Valleycare Medical Center Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Valleycare Medical Center, Pleasanton, CA in 2024, from traditional Medicare claims. Back to the Valleycare Medical Center profile, with quality ratings, finances and negotiated rates.
1,579
Medicare inpatient discharges
In 57 published DRGs
2.36
Case mix index
IPPS FY 2027
25%
Surgical stays
83%
Stays with complications
In DRGs with a CC or MCC
3,665
Medicare outpatient services
In 37 service groups
Inpatient stays by major diagnostic category
Circulatory system398 discharges in 15 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 146 | $139,992 | $13,263 | $25,479 | 1.28 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 32 | $155,080 | $15,025 | $28,224 | 1.59 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 26 | $327,264 | $44,494 | $59,562 | 3.35 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 23 | $240,555 | $51,706 | $43,781 | 4.88 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 20 | $183,438 | $17,028 | $33,386 | 1.82 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 19 | $320,906 | $39,228 | $58,405 | 2.16 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 19 | $114,250 | $12,502 | $20,793 | 1.20 |
| Other vascular procedures with CCMS-DRG 253, surgical | 18 | $253,863 | $27,414 | $46,203 | 2.55 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 17 | $639,554 | $77,353 | $116,399 | 5.06 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 17 | $291,622 | $31,586 | $53,075 | 3.46 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 14 | $290,718 | $44,493 | $52,911 | 4.16 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 12 | $96,822 | $7,346 | $17,622 | 0.74 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 12 | $187,860 | $22,087 | $34,190 | 2.09 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 12 | $250,408 | $30,808 | $45,574 | 2.87 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 11 | $195,200 | $21,821 | $35,526 | 2.28 |
Infectious and parasitic diseases347 discharges in 3 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 | 282 | $191,834 | $21,533 | $34,914 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 39 | $102,462 | $9,541 | $18,648 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 26 | $412,543 | $56,359 | $75,083 | 5.00 |
Respiratory system210 discharges in 7 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 72 | $167,573 | $17,407 | $30,498 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 42 | $126,487 | $12,811 | $23,021 | 1.33 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 34 | $170,956 | $13,755 | $31,114 | 1.23 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 20 | $187,745 | $15,477 | $34,170 | 1.10 |
| Major chest procedures with CCMS-DRG 164, surgical | 15 | $228,447 | $24,983 | $41,577 | 2.55 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 15 | $137,985 | $18,722 | $25,113 | 1.74 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 12 | $154,258 | $13,415 | $28,075 | 1.40 |
Musculoskeletal system and connective tissue162 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 33 | $260,155 | $63,958 | $47,348 | 6.12 |
| Combined anterior and posterior spinal fusion without cc/mccMS-DRG 455, surgical | 27 | $216,880 | $49,380 | $39,472 | 4.61 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 24 | $143,012 | $19,482 | $26,028 | 1.88 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 18 | $160,263 | $21,041 | $29,168 | 2.07 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 14 | $187,618 | $18,749 | $34,146 | 2.11 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 13 | $78,883 | $11,219 | $14,357 | 1.09 |
| Major hip and knee joint replacement or reattachment of lower extremity with MCC or totaMS-DRG 469, surgical | 11 | $187,664 | $30,915 | $34,155 | 3.33 |
| Back and neck procedures except spinal fusion with CCMS-DRG 519, surgical | 11 | $235,134 | $19,663 | $42,794 | 1.97 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 11 | $258,895 | $30,240 | $47,119 | 2.99 |
Kidney and urinary tract151 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 32 | $113,810 | $11,506 | $20,713 | 1.17 |
| Renal failure with MCCMS-DRG 682, medical | 30 | $166,834 | $14,662 | $30,364 | 1.50 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 29 | $164,060 | $17,386 | $29,859 | 1.65 |
| Renal failure with CCMS-DRG 683, medical | 28 | $95,231 | $9,197 | $17,332 | 0.90 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 20 | $80,323 | $7,804 | $14,619 | 0.81 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 12 | $227,454 | $39,992 | $41,397 | 3.70 |
Digestive system109 discharges in 6 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 27 | $188,544 | $21,210 | $34,315 | 1.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 21 | $107,618 | $9,913 | $19,586 | 0.98 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 20 | $100,561 | $7,850 | $18,302 | 0.79 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 16 | $78,396 | $7,772 | $14,268 | 0.80 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 13 | $136,499 | $13,774 | $24,843 | 1.28 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 12 | $189,283 | $21,933 | $34,449 | 2.37 |
Nervous system107 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 33 | $176,645 | $23,170 | $32,149 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 29 | $119,333 | $10,124 | $21,719 | 1.02 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 17 | $197,467 | $22,009 | $35,939 | 2.39 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 16 | $95,311 | $13,451 | $17,347 | 1.36 |
| Seizures with MCCMS-DRG 100, medical | 12 | $106,930 | $18,601 | $19,461 | 1.98 |
Endocrine, nutritional and metabolic41 discharges in 2 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 | 29 | $124,455 | $13,896 | $22,651 | 1.32 |
| Diabetes with MCCMS-DRG 637, medical | 12 | $160,682 | $13,905 | $29,244 | 1.45 |
Skin, subcutaneous tissue and breast16 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 16 | $79,855 | $8,924 | $14,534 | 0.88 |
Other16 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 16 | $452,340 | $51,969 | $82,326 | 4.74 |
Liver, gallbladder and pancreas11 discharges in 1 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 | 11 | $170,244 | $18,792 | $30,984 | 1.76 |
Injuries, poisonings and toxic effects of drugs11 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 11 | $165,465 | $18,859 | $30,115 | 1.82 |
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 1 Intraocular ProceduresAPC 5491 | 530 | 323 | $41,991 | $2,591 | $1,752 |
| Comprehensive Observation ServicesAPC 8011 | 488 | 451 | $54,565 | $3,064 | $2,090 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 420 | 407 | $95,440 | $16,805 | $10,772 |
| Level 1 Endovascular ProceduresAPC 5191 | 225 | 223 | $53,855 | $3,268 | $2,208 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 216 | 198 | $15,840 | $1,818 | $1,220 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 147 | 144 | $77,296 | $8,432 | $5,339 |
| Level 2 Upper GI ProceduresAPC 5302 | 142 | 128 | $29,580 | $2,128 | $1,445 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 139 | 137 | $77,589 | $6,281 | $4,358 |
| Level 3 Vascular ProceduresAPC 5183 | 117 | 112 | $34,899 | $3,543 | $2,405 |
| Level 3 Endovascular ProceduresAPC 5193 | 116 | 113 | $114,228 | $13,590 | $8,874 |
| Level 1 Nerve ProceduresAPC 5431 | 109 | 96 | $18,045 | $2,165 | $1,407 |
| Level 5 Urology and Related ServicesAPC 5375 | 104 | 96 | $54,332 | $5,805 | $3,918 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 82 | 77 | $47,718 | $3,543 | $2,373 |
| Level 2 Endovascular ProceduresAPC 5192 | 71 | 65 | $57,165 | $6,416 | $4,338 |
| Level 4 Endovascular ProceduresAPC 5194 | 71 | 66 | $128,482 | $22,667 | $14,606 |
| Level 4 Vascular ProceduresAPC 5184 | 58 | 50 | $57,068 | $6,059 | $3,946 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 56 | 53 | $23,123 | $1,697 | $1,196 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 53 | 53 | $67,686 | $13,376 | $8,569 |
| Level 4 Urology and Related ServicesAPC 5374 | 46 | 41 | $45,457 | $3,911 | $2,629 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 40 | 39 | $102,900 | $7,546 | $4,982 |
| Level 2 Vascular ProceduresAPC 5182 | 38 | 37 | $30,976 | $1,792 | $1,204 |
| Complex GI ProceduresAPC 5331 | 38 | 25 | $38,152 | $5,721 | $4,263 |
| Level 3 Urology and Related ServicesAPC 5373 | 36 | 23 | $32,487 | $2,285 | $1,516 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 35 | 34 | $56,520 | $4,277 | $2,930 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 35 | 19 | $40,036 | $4,795 | $4,524 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 30 | 27 | $37,518 | $3,082 | $2,141 |
| Level 4 Gynecologic ProceduresAPC 5414 | 28 | 26 | $43,064 | $3,508 | $2,389 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 27 | 27 | $118,198 | $12,833 | $8,164 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 25 | 23 | $55,123 | $3,882 | $2,636 |
| Level 5 ENT ProceduresAPC 5165 | 24 | 24 | $74,078 | $6,476 | $4,436 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 22 | 21 | $34,231 | $2,622 | $1,780 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 20 | 20 | $156,494 | $24,536 | $15,763 |
| Level 2 Intraocular ProceduresAPC 5492 | 17 | 16 | $60,130 | $4,562 | $3,116 |
| Level 4 Airway EndoscopyAPC 5154 | 16 | 14 | $54,759 | $4,202 | $2,833 |
| Level 3 Intraocular ProceduresAPC 5493 | 16 | 13 | $54,474 | $5,864 | $4,004 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 14 | 14 | $51,560 | $10,315 | $6,514 |
| Level 3 Lower GI ProceduresAPC 5313 | 14 | 13 | $26,681 | $3,151 | $2,176 |
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.