Wake Forest Baptist Medical Center Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Wake Forest Baptist Medical Center, Winston-Salem, NC in 2024, from traditional Medicare claims. Back to the Wake Forest Baptist Medical Center profile, with quality ratings, finances and negotiated rates.
4,987
Medicare inpatient discharges
In 166 published DRGs
2.23
Case mix index
IPPS FY 2027
33%
Surgical stays
70%
Stays with complications
In DRGs with a CC or MCC
6,236
Medicare outpatient services
In 54 service groups
Inpatient stays by major diagnostic category
Circulatory system1,389 discharges in 41 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 207 | $39,937 | $11,333 | $7,947 | 1.28 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 84 | $57,593 | $13,400 | $11,461 | 1.59 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 76 | $25,231 | $6,791 | $5,021 | 0.74 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 64 | $224,307 | $41,465 | $44,637 | 4.88 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 62 | $154,625 | $28,361 | $30,770 | 3.24 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 54 | $42,367 | $10,790 | $8,431 | 1.20 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 48 | $31,818 | $8,288 | $6,332 | 0.91 |
| Syncope and collapseMS-DRG 312, medical | 47 | $34,096 | $7,753 | $6,785 | 0.86 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 45 | $91,797 | $15,147 | $18,268 | 1.82 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 43 | $200,063 | $34,132 | $39,812 | 4.04 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 42 | $24,076 | $4,604 | $4,791 | 0.55 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 41 | $263,907 | $53,677 | $52,517 | 6.25 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 34 | $74,142 | $17,641 | $14,754 | 2.09 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 33 | $51,475 | $9,003 | $10,243 | 1.08 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 31 | $268,947 | $43,422 | $53,520 | 5.24 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 30 | $120,758 | $23,930 | $24,031 | 2.87 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 28 | $360,111 | $64,249 | $71,662 | 7.71 |
| Other vascular procedures with CCMS-DRG 253, surgical | 27 | $133,890 | $22,078 | $26,644 | 2.55 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 26 | $69,262 | $17,495 | $13,783 | 2.16 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 24 | $236,104 | $48,447 | $46,985 | 5.88 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 23 | $35,169 | $8,340 | $6,999 | 0.97 |
| Hypertension with MCCMS-DRG 304, medical | 22 | $36,842 | $10,454 | $7,332 | 1.15 |
| Aortic and heart assist procedures except pulsation balloon without MCCMS-DRG 269, surgical | 21 | $219,922 | $35,517 | $43,764 | 4.16 |
| Coronary bypass with cardiac catheterization or open ablation without MCCMS-DRG 234, surgical | 19 | $231,399 | $37,755 | $46,048 | 5.20 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 19 | $130,784 | $27,815 | $26,026 | 3.35 |
| Other cardiothoracic procedures with MCCMS-DRG 228, surgical | 18 | $291,533 | $56,643 | $58,015 | 5.04 |
| Hypertension without MCCMS-DRG 305, medical | 18 | $30,630 | $7,165 | $6,095 | 0.75 |
| Acute myocardial infarction, discharged alive without cc/mccMS-DRG 282, medical | 17 | $35,984 | $6,199 | $7,161 | 0.72 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 17 | $21,834 | $9,663 | $4,345 | 1.07 |
| Atherosclerosis without MCCMS-DRG 303, medical | 17 | $28,966 | $6,294 | $5,764 | 0.66 |
| Amputation for circulatory system disorders except upper limb and toe with CCMS-DRG 240, surgical | 16 | $93,283 | $22,285 | $18,563 | 2.81 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 16 | $112,066 | $16,149 | $22,301 | 2.28 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 16 | $165,209 | $26,733 | $32,877 | 3.46 |
| Permanent cardiac pacemaker implant with MCCMS-DRG 242, surgical | 15 | $146,927 | $30,254 | $29,238 | 3.46 |
| Heart failure and shock with CCMS-DRG 292, medical | 15 | $35,283 | $7,921 | $7,021 | 0.86 |
| Coronary bypass with cardiac catheterization or open ablation with MCCMS-DRG 233, surgical | 14 | $285,415 | $69,628 | $56,797 | 7.80 |
| Coronary intravascular lithotripsy with intraluminal device without MCCMS-DRG 324, surgical | 14 | $142,859 | $25,893 | $28,429 | 2.97 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 13 | $114,824 | $23,494 | $22,850 | 3.27 |
| Other cardiothoracic procedures without MCCMS-DRG 229, surgical | 11 | $198,820 | $30,806 | $39,565 | 3.18 |
| Percutaneous and other intracardiac procedures with MCCMS-DRG 273, surgical | 11 | $205,854 | $34,305 | $40,965 | 3.90 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 11 | $44,171 | $13,250 | $8,790 | 1.58 |
Kidney and urinary tract541 discharges in 14 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 85 | $29,368 | $7,405 | $5,844 | 0.81 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 75 | $58,511 | $13,244 | $11,644 | 1.65 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 70 | $39,541 | $8,563 | $7,869 | 1.02 |
| Renal failure with CCMS-DRG 683, medical | 58 | $25,348 | $8,032 | $5,044 | 0.90 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 48 | $33,524 | $9,866 | $6,671 | 1.17 |
| Renal failure with MCCMS-DRG 682, medical | 38 | $45,462 | $12,781 | $9,047 | 1.50 |
| Kidney transplantMS-DRG 652, surgical | 31 | $276,758 | $19,197 | $55,075 | 3.00 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 23 | $273,293 | $34,600 | $54,385 | 4.50 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 23 | $81,457 | $12,300 | $16,210 | 1.35 |
| Other kidney and urinary tract procedures with MCCMS-DRG 673, surgical | 21 | $89,272 | $30,264 | $17,765 | 3.70 |
| Major bladder procedures with CCMS-DRG 654, surgical | 20 | $169,433 | $24,964 | $33,717 | 2.74 |
| Other kidney and urinary tract procedures with CCMS-DRG 674, surgical | 20 | $93,232 | $21,676 | $18,553 | 2.38 |
| Kidney and ureter procedures for non-neoplasm without cc/mccMS-DRG 661, surgical | 16 | $66,718 | $8,604 | $13,277 | 1.05 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 13 | $89,435 | $11,929 | $17,798 | 1.48 |
Nervous system522 discharges in 20 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 72 | $40,201 | $8,686 | $8,000 | 1.02 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 56 | $158,505 | $35,254 | $31,542 | 4.42 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 54 | $70,985 | $16,524 | $14,126 | 2.00 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 36 | $123,862 | $20,076 | $24,649 | 2.43 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 30 | $60,827 | $12,084 | $12,105 | 1.36 |
| Seizures without MCCMS-DRG 101, medical | 29 | $28,240 | $7,464 | $5,620 | 0.91 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 28 | $272,806 | $45,216 | $54,288 | 5.67 |
| Craniotomy and endovascular intracranial procedures with CCMS-DRG 026, surgical | 21 | $107,618 | $21,911 | $21,416 | 2.95 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 20 | $31,286 | $10,831 | $6,226 | 1.36 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 19 | $82,563 | $18,328 | $16,430 | 2.28 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 19 | $65,359 | $11,827 | $13,006 | 1.32 |
| Nervous system neoplasms with MCCMS-DRG 054, medical | 18 | $39,451 | $11,130 | $7,851 | 1.47 |
| Traumatic stupor and coma >1 hour without cc/mccMS-DRG 084, medical | 18 | $44,419 | $8,685 | $8,839 | 0.92 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 16 | $37,626 | $15,758 | $7,488 | 1.79 |
| Seizures with MCCMS-DRG 100, medical | 16 | $91,269 | $18,697 | $18,162 | 1.98 |
| Ventricular shunt procedures with CCMS-DRG 032, surgical | 15 | $93,996 | $15,683 | $18,705 | 2.15 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 15 | $29,403 | $6,119 | $5,851 | 0.69 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis without mcMS-DRG 024, surgical | 14 | $201,011 | $30,513 | $40,001 | 3.79 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 13 | $63,102 | $13,229 | $12,557 | 1.79 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 13 | $36,401 | $8,451 | $7,244 | 1.03 |
Respiratory system490 discharges in 16 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 75 | $62,667 | $14,802 | $12,471 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 57 | $91,652 | $19,328 | $18,239 | 1.33 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 53 | $32,278 | $7,472 | $6,423 | 0.82 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 49 | $57,757 | $10,247 | $11,494 | 1.23 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 30 | $37,594 | $9,590 | $7,481 | 1.10 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 28 | $98,041 | $23,554 | $19,510 | 2.70 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 27 | $30,576 | $7,308 | $6,085 | 0.82 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 24 | $60,912 | $11,222 | $12,121 | 1.40 |
| Major chest trauma with CCMS-DRG 184, medical | 24 | $50,030 | $9,462 | $9,956 | 1.05 |
| Major chest procedures with CCMS-DRG 164, surgical | 23 | $165,988 | $20,153 | $33,032 | 2.55 |
| Chronic obstructive pulmonary disease with CCMS-DRG 191, medical | 23 | $26,754 | $7,841 | $5,324 | 0.85 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 20 | $34,629 | $7,562 | $6,891 | 0.99 |
| Pneumothorax with CCMS-DRG 200, medical | 19 | $46,223 | $9,274 | $9,198 | 1.08 |
| Respiratory neoplasms with MCCMS-DRG 180, medical | 15 | $81,593 | $15,122 | $16,237 | 1.74 |
| Major chest procedures without cc/mccMS-DRG 165, surgical | 12 | $135,388 | $16,094 | $26,942 | 1.88 |
| Major chest procedures with MCCMS-DRG 163, surgical | 11 | $270,683 | $45,450 | $53,866 | 4.71 |
Digestive system461 discharges in 16 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 | 69 | $116,451 | $19,091 | $23,174 | 2.37 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 69 | $29,883 | $7,255 | $5,947 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 36 | $52,184 | $8,997 | $10,385 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 35 | $73,308 | $15,262 | $14,588 | 1.79 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 35 | $41,349 | $10,863 | $8,228 | 1.28 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 31 | $163,954 | $33,243 | $32,627 | 4.52 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 31 | $28,197 | $8,816 | $5,611 | 0.94 |
| Major small and large bowel procedures without cc/mccMS-DRG 331, surgical | 24 | $91,997 | $12,682 | $18,307 | 1.67 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 21 | $132,547 | $20,604 | $26,377 | 2.50 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 20 | $24,570 | $7,208 | $4,889 | 0.80 |
| Stomach, esophageal and duodenal procedures with MCCMS-DRG 326, surgical | 19 | $214,025 | $42,655 | $42,591 | 5.08 |
| Gastrointestinal obstruction without cc/mccMS-DRG 390, medical | 19 | $17,197 | $5,069 | $3,422 | 0.56 |
| Other digestive system diagnoses with MCCMS-DRG 393, medical | 19 | $44,582 | $13,761 | $8,872 | 1.62 |
| Stomach, esophageal and duodenal procedures without cc/mccMS-DRG 328, surgical | 11 | $82,707 | $12,390 | $16,459 | 1.60 |
| Major gastrointestinal disorders and peritoneal infections with MCCMS-DRG 371, medical | 11 | $54,306 | $14,911 | $10,807 | 1.75 |
| Other digestive system diagnoses without cc/mccMS-DRG 395, medical | 11 | $24,059 | $5,634 | $4,788 | 0.65 |
Infectious and parasitic diseases431 discharges in 6 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 | 296 | $68,633 | $16,371 | $13,658 | 1.98 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 46 | $195,831 | $38,629 | $38,970 | 5.00 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 43 | $34,228 | $8,243 | $6,811 | 1.03 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 21 | $195,756 | $51,502 | $38,955 | 6.96 |
| Postoperative and post-traumatic infections without MCCMS-DRG 863, medical | 14 | $27,230 | $8,819 | $5,419 | 1.01 |
| Postoperative or post-traumatic infections with o.r. procedures with CCMS-DRG 857, surgical | 11 | $51,555 | $16,777 | $10,259 | 2.14 |
Musculoskeletal system and connective tissue319 discharges in 15 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 57 | $121,767 | $16,389 | $24,232 | 2.07 |
| Medical back problems without MCCMS-DRG 552, medical | 41 | $36,859 | $8,276 | $7,335 | 0.97 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 23 | $219,692 | $31,865 | $43,719 | 3.66 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 23 | $148,517 | $21,042 | $29,555 | 2.96 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 22 | $121,306 | $18,040 | $24,140 | 2.11 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 21 | $160,381 | $29,143 | $31,916 | 3.49 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 21 | $151,705 | $25,872 | $30,189 | 2.99 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 17 | $114,644 | $15,214 | $22,814 | 2.40 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 16 | $164,796 | $25,360 | $32,794 | 2.95 |
| Pathological fractures and musculoskeletal and connective tissue malignancy with CCMS-DRG 543, medical | 15 | $53,142 | $8,864 | $10,575 | 1.09 |
| Combined anterior and posterior spinal fusion with CCMS-DRG 454, surgical | 13 | $325,104 | $61,063 | $64,696 | 6.12 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 13 | $114,920 | $22,878 | $22,869 | 2.67 |
| Medical back problems with MCCMS-DRG 551, medical | 13 | $86,492 | $13,086 | $17,212 | 1.70 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 12 | $122,327 | $15,081 | $24,343 | 1.88 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 12 | $30,065 | $7,121 | $5,983 | 0.79 |
Endocrine, nutritional and metabolic195 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 | 71 | $58,638 | $11,683 | $11,669 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 61 | $27,578 | $6,936 | $5,488 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 28 | $31,462 | $7,072 | $6,261 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 24 | $44,875 | $11,215 | $8,930 | 1.45 |
| Endocrine disorders with CCMS-DRG 644, medical | 11 | $48,780 | $8,663 | $9,707 | 1.06 |
Liver, gallbladder and pancreas174 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Disorders of the biliary tract with CCMS-DRG 445, medical | 30 | $70,949 | $11,495 | $14,119 | 1.09 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 27 | $74,450 | $15,860 | $14,816 | 1.76 |
| Disorders of pancreas except malignancy with CCMS-DRG 439, medical | 27 | $29,802 | $7,006 | $5,931 | 0.86 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 22 | $65,440 | $14,135 | $13,023 | 1.63 |
| Pancreas, liver and shunt procedures with CCMS-DRG 406, surgical | 21 | $166,658 | $22,763 | $33,165 | 2.89 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with CCMS-DRG 442, medical | 14 | $37,696 | $7,836 | $7,501 | 0.95 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 11 | $80,392 | $11,661 | $15,998 | 1.63 |
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 11 | $50,097 | $17,178 | $9,969 | 1.92 |
| Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with MCCMS-DRG 441, medical | 11 | $55,910 | $15,862 | $11,126 | 1.83 |
Blood and immune system97 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Red blood cell disorders without MCCMS-DRG 812, medical | 32 | $31,269 | $8,606 | $6,222 | 0.90 |
| Coagulation disordersMS-DRG 813, medical | 19 | $54,482 | $13,463 | $10,842 | 1.56 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 17 | $73,220 | $12,727 | $14,571 | 1.40 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 809, medical | 16 | $91,115 | $15,516 | $18,132 | 1.20 |
| Major hematological and immunological diagnoses except sickle cell crisis and coagulatioMS-DRG 808, medical | 13 | $153,966 | $21,634 | $30,639 | 2.19 |
Transplants, ECMO and tracheostomy (pre-MDC)82 discharges in 5 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart transplant or implant of heart assist system with MCCMS-DRG 001, surgical | 21 | $1,320,088 | $259,089 | $262,697 | 27.10 |
| ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and necMS-DRG 003, surgical | 20 | $633,894 | $178,625 | $126,145 | 21.32 |
| Tracheostomy for face, mouth and neck diagnoses or laryngectomy with CCMS-DRG 012, surgical | 15 | $226,618 | $33,810 | $45,097 | 4.00 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 14 | $408,893 | $86,243 | $81,370 | 14.70 |
| Allogeneic bone marrow transplantMS-DRG 014, medical | 12 | $329,703 | $94,782 | $65,611 | 11.46 |
Blood cancers and poorly differentiated neoplasms77 discharges in 4 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 | 34 | $80,009 | $16,907 | $15,922 | 1.21 |
| Acute leukemia with MCCMS-DRG 834, medical | 19 | $270,213 | $48,311 | $53,772 | 5.60 |
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 12 | $219,723 | $39,567 | $43,725 | 3.13 |
| Chemotherapy without acute leukemia as secondary diagnosis with MCCMS-DRG 846, medical | 12 | $50,181 | $14,810 | $9,986 | 2.44 |
Other61 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 981, surgical | 31 | $210,924 | $37,848 | $41,974 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 30 | $107,985 | $19,684 | $21,489 | 2.49 |
Skin, subcutaneous tissue and breast57 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 43 | $22,719 | $7,295 | $4,521 | 0.88 |
| Cellulitis with MCCMS-DRG 602, medical | 14 | $41,285 | $12,682 | $8,216 | 1.49 |
Injuries, poisonings and toxic effects of drugs48 discharges in 3 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Complications of treatment with MCCMS-DRG 919, medical | 20 | $80,816 | $18,918 | $16,082 | 1.82 |
| Other o.r. procedures for injuries with MCCMS-DRG 907, surgical | 14 | $85,444 | $29,604 | $17,003 | 3.72 |
| Complications of treatment with CCMS-DRG 920, medical | 14 | $29,374 | $9,954 | $5,845 | 1.03 |
Ear, nose, mouth and throat16 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 | 16 | $101,749 | $15,706 | $20,248 | 2.07 |
Mental diseases and disorders14 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 | 14 | $46,149 | $14,761 | $9,184 | 1.76 |
Burns13 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Full thickness burn with skin graft or inhalation injury with cc/mccMS-DRG 928, surgical | 13 | $335,576 | $58,145 | $66,780 | 6.92 |
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 | 491 | 454 | $17,013 | $1,935 | $2,090 |
| Level 1 Intraocular ProceduresAPC 5491 | 425 | 280 | $23,717 | $1,669 | $1,752 |
| Level 2 Upper GI ProceduresAPC 5302 | 396 | 343 | $15,932 | $1,343 | $1,445 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 380 | 350 | $11,751 | $1,125 | $1,220 |
| Level 1 Nerve ProceduresAPC 5431 | 303 | 195 | $8,864 | $1,392 | $1,407 |
| Level 3 Urology and Related ServicesAPC 5373 | 301 | 146 | $18,858 | $1,465 | $1,516 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 299 | 284 | $82,517 | $9,978 | $10,772 |
| Level 3 Vascular ProceduresAPC 5183 | 260 | 213 | $20,987 | $2,215 | $2,405 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 251 | 217 | $20,367 | $2,003 | $2,141 |
| Level 1 Endovascular ProceduresAPC 5191 | 199 | 198 | $23,484 | $2,047 | $2,208 |
| Level 3 Airway EndoscopyAPC 5153 | 185 | 123 | $9,028 | $1,217 | $1,264 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 166 | 166 | $62,131 | $5,044 | $5,339 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 146 | 145 | $186,729 | $19,675 | $21,117 |
| Level 2 Intraocular ProceduresAPC 5492 | 143 | 126 | $58,432 | $2,901 | $3,116 |
| Level 4 Airway EndoscopyAPC 5154 | 138 | 120 | $27,511 | $2,659 | $2,833 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 127 | 122 | $56,569 | $4,058 | $4,358 |
| Level 7 Radiation TherapyAPC 5627 | 123 | 115 | $240,084 | $5,609 | $6,121 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 108 | 101 | $26,337 | $2,202 | $2,373 |
| Level 4 Urology and Related ServicesAPC 5374 | 100 | 84 | $33,367 | $2,481 | $2,629 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 99 | 98 | $87,321 | $7,609 | $8,164 |
| Level 2 Endovascular ProceduresAPC 5192 | 93 | 77 | $23,710 | $4,039 | $4,338 |
| Level 2 Vascular ProceduresAPC 5182 | 88 | 88 | $4,882 | $1,117 | $1,204 |
| Level 5 ENT ProceduresAPC 5165 | 82 | 81 | $55,286 | $4,251 | $4,436 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 81 | 80 | $11,733 | $1,134 | $1,196 |
| Level 5 Airway EndoscopyAPC 5155 | 80 | 80 | $45,161 | $4,908 | $5,183 |
| Complex GI ProceduresAPC 5331 | 80 | 57 | $35,335 | $4,087 | $4,263 |
| Level 3 Endovascular ProceduresAPC 5193 | 79 | 72 | $66,883 | $8,281 | $8,874 |
| Level 5 Urology and Related ServicesAPC 5375 | 75 | 67 | $50,827 | $3,606 | $3,918 |
| Level 4 Vascular ProceduresAPC 5184 | 74 | 49 | $46,760 | $2,801 | $3,946 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 65 | 61 | $22,394 | $1,697 | $1,780 |
| Level 3 Upper GI ProceduresAPC 5303 | 60 | 58 | $27,774 | $2,738 | $2,888 |
| Level 2 Breast/Lymphatic Surgery and Related ProceduresAPC 5092 | 58 | 57 | $59,618 | $4,571 | $4,982 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 54 | 54 | $125,720 | $15,035 | $15,763 |
| Level 3 Lower GI ProceduresAPC 5313 | 49 | 48 | $21,497 | $2,012 | $2,176 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 46 | 43 | $43,165 | $2,402 | $2,636 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 44 | 44 | $93,042 | $8,089 | $8,569 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 44 | 43 | $163,861 | $26,590 | $26,719 |
| Level 4 ENT ProceduresAPC 5164 | 43 | 42 | $31,193 | $2,331 | $2,217 |
| Level 2 Urology and Related ServicesAPC 5372 | 43 | 37 | $6,594 | $481 | $502 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 39 | 39 | $37,918 | $2,763 | $2,930 |
| Level 3 ENT ProceduresAPC 5163 | 39 | 28 | $4,884 | $1,021 | $1,106 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 37 | 37 | $42,625 | $6,003 | $6,514 |
| Level 6 Urology and Related ServicesAPC 5376 | 32 | 31 | $69,849 | $6,552 | $7,291 |
| Level 3 Intraocular ProceduresAPC 5493 | 32 | 28 | $60,655 | $3,790 | $4,004 |
| Level 5 Gynecologic ProceduresAPC 5415 | 25 | 25 | $40,027 | $3,323 | $3,792 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 23 | 23 | $121,161 | $17,465 | $18,465 |
| Level 4 Endovascular ProceduresAPC 5194 | 22 | 21 | $104,930 | $14,319 | $14,606 |
| Level 4 Gynecologic ProceduresAPC 5414 | 22 | 22 | $35,698 | $2,160 | $2,389 |
| Level 2 Neurostimulator and Related ProceduresAPC 5462 | 21 | 14 | $25,118 | $4,021 | $4,524 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 19 | 19 | $165,197 | $26,779 | $29,375 |
| Cochlear Implant ProcedureAPC 5166 | 14 | 14 | $169,552 | $28,843 | $29,489 |
| Level 4 Pacemaker and Similar ProceduresAPC 5224 | 11 | 11 | $113,569 | $16,089 | $17,052 |
| Level 6 Gynecologic ProceduresAPC 5416 | 11 | 11 | $74,008 | $5,488 | $5,836 |
| Level 3 Neurostimulator and Related ProceduresAPC 5463 | 11 | 11 | $47,586 | $10,767 | $11,550 |
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.