | $160,309 | $8,899 | $13,145 | 1.03 |
| Malignancy of hepatobiliary system or pancreas with CCMS-DRG 436, medical | 11 | $85,797 | $9,279 | $7,035 | 1.10 |
Blood cancers and poorly differentiated neoplasms236 discharges in 10 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 | 56 | $119,676 | $10,739 | $9,813 | 1.21 |
| Acute leukemia with MCCMS-DRG 834, medical | 35 | $677,198 | $55,533 | $55,530 | 5.60 |
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 30 | $336,976 | $26,700 | $27,632 | 3.13 |
| Chemotherapy without acute leukemia as secondary diagnosis with MCCMS-DRG 846, medical | 22 | $199,176 | $21,567 | $16,332 | 2.44 |
| Chemotherapy with acute leukemia as secondary diagnosis or with high dose chemotherapy aMS-DRG 837, medical | 20 | $315,595 | $43,886 | $25,879 | 4.84 |
| Lymphoma and non-acute leukemia with CCMS-DRG 841, medical | 19 | $188,976 | $11,644 | $15,496 | 1.57 |
| Chemotherapy with acute leukemia as secondary diagnosis with CC or high dose chemotherapMS-DRG 838, medical | 17 | $125,539 | $17,853 | $10,294 | 2.00 |
| Myeloproliferative disorders or poorly differentiated neoplasms with other procedures wiMS-DRG 829, surgical | 14 | $356,955 | $36,150 | $29,270 | 3.15 |
| Lymphoma and non-acute leukemia with other procedures with MCCMS-DRG 823, surgical | 12 | $739,505 | $38,318 | $60,639 | 4.50 |
| Myeloproliferative disorders or poorly differentiated neoplasms with major o.r. procedurMS-DRG 827, surgical | 11 | $234,921 | $17,559 | $19,264 | 2.32 |
Transplants, ECMO and tracheostomy (pre-MDC)158 discharges in 7 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 | 42 | $1,856,698 | $159,100 | $152,249 | 21.32 |
| Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CCMS-DRG 012, surgical | 25 | $409,542 | $31,556 | $33,582 | 4.00 |
| Chimeric antigen receptor (car) t-cell and other immunotherapiesMS-DRG 018, medical | 25 | $6,565,675 | $513,067 | $538,385 | 36.84 |
| Liver transplant with MCC or intestinal transplantMS-DRG 005, surgical | 20 | $1,552,666 | $94,903 | $127,319 | 10.35 |
| Tracheostomy for face, mouth and neck diagnoses or laryngectomy with MCCMS-DRG 011, surgical | 19 | $499,122 | $45,934 | $40,928 | 5.16 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 16 | $1,556,343 | $105,588 | $127,620 | 14.70 |
| Allogeneic bone marrow transplantMS-DRG 014, medical | 11 | $648,526 | $84,546 | $53,179 | 11.46 |
Endocrine, nutritional and metabolic153 discharges in 5 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 | 56 | $137,575 | $11,110 | $11,281 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 47 | $91,198 | $6,076 | $7,478 | 0.78 |
| Endocrine disorders with CCMS-DRG 644, medical | 21 | $144,360 | $8,648 | $11,837 | 1.06 |
| Diabetes with CCMS-DRG 638, medical | 16 | $77,649 | $6,269 | $6,367 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 13 | $184,105 | $11,377 | $15,097 | 1.45 |
Injuries, poisonings and toxic effects of drugs147 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 53 | $163,292 | $14,860 | $13,390 | 1.82 |
| Complications of treatment with CCMS-DRG 920, medical | 29 | $96,074 | $8,045 | $7,878 | 1.03 |
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 25 | $190,211 | $13,534 | $15,597 | 1.60 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 24 | $603,406 | $46,380 | $49,479 | 3.72 |
| Other o.r. procedures for injuries with CCMS-DRG 908, surgical | 16 | $184,601 | $14,291 | $15,137 | 2.00 |
Other92 discharges in 5 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 | 42 | $508,555 | $42,677 | $41,702 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 14 | $243,855 | $15,660 | $19,996 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 14 | $422,213 | $26,996 | $34,621 | 3.38 |
| Multiple level combined anterior and posterior spinal fusion except cervical with CCMS-DRG 427 | 11 | $423,421 | $62,898 | $34,721 | |
| Non-extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 988, surgical | 11 | $226,675 | $13,884 | $18,587 | 1.70 |
Skin, subcutaneous tissue and breast91 discharges in 4 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 46 | $86,525 | $6,822 | $7,095 | 0.88 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 23 | $71,274 | $6,799 | $5,844 | 0.91 |
| Cellulitis with MCCMS-DRG 602, medical | 11 | $104,439 | $11,008 | $8,564 | 1.49 |
| Minor skin disorders without MCCMS-DRG 607, medical | 11 | $80,838 | $6,576 | $6,629 | 0.89 |
Blood and immune system65 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 27 | $73,427 | $7,670 | $6,021 | 0.90 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 23 | $173,905 | $10,884 | $14,260 | 1.20 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 15 | $134,345 | $11,428 | $11,016 | 1.40 |
Male reproductive system46 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major male pelvic procedures without cc/mccMS-DRG 708, surgical | 30 | $123,300 | $11,843 | $10,111 | 1.46 |
| Major male pelvic procedures with cc/mccMS-DRG 707, surgical | 16 | $139,299 | $15,061 | $11,423 | 1.96 |
Factors influencing health status27 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 | 27 | $65,897 | $6,081 | $5,404 | 0.80 |
Ear, nose, mouth and throat19 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Major head and neck procedures with CCMS-DRG 141, surgical | 19 | $209,144 | $17,567 | $17,150 | 2.07 |
Mental diseases and disorders19 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 | 19 | $154,377 | $14,330 | $12,659 | 1.76 |
Multiple significant trauma11 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other multiple significant trauma with CCMS-DRG 964, medical | 11 | $154,128 | $11,669 | $12,639 | 1.50 |
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 Upper GI ProceduresAPC 5302 | 420 | 376 | $26,411 | $1,332 | $1,445 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 308 | 275 | $24,859 | $1,140 | $1,220 |
| Level 3 Vascular ProceduresAPC 5183 | 270 | 236 | $36,232 | $2,259 | $2,405 |
| Level 1 Endovascular ProceduresAPC 5191 | 216 | 214 | $32,730 | $2,014 | $2,208 |
| Level 4 Airway EndoscopyAPC 5154 | 214 | 148 | $51,861 | $2,544 | $2,833 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 213 | 205 | $96,644 | $9,964 | $10,772 |
| Comprehensive Observation ServicesAPC 8011 | 205 | 201 | $47,501 | $1,860 | $2,090 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 142 | 139 | $80,288 | $4,949 | $5,339 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 137 | 135 | $62,019 | $4,022 | $4,358 |
| Level 7 Radiation TherapyAPC 5627 | 131 | 125 | $58,551 | $5,499 | $6,121 |
| Level 4 Urology and Related ServicesAPC 5374 | 123 | 98 | $45,634 | $2,459 | $2,629 |
| Level 3 Endovascular ProceduresAPC 5193 | 119 | 107 | $125,316 | $8,117 | $8,874 |
| Level 3 Urology and Related ServicesAPC 5373 | 117 | 59 | $22,757 | $1,449 | $1,516 |
| Level 4 Vascular ProceduresAPC 5184 | 109 | 57 | $61,946 | $2,079 | $3,946 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 104 | 102 | $237,220 | $19,527 | $21,117 |
| Level 5 Urology and Related ServicesAPC 5375 | 100 | 89 | $61,213 | $3,682 | $3,918 |
| Level 2 Vascular ProceduresAPC 5182 | 96 | 90 | $16,093 | $1,136 | $1,204 |
| Level 5 ENT ProceduresAPC 5165 | 92 | 92 | $53,260 | $4,099 | $4,436 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 91 | 88 | $36,540 | $2,022 | $2,141 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 83 | 81 | $43,013 | $2,250 | $2,373 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 78 | 75 | $17,001 | $1,141 | $1,196 |
| Level 3 Upper GI ProceduresAPC 5303 | 76 | 64 | $47,872 | $2,651 | $2,888 |
| Level 2 Endovascular ProceduresAPC 5192 | 75 | 73 | $58,665 | $4,065 | $4,338 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 73 | 58 | $44,004 | $2,458 | $2,636 |
| Level 1 Nerve ProceduresAPC 5431 | 73 | 65 | $26,067 | $1,323 | $1,407 |
| Level 3 Airway EndoscopyAPC 5153 | 59 | 52 | $60,841 | $1,197 | $1,264 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 57 | 56 | $56,627 | $2,713 | $2,930 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 46 | 44 | $82,108 | $4,641 | $4,982 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 46 | 44 | $33,138 | $1,663 | $1,780 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 44 | 44 | $131,593 | $7,899 | $8,569 |
| Level 4 Endovascular ProceduresAPC 5194 | 39 | 39 | $157,015 | $13,993 | $14,606 |
| Level 5 Airway EndoscopyAPC 5155 | 38 | 35 | $78,545 | $4,871 | $5,183 |
| Complex GI ProceduresAPC 5331 | 35 | 29 | $51,704 | $4,056 | $4,263 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 32 | 32 | $336,834 | $27,665 | $29,375 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 23 | 23 | $100,943 | $7,229 | $8,164 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 19 | 19 | $182,669 | $15,733 | $17,052 |
| Level 3 Lower GI ProceduresAPC 5313 | 17 | 17 | $28,722 | $1,911 | $2,176 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 16 | 16 | $62,346 | $6,038 | $6,514 |
| Level 4 ENT ProceduresAPC 5164 | 14 | 13 | $51,533 | $2,291 | $2,217 |
| Level 1 ICD and Similar ProceduresAPC 5231 | 14 | 14 | $234,118 | $19,368 | $21,011 |
| Level 4 Extraocular, Repair, and Plastic Eye ProceduresAPC 5504 | 14 | 13 | $50,077 | $2,751 | $2,969 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 12 | 12 | $164,481 | $26,023 | $26,719 |
| Level 2 Urology and Related ServicesAPC 5372 | 11 | 11 | $17,857 | $486 | $502 |
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.