Westchester Medical Center Medicare inpatient and outpatient services
Every DRG and outpatient service group CMS publishes for Westchester Medical Center, Valhalla, NY in 2024, from traditional Medicare claims. Back to the Westchester Medical Center profile, with quality ratings, finances and negotiated rates.
4,024
Medicare inpatient discharges
In 149 published DRGs
2.39
Case mix index
IPPS FY 2027
28%
Surgical stays
66%
Stays with complications
In DRGs with a CC or MCC
2,778
Medicare outpatient services
In 46 service groups
Inpatient stays by major diagnostic category
Nervous system737 discharges in 22 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 128 | $253,937 | $21,491 | $35,805 | 2.00 |
| Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hoursMS-DRG 065, medical | 81 | $157,130 | $10,247 | $22,155 | 1.02 |
| Traumatic stupor and coma >1 hour with MCCMS-DRG 082, medical | 55 | $300,740 | $25,914 | $42,404 | 2.28 |
| Seizures without MCCMS-DRG 101, medical | 54 | $121,949 | $8,887 | $17,195 | 0.91 |
| Traumatic stupor and coma >1 hour with CCMS-DRG 083, medical | 51 | $181,888 | $13,490 | $25,646 | 1.36 |
| Craniotomy with major device implant or acute complex CNS principal diagnosis with MCC oMS-DRG 023, surgical | 50 | $469,693 | $62,129 | $66,227 | 5.67 |
| Degenerative nervous system disorders without MCCMS-DRG 057, medical | 49 | $149,302 | $13,787 | $21,052 | 1.36 |
| Craniotomy and endovascular intracranial procedures with MCCMS-DRG 025, surgical | 33 | $466,765 | $47,721 | $65,814 | 4.42 |
| Seizures with MCCMS-DRG 100, medical | 27 | $312,765 | $28,915 | $44,100 | 1.98 |
| Traumatic stupor and coma >1 hour without cc/mccMS-DRG 084, medical | 25 | $121,024 | $9,007 | $17,064 | 0.92 |
| Intracranial hemorrhage or cerebral infarction without cc/mccMS-DRG 066, medical | 23 | $127,260 | $6,585 | $17,944 | 0.69 |
| Transient ischemia without thrombolyticMS-DRG 069, medical | 22 | $110,373 | $7,834 | $15,563 | 0.80 |
| Craniotomy and endovascular intracranial procedures without cc/mccMS-DRG 027, surgical | 18 | $207,330 | $23,527 | $29,234 | 2.43 |
| Degenerative nervous system disorders with MCCMS-DRG 056, medical | 17 | $299,543 | $30,915 | $42,236 | 2.39 |
| Other disorders of nervous system with CCMS-DRG 092, medical | 16 | $205,366 | $12,807 | $28,957 | 1.03 |
| Peripheral, cranial nerve and other nervous system procedures with CC or peripheral neurMS-DRG 041, surgical | 14 | $239,796 | $23,342 | $33,811 | 2.23 |
| Other cerebrovascular disorders with MCCMS-DRG 070, medical | 14 | $219,861 | $16,585 | $31,000 | 1.79 |
| Other disorders of nervous system with MCCMS-DRG 091, medical | 14 | $258,305 | $18,192 | $36,421 | 1.79 |
| Traumatic stupor and coma <1 hour with CCMS-DRG 086, medical | 13 | $163,912 | $12,649 | $23,112 | 1.32 |
| Cranial and peripheral nerve disorders without MCCMS-DRG 074, medical | 11 | $166,585 | $10,292 | $23,488 | 1.03 |
| Traumatic stupor and coma <1 hour with MCCMS-DRG 085, medical | 11 | $240,343 | $23,436 | $33,888 | 2.27 |
| Other disorders of nervous system without cc/mccMS-DRG 093, medical | 11 | $160,949 | $7,630 | $22,694 | 0.77 |
Circulatory system716 discharges in 31 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Heart failure and shock with MCCMS-DRG 291, medical | 125 | $179,043 | $14,014 | $25,245 | 1.28 |
| Syncope and collapseMS-DRG 312, medical | 40 | $158,907 | $8,511 | $22,406 | 0.86 |
| Endovascular cardiac valve replacement and supplement procedures without MCCMS-DRG 267, surgical | 35 | $369,966 | $51,732 | $52,165 | 4.88 |
| Circulatory disorders except AMI, with cardiac catheterization with MCCMS-DRG 286, medical | 34 | $364,616 | $27,254 | $51,411 | 2.16 |
| Cardiac arrhythmia and conduction disorders with CCMS-DRG 309, medical | 29 | $123,233 | $7,403 | $17,376 | 0.74 |
| Acute myocardial infarction, discharged alive with MCCMS-DRG 280, medical | 27 | $212,892 | $17,974 | $30,018 | 1.59 |
| Coronary bypass without cardiac catheterization without MCCMS-DRG 236, surgical | 24 | $542,330 | $41,674 | $76,468 | 4.04 |
| Percutaneous and other intracardiac procedures without MCCMS-DRG 274, surgical | 24 | $248,284 | $33,910 | $35,008 | 3.24 |
| Other vascular procedures with MCCMS-DRG 252, surgical | 22 | $499,425 | $47,280 | $70,419 | 3.35 |
| Other major cardiovascular procedures with MCCMS-DRG 270, surgical | 22 | $649,212 | $68,965 | $91,539 | 5.06 |
| Other vascular procedures with CCMS-DRG 253, surgical | 21 | $368,904 | $30,266 | $52,015 | 2.55 |
| Endovascular cardiac valve replacement and supplement procedures with MCCMS-DRG 266, surgical | 21 | $590,938 | $70,547 | $83,322 | 6.25 |
| Peripheral vascular disorders with CCMS-DRG 300, medical | 21 | $139,550 | $11,325 | $19,676 | 1.07 |
| Percutaneous cardiovascular procedures with intraluminal device without MCCMS-DRG 322, surgical | 21 | $215,864 | $19,024 | $30,437 | 1.82 |
| Percutaneous cardiovascular procedures with intraluminal device with MCC or 4+ arteries/MS-DRG 321, surgical | 20 | $341,222 | $33,886 | $48,112 | 2.87 |
| Cardiac arrhythmia and conduction disorders with MCCMS-DRG 308, medical | 18 | $199,999 | $13,355 | $28,200 | 1.20 |
| Cardiac arrhythmia and conduction disorders without cc/mccMS-DRG 310, medical | 18 | $79,228 | $5,121 | $11,171 | 0.55 |
| Acute myocardial infarction, discharged alive with CCMS-DRG 281, medical | 17 | $130,997 | $9,170 | $18,471 | 0.91 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 220, surgical | 16 | $758,725 | $69,019 | $106,980 | 5.24 |
| Circulatory disorders except AMI, with cardiac catheterization without MCCMS-DRG 287, medical | 15 | $218,284 | $10,661 | $30,778 | 1.08 |
| Peripheral vascular disorders with MCCMS-DRG 299, medical | 15 | $219,762 | $21,699 | $30,986 | 1.58 |
| Other circulatory system diagnoses with CCMS-DRG 315, medical | 15 | $148,638 | $9,462 | $20,958 | 0.97 |
| Other circulatory system o.r. proceduresMS-DRG 264, surgical | 14 | $239,925 | $32,895 | $33,829 | 3.27 |
| Other circulatory system diagnoses with MCCMS-DRG 314, medical | 14 | $294,086 | $25,951 | $41,466 | 2.09 |
| Cardiac valve and other major cardiothoracic procedures without cardiac catheterizationMS-DRG 219, surgical | 13 | $947,555 | $107,874 | $133,605 | 7.71 |
| Coronary bypass without cardiac catheterization with MCCMS-DRG 235, surgical | 13 | $761,656 | $63,004 | $107,394 | 5.88 |
| Permanent cardiac pacemaker implant with CCMS-DRG 243, surgical | 13 | $257,506 | $24,733 | $36,308 | 2.28 |
| Other major cardiovascular procedures with CCMS-DRG 271, surgical | 13 | $450,511 | $47,490 | $63,522 | 3.46 |
| Other vascular procedures without cc/mccMS-DRG 254, surgical | 12 | $191,911 | $18,362 | $27,059 | 1.74 |
| Heart failure and shock with CCMS-DRG 292, medical | 12 | $117,761 | $8,744 | $16,604 | 0.86 |
| Hypertension without MCCMS-DRG 305, medical | 12 | $133,300 | $7,898 | $18,795 | 0.75 |
Musculoskeletal system and connective tissue482 discharges in 20 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 | 72 | $260,870 | $21,649 | $36,783 | 2.07 |
| Major hip and knee joint replacement or reattachment of lower extremity without MCCMS-DRG 470, surgical | 52 | $168,503 | $19,833 | $23,759 | 1.88 |
| Medical back problems without MCCMS-DRG 552, medical | 49 | $145,433 | $9,818 | $20,506 | 0.97 |
| Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without MCCMS-DRG 563, medical | 33 | $124,221 | $8,767 | $17,515 | 0.90 |
| Hip and femur procedures except major joint with MCCMS-DRG 480, surgical | 28 | $272,287 | $29,721 | $38,393 | 2.95 |
| Revision of hip or knee replacement with CCMS-DRG 467, surgical | 26 | $324,761 | $36,381 | $45,791 | 3.49 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 24 | $261,981 | $23,784 | $36,939 | 2.11 |
| Fractures of hip and pelvis without MCCMS-DRG 536, medical | 23 | $119,694 | $7,829 | $16,877 | 0.79 |
| Lower extremity and humerus procedures except hip, foot and femur with CCMS-DRG 493, surgical | 20 | $367,278 | $27,433 | $51,786 | 2.40 |
| Medical back problems with MCCMS-DRG 551, medical | 20 | $271,661 | $18,450 | $38,304 | 1.70 |
| Hip and femur procedures except major joint without cc/mccMS-DRG 482, surgical | 17 | $157,261 | $15,746 | $22,174 | 1.59 |
| Other musculoskeletal system and connective tissue o.r. procedures with CCMS-DRG 516, surgical | 17 | $311,260 | $20,528 | $43,888 | 2.04 |
| Revision of hip or knee replacement without cc/mccMS-DRG 468, surgical | 15 | $204,185 | $24,138 | $28,790 | 2.67 |
| Cervical spinal fusion with CCMS-DRG 472, surgical | 14 | $339,709 | $30,630 | $47,899 | 2.96 |
| Spinal fusion except cervical without MCCMS-DRG 460, surgical | 13 | $407,542 | $38,359 | $57,463 | 3.66 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 463, surgical | 13 | $1,094,617 | $103,547 | $154,341 | 5.66 |
| Wound debridement and skin graft except hand for musculoskeletal and connective tissue dMS-DRG 464, surgical | 13 | $486,195 | $38,107 | $68,554 | 3.00 |
| Lower extremity and humerus procedures except hip, foot and femur with MCCMS-DRG 492, surgical | 11 | $426,187 | $33,813 | $60,092 | 3.46 |
| Hip replacement with principal diagnosis of hip fracture with MCCMS-DRG 521, surgical | 11 | $362,966 | $31,025 | $51,178 | 2.99 |
| Signs and symptoms of musculoskeletal system and connective tissue without MCCMS-DRG 556, medical | 11 | $127,690 | $8,265 | $18,004 | 0.82 |
Respiratory system433 discharges in 17 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 66 | $235,529 | $19,161 | $33,210 | 1.70 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 62 | $159,475 | $13,746 | $22,486 | 1.33 |
| Pulmonary embolism with MCC or acute cor pulmonaleMS-DRG 175, medical | 32 | $181,359 | $14,442 | $25,572 | 1.40 |
| Pulmonary edema and respiratory failureMS-DRG 189, medical | 27 | $171,896 | $11,984 | $24,237 | 1.23 |
| Chronic obstructive pulmonary disease with MCCMS-DRG 190, medical | 27 | $209,302 | $16,325 | $29,512 | 1.10 |
| Major chest procedures with MCCMS-DRG 163, surgical | 26 | $445,798 | $51,046 | $62,858 | 4.71 |
| Respiratory system diagnosis with ventilator support <=96 hoursMS-DRG 208, medical | 26 | $290,540 | $28,697 | $40,966 | 2.70 |
| Respiratory infections and inflammations with CCMS-DRG 178, medical | 24 | $168,684 | $9,126 | $23,784 | 0.99 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 24 | $120,001 | $7,705 | $16,920 | 0.82 |
| Major chest procedures with CCMS-DRG 164, surgical | 20 | $281,499 | $26,747 | $39,691 | 2.55 |
| Major chest trauma with MCCMS-DRG 183, medical | 19 | $274,776 | $17,761 | $38,743 | 1.57 |
| Pulmonary embolism without MCCMS-DRG 176, medical | 18 | $151,056 | $8,074 | $21,299 | 0.82 |
| Major chest trauma with CCMS-DRG 184, medical | 15 | $137,525 | $10,465 | $19,391 | 1.05 |
| Other respiratory system diagnoses without MCCMS-DRG 206, medical | 13 | $133,892 | $9,401 | $18,879 | 0.91 |
| Pneumothorax with CCMS-DRG 200, medical | 12 | $155,609 | $11,451 | $21,941 | 1.08 |
| Other respiratory system o.r. procedures with MCCMS-DRG 166, surgical | 11 | $437,292 | $45,890 | $61,658 | 4.06 |
| Bronchitis and asthma with cc/mccMS-DRG 202, medical | 11 | $121,416 | $9,625 | $17,120 | 0.96 |
Infectious and parasitic diseases397 discharges in 4 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 | 277 | $262,618 | $23,335 | $37,029 | 1.98 |
| Septicemia or severe sepsis without MV >96 hours without MCCMS-DRG 872, medical | 59 | $144,717 | $9,970 | $20,405 | 1.03 |
| Infectious and parasitic diseases with o.r. procedures with MCCMS-DRG 853, surgical | 43 | $681,804 | $75,231 | $96,134 | 5.00 |
| Septicemia or severe sepsis with MV >96 hoursMS-DRG 870, medical | 18 | $727,270 | $82,377 | $102,545 | 6.96 |
Kidney and urinary tract304 discharges in 9 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 55 | $118,744 | $8,204 | $16,743 | 0.81 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 48 | $174,848 | $12,415 | $24,654 | 1.17 |
| Other kidney and urinary tract diagnoses with CCMS-DRG 699, medical | 44 | $153,537 | $10,728 | $21,649 | 1.02 |
| Renal failure with CCMS-DRG 683, medical | 40 | $136,242 | $9,264 | $19,210 | 0.90 |
| Renal failure with MCCMS-DRG 682, medical | 35 | $212,741 | $16,682 | $29,996 | 1.50 |
| Other kidney and urinary tract diagnoses with MCCMS-DRG 698, medical | 34 | $294,753 | $21,770 | $41,560 | 1.65 |
| Kidney and ureter procedures for non-neoplasm with CCMS-DRG 660, surgical | 23 | $161,039 | $14,040 | $22,707 | 1.35 |
| Kidney and ureter procedures for neoplasm without cc/mccMS-DRG 658, surgical | 13 | $95,013 | $15,214 | $13,397 | 1.48 |
| Kidney transplant with hemodialysis with MCCMS-DRG 650, surgical | 12 | $501,725 | $50,149 | $70,743 | 4.50 |
Digestive system236 discharges in 11 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 | 44 | $124,719 | $8,240 | $17,585 | 0.79 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 35 | $185,357 | $10,413 | $26,135 | 0.98 |
| Gastrointestinal hemorrhage with MCCMS-DRG 377, medical | 32 | $257,470 | $20,953 | $36,303 | 1.79 |
| Major small and large bowel procedures with MCCMS-DRG 329, surgical | 21 | $667,488 | $63,415 | $94,116 | 4.52 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCCMS-DRG 391, medical | 20 | $245,284 | $13,908 | $34,585 | 1.28 |
| Other digestive system diagnoses with CCMS-DRG 394, medical | 19 | $130,119 | $10,096 | $18,347 | 0.94 |
| Stomach, esophageal and duodenal procedures with CCMS-DRG 327, surgical | 15 | $281,755 | $25,690 | $39,727 | 2.50 |
| Major small and large bowel procedures with CCMS-DRG 330, surgical | 15 | $364,599 | $26,392 | $51,408 | 2.37 |
| Other digestive system o.r. procedures with MCCMS-DRG 356, surgical | 13 | $576,252 | $47,826 | $81,252 | 4.28 |
| Stomach, esophageal and duodenal procedures without cc/mccMS-DRG 328, surgical | 11 | $181,055 | $19,051 | $25,529 | 1.60 |
| Gastrointestinal obstruction with CCMS-DRG 389, medical | 11 | $160,200 | $7,959 | $22,588 | 0.80 |
Liver, gallbladder and pancreas130 discharges in 8 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cirrhosis and alcoholic hepatitis with MCCMS-DRG 432, medical | 29 | $360,093 | $27,692 | $50,773 | 1.92 |
| Cirrhosis and alcoholic hepatitis with CCMS-DRG 433, medical | 27 | $198,208 | $10,528 | $27,947 | 1.03 |
| Disorders of the biliary tract with MCCMS-DRG 444, medical | 15 | $349,953 | $22,965 | $49,343 | 1.63 |
| Malignancy of hepatobiliary system or pancreas with MCCMS-DRG 435, medical | 13 | $219,496 | $18,803 | $30,949 | 1.76 |
| Pancreas, liver and shunt procedures with MCCMS-DRG 405, surgical | 12 | $783,671 | $84,517 | $110,498 | 5.51 |
| Disorders of the biliary tract with CCMS-DRG 445, medical | 12 | $196,162 | $11,712 | $27,659 | 1.09 |
| Laparoscopic cholecystectomy without C.D.E. with CCMS-DRG 418, surgical | 11 | $216,192 | $17,109 | $30,483 | 1.63 |
| Disorders of pancreas except malignancy with MCCMS-DRG 438, medical | 11 | $357,880 | $27,795 | $50,461 | 1.67 |
Endocrine, nutritional and metabolic91 discharges in 4 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 | $219,437 | $16,201 | $30,941 | 1.32 |
| Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without MCCMS-DRG 641, medical | 27 | $138,171 | $8,068 | $19,482 | 0.78 |
| Diabetes with CCMS-DRG 638, medical | 23 | $152,448 | $8,955 | $21,495 | 0.90 |
| Diabetes with MCCMS-DRG 637, medical | 12 | $222,156 | $16,084 | $31,324 | 1.45 |
Skin, subcutaneous tissue and breast72 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Cellulitis without MCCMS-DRG 603, medical | 46 | $95,978 | $8,447 | $13,533 | 0.88 |
| Trauma to the skin, subcutaneous tissue and breast without MCCMS-DRG 605, medical | 26 | $126,353 | $9,548 | $17,816 | 0.91 |
Blood and immune system71 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 | 30 | $130,623 | $9,484 | $18,418 | 0.90 |
| Red blood cell disorders with MCCMS-DRG 811, medical | 25 | $162,073 | $14,074 | $22,852 | 1.40 |
| Coagulation disordersMS-DRG 813, medical | 16 | $308,009 | $16,134 | $43,429 | 1.56 |
Alcohol and drug use70 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Alcohol, drug abuse or dependence with rehabilitation therapyMS-DRG 895, medical | 38 | $150,433 | $13,772 | $21,211 | 1.61 |
| Alcohol, drug abuse or dependence without rehabilitation therapy without MCCMS-DRG 897, medical | 32 | $89,814 | $8,322 | $12,664 | 0.86 |
Mental diseases and disorders56 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| PsychosesMS-DRG 885, medical | 33 | $236,279 | $15,481 | $33,315 | 1.37 |
| Organic disturbances and intellectual disabilityMS-DRG 884, medical | 23 | $166,972 | $15,743 | $23,543 | 1.76 |
Transplants, ECMO and tracheostomy (pre-MDC)54 discharges in 2 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 | 34 | $2,468,194 | $262,127 | $348,015 | 21.32 |
| Tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck withouMS-DRG 004, surgical | 20 | $1,909,248 | $197,180 | $269,204 | 14.70 |
Other52 discharges in 3 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 | 27 | $750,021 | $80,993 | $105,753 | 4.74 |
| Extensive o.r. procedures unrelated to principal diagnosis with CCMS-DRG 982, surgical | 13 | $356,255 | $28,010 | $50,232 | 2.49 |
| Non-extensive o.r. procedures unrelated to principal diagnosis with MCCMS-DRG 987, surgical | 12 | $607,405 | $46,280 | $85,644 | 3.38 |
Blood cancers and poorly differentiated neoplasms37 discharges in 3 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 | 14 | $219,206 | $13,202 | $30,908 | 1.21 |
| Lymphoma and non-acute leukemia with MCCMS-DRG 840, medical | 12 | $632,611 | $54,527 | $89,198 | 3.13 |
| Chemotherapy without acute leukemia as secondary diagnosis with MCCMS-DRG 846, medical | 11 | $233,392 | $27,354 | $32,908 | 2.44 |
Multiple significant trauma33 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other multiple significant trauma with CCMS-DRG 964, medical | 17 | $236,851 | $17,944 | $33,396 | 1.50 |
| Limb reattachment, hip and femur procedures for multiple significant traumaMS-DRG 956, surgical | 16 | $325,718 | $35,270 | $45,926 | 3.88 |
Burns26 discharges in 2 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Non-extensive burnsMS-DRG 935, medical | 14 | $273,967 | $15,837 | $38,629 | 2.04 |
| Full thickness burn with skin graft or inhalation injury with cc/mccMS-DRG 928, surgical | 12 | $1,073,380 | $98,843 | $151,347 | 6.92 |
Injuries, poisonings and toxic effects of drugs16 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Poisoning and toxic effects of drugs with MCCMS-DRG 917, medical | 16 | $219,964 | $19,244 | $31,015 | 1.60 |
Eye11 discharges in 1 DRGs
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Other disorders of the eye without MCCMS-DRG 125, medical | 11 | $109,749 | $7,936 | $15,475 | 0.80 |
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 | 366 | 351 | $65,496 | $2,475 | $2,090 |
| Level 1 Intraocular ProceduresAPC 5491 | 229 | 170 | $37,365 | $2,086 | $1,752 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 171 | 164 | $90,783 | $12,902 | $10,772 |
| Level 2 Upper GI ProceduresAPC 5302 | 164 | 145 | $20,431 | $1,691 | $1,445 |
| Level 1 Endovascular ProceduresAPC 5191 | 134 | 132 | $76,022 | $2,663 | $2,208 |
| Level 4 Vascular ProceduresAPC 5184 | 124 | 109 | $30,607 | $4,937 | $3,946 |
| Level 5 Urology and Related ServicesAPC 5375 | 124 | 117 | $44,524 | $4,620 | $3,918 |
| Level 4 Urology and Related ServicesAPC 5374 | 113 | 102 | $43,609 | $3,136 | $2,629 |
| Level 3 Vascular ProceduresAPC 5183 | 109 | 92 | $44,630 | $2,798 | $2,405 |
| Level 3 Electrophysiologic ProceduresAPC 5213 | 93 | 89 | $216,293 | $25,040 | $21,117 |
| Level 3 Urology and Related ServicesAPC 5373 | 93 | 79 | $36,113 | $1,821 | $1,516 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 72 | 70 | $47,806 | $5,140 | $4,358 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 68 | 66 | $35,029 | $1,466 | $1,220 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 63 | 61 | $41,744 | $2,871 | $2,373 |
| Level 2 Intraocular ProceduresAPC 5492 | 61 | 53 | $45,500 | $3,682 | $3,116 |
| Level 4 Airway EndoscopyAPC 5154 | 57 | 52 | $56,179 | $3,275 | $2,833 |
| Level 3 Endovascular ProceduresAPC 5193 | 52 | 49 | $104,149 | $10,645 | $8,874 |
| Level 3 Extraocular, Repair, and Plastic Eye ProceduresAPC 5503 | 44 | 41 | $39,965 | $2,070 | $1,780 |
| Level 1 Nerve ProceduresAPC 5431 | 43 | 39 | $26,722 | $1,726 | $1,407 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 40 | 39 | $80,727 | $6,291 | $5,339 |
| Level 5 ENT ProceduresAPC 5165 | 34 | 33 | $47,176 | $5,284 | $4,436 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 32 | 32 | $41,736 | $2,485 | $2,141 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 31 | 31 | $36,522 | $1,446 | $1,196 |
| Level 3 Airway EndoscopyAPC 5153 | 27 | 26 | $50,530 | $1,462 | $1,264 |
| Level 1 Abdominal/Peritoneal/Biliary and Related ProceduresAPC 5341 | 27 | 25 | $42,347 | $2,998 | $2,636 |
| Level 2 Laparoscopy and Related ServicesAPC 5362 | 27 | 27 | $66,238 | $10,019 | $8,164 |
| Level 3 Pacemaker and Similar ProceduresAPC 5223 | 25 | 25 | $116,359 | $10,499 | $8,569 |
| Level 2 Vascular ProceduresAPC 5182 | 24 | 23 | $23,865 | $1,383 | $1,204 |
| Level 2 Endovascular ProceduresAPC 5192 | 24 | 23 | $76,516 | $5,165 | $4,338 |
| Level 2 Pacemaker and Similar ProceduresAPC 5222 | 24 | 24 | $84,103 | $8,015 | $6,514 |
| Level 6 Gynecologic ProceduresAPC 5416 | 24 | 24 | $48,036 | $6,619 | $5,836 |
| Level 5 Airway EndoscopyAPC 5155 | 23 | 23 | $68,012 | $6,196 | $5,183 |
| Level 4 Neurostimulator and Related ProceduresAPC 5464 | 23 | 23 | $95,169 | $23,109 | $18,465 |
| Level 5 Neurostimulator and Related ProceduresAPC 5465 | 22 | 22 | $133,511 | $33,411 | $26,719 |
| Level 6 Urology and Related ServicesAPC 5376 | 21 | 20 | $51,208 | $7,965 | $7,291 |
| Level 2 Urology and Related ServicesAPC 5372 | 20 | 19 | $29,732 | $615 | $502 |
| Level 4 Gynecologic ProceduresAPC 5414 | 19 | 19 | $39,189 | $2,830 | $2,389 |
| Level 5 Gynecologic ProceduresAPC 5415 | 19 | 19 | $43,885 | $4,482 | $3,792 |
| Level 2 ICD and Similar ProceduresAPC 5232 | 17 | 17 | $176,219 | $35,685 | $29,375 |
| Level 3 Upper GI ProceduresAPC 5303 | 17 | 16 | $32,590 | $3,470 | $2,888 |
| Implantation of Drug Infusion DeviceAPC 5471 | 15 | 15 | $94,829 | $18,553 | $14,829 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 14 | 14 | $151,945 | $18,027 | $15,763 |
| Level 4 Endovascular ProceduresAPC 5194 | 14 | 14 | $131,260 | $18,254 | $14,606 |
| Level 1 Breast/Lymphatic Surgery and Related ProceduresAPC 5091 | 13 | 13 | $52,021 | $3,450 | $2,930 |
| Cochlear Implant ProcedureAPC 5166 | 11 | 11 | $136,714 | $36,405 | $29,489 |
| Level 3 Lower GI ProceduresAPC 5313 | 11 | $39,960 | $2,533 | $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.