Jun 01, 2015
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See 2013 inpatient payment levels for top 100 diagnosis-related groups
Infections treatments lead to millions in medical charges.
The table below shows the top 100 diagnosis-related groups in the United States in 2013 based on total inpatient discharges. The Centers for Medicare and Medicaid services released the data Monday as part of a push to make the costs for these treatments more transparent. The data only includes treatments billed in a fee-for-service model and not part of any value-based purchasing model.
Click on the table below to sort by total cost and amount reimbursed my Medicare. Clicking on the green dot opens more data for each DRG.
[Also: Medicare billed $90 billion in 2013]
| Diagnosis-related group | Average covered charges | Average total payments | Average Medicare payments | Total discharges |
|---|---|---|---|---|
| Diagnosis-related group | Average covered charges | Average total payments | Average Medicare payments | Total discharges |
| 870 - SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS | $170,440.79 | $46,192.75 | $42,466.15 | 33,180 |
| 853 - INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC | $146,309.84 | $41,037.11 | $37,484.60 | 53,117 |
| 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS | $150,891.99 | $40,518.63 | $36,895.15 | 31,097 |
| 329 - MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC | $141,088.38 | $39,097.12 | $35,506.85 | 40,966 |
| 460 - SPINAL FUSION EXCEPT CERVICAL W/O MCC | $100,940.90 | $28,554.12 | $24,355.65 | 73,512 |
| 252 - OTHER VASCULAR PROCEDURES W MCC | $95,906.36 | $24,654.31 | $22,402.86 | 33,867 |
| 246 - PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS | $105,399.30 | $24,289.41 | $21,425.39 | 32,548 |
| 238 - MAJOR CARDIOVASC PROCEDURES W/O MCC | $94,440.85 | $24,062.57 | $21,180.05 | 35,980 |
| 469 - MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC | $86,021.01 | $22,938.28 | $20,727.12 | 26,589 |
| 467 - REVISION OF HIP OR KNEE REPLACEMENT W CC | $87,901.49 | $23,462.73 | $20,527.24 | 23,584 |
| 480 - HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC | $81,295.61 | $21,469.76 | $19,623.13 | 26,290 |
| 243 - PERMANENT CARDIAC PACEMAKER IMPLANT W CC | $73,414.21 | $18,692.95 | $16,893.31 | 29,612 |
| 253 - OTHER VASCULAR PROCEDURES W CC | $77,353.17 | $18,956.76 | $16,756.99 | 37,702 |
| 330 - MAJOR SMALL & LARGE BOWEL PROCEDURES W CC | $72,084.64 | $18,934.28 | $16,135.02 | 54,167 |
| 208 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <96 HOURS | $67,580.77 | $17,082.42 | $15,275.48 | 71,750 |
| 286 - CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC | $67,223.81 | $16,412.75 | $14,100.65 | 28,241 |
| 244 - PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC | $58,987.82 | $14,725.64 | $12,921.00 | 24,138 |
| 177 - RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | $52,718.19 | $14,215.11 | $12,760.94 | 72,906 |
| 251 - PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC | $75,331.05 | $15,250.37 | $12,743.47 | 27,867 |
| 314 - OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC | $53,398.56 | $14,546.70 | $12,649.48 | 49,378 |
| 473 - CERVICAL SPINAL FUSION W/O CC/MCC | $60,513.96 | $15,426.35 | $12,493.30 | 29,436 |
| 484 - MAJOR JOINT & LIMB REATTACHMENT PROC OF UPPER EXTREMITY W/O CC/MCC | $58,350.84 | $14,895.66 | $12,409.59 | 25,173 |
| 871 - SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC | $51,594.24 | $13,972.00 | $12,381.78 | 398,004 |
| 247 - PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC | $70,729.04 | $14,874.95 | $12,170.99 | 100,850 |
| 064 - INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC | $51,921.55 | $13,887.12 | $12,098.03 | 72,142 |
| 470 - MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC | $54,238.62 | $14,794.56 | $12,087.69 | 446,148 |
| 481 - HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC | $53,556.12 | $13,404.93 | $11,834.69 | 81,738 |
| 377 - G.I. HEMORRHAGE W MCC | $49,345.66 | $13,207.19 | $11,739.74 | 56,859 |
| 280 - ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC | $48,593.10 | $12,780.22 | $11,305.43 | 68,611 |
| 100 - SEIZURES W MCC | $46,064.98 | $12,150.50 | $10,531.17 | 23,604 |
| 698 - OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC | $43,007.51 | $12,173.87 | $10,488.13 | 33,905 |
| 254 - OTHER VASCULAR PROCEDURES W/O CC/MCC | $53,158.39 | $12,300.24 | $10,372.10 | 24,617 |
| 682 - RENAL FAILURE W MCC | $41,438.97 | $11,593.26 | $10,147.66 | 111,460 |
| 418 - LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC | $51,943.02 | $12,046.29 | $10,126.55 | 25,277 |
| 331 - MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC | $47,964.27 | $12,124.12 | $9,618.87 | 23,722 |
| 291 - HEART FAILURE & SHOCK W MCC | $41,021.34 | $10,858.95 | $9,600.89 | 194,697 |
| 482 - HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC | $44,468.38 | $11,036.85 | $9,442.48 | 26,070 |
| 917 - POISONING & TOXIC EFFECTS OF DRUGS W MCC | $41,269.31 | $10,942.16 | $9,325.38 | 28,346 |
| 602 - CELLULITIS W MCC | $38,279.99 | $10,739.14 | $9,240.58 | 27,083 |
| 637 - DIABETES W MCC | $39,055.94 | $10,482.49 | $8,949.32 | 23,272 |
| 193 - SIMPLE PNEUMONIA & PLEURISY W MCC | $39,601.52 | $10,352.03 | $8,948.14 | 145,391 |
| 178 - RESPIRATORY INFECTIONS & INFLAMMATIONS W CC | $37,607.83 | $10,063.29 | $8,681.18 | 52,714 |
| 811 - RED BLOOD CELL DISORDERS W MCC | $35,901.10 | $9,535.17 | $8,199.68 | 31,975 |
| 189 - PULMONARY EDEMA & RESPIRATORY FAILURE | $34,175.29 | $9,052.35 | $7,748.97 | 113,944 |
| 308 - CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC | $34,392.25 | $8,995.56 | $7,658.80 | 71,118 |
| 391 - ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC | $35,532.23 | $9,082.73 | $7,645.32 | 47,589 |
| 372 - MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC | $31,125.85 | $8,755.86 | $7,493.80 | 34,934 |
| 640 - MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS /ELECTROLYTES W MCC | $30,711.22 | $8,390.89 | $7,138.44 | 64,349 |
| 190 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC | $32,391.28 | $8,338.49 | $6,995.34 | 152,880 |
| 689 - KIDNEY & URINARY TRACT INFECTIONS W MCC | $30,493.98 | $8,184.96 | $6,972.91 | 74,394 |
| 065 - INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS | $32,851.83 | $8,099.14 | $6,587.40 | 107,755 |
| 872 - SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W/O MCC | $30,065.77 | $7,990.79 | $6,564.05 | 127,832 |
| 699 - OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC | $29,822.87 | $8,022.80 | $6,436.54 | 31,866 |
| 281 - ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC | $31,462.41 | $7,755.18 | $6,407.21 | 46,035 |
| 885 - PSYCHOSES | $20,713.32 | $7,652.70 | $6,326.49 | 95,746 |
| 287 - CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC | $39,092.69 | $7,996.94 | $6,189.31 | 92,092 |
| 057 - DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC | $28,033.05 | $7,554.63 | $6,020.11 | 29,902 |
| 292 - HEART FAILURE & SHOCK W CC | $26,830.41 | $7,189.53 | $5,991.57 | 198,483 |
| 394 - OTHER DIGESTIVE SYSTEM DIAGNOSES W CC | $28,417.28 | $7,400.53 | $5,981.35 | 45,706 |
| 378 - G.I. HEMORRHAGE W CC | $28,517.68 | $7,267.76 | $5,944.90 | 141,425 |
| 315 - OTHER CIRCULATORY SYSTEM DIAGNOSES W CC | $28,486.42 | $7,337.96 | $5,879.07 | 24,596 |
| 176 - PULMONARY EMBOLISM W/O MCC | $28,066.42 | $7,391.60 | $5,854.88 | 39,139 |
| 683 - RENAL FAILURE W CC | $26,452.32 | $7,120.69 | $5,833.05 | 154,280 |
| 491 - BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC | $36,215.26 | $7,942.44 | $5,817.65 | 27,539 |
| 300 - PERIPHERAL VASCULAR DISORDERS W CC | $26,344.82 | $7,071.36 | $5,750.61 | 39,834 |
| 194 - SIMPLE PNEUMONIA & PLEURISY W CC | $26,964.06 | $7,101.02 | $5,737.51 | 182,388 |
| 039 - EXTRACRANIAL PROCEDURES W/O CC/MCC | $33,384.23 | $7,205.13 | $5,658.88 | 32,670 |
| 439 - DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC | $28,095.08 | $7,250.11 | $5,626.69 | 27,489 |
| 191 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC | $26,111.87 | $6,714.10 | $5,464.13 | 136,630 |
| 074 - CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC | $27,273.80 | $6,891.52 | $5,329.34 | 24,795 |
| 389 - G.I. OBSTRUCTION W CC | $25,816.94 | $6,679.95 | $5,286.20 | 53,794 |
| 202 - BRONCHITIS & ASTHMA W CC/MCC | $25,024.76 | $6,425.59 | $4,955.29 | 40,588 |
| 638 - DIABETES W CC | $23,382.21 | $6,160.22 | $4,845.84 | 51,927 |
| 552 - MEDICAL BACK PROBLEMS W/O MCC | $26,214.28 | $6,341.40 | $4,824.90 | 54,363 |
| 603 - CELLULITIS W/O MCC | $22,062.89 | $6,112.00 | $4,679.63 | 134,288 |
| 812 - RED BLOOD CELL DISORDERS W/O MCC | $23,065.65 | $5,860.93 | $4,628.47 | 83,031 |
| 309 - CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC | $23,063.37 | $5,841.87 | $4,593.70 | 104,434 |
| 101 - SEIZURES W/O MCC | $24,510.69 | $5,992.83 | $4,551.13 | 49,572 |
| 066 - INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC | $25,466.22 | $5,916.12 | $4,406.82 | 59,034 |
| 690 - KIDNEY & URINARY TRACT INFECTIONS W/O MCC | $22,061.28 | $5,597.65 | $4,395.46 | 175,529 |
| 282 - ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC | $25,084.43 | $5,550.98 | $4,215.14 | 27,822 |
| 312 - SYNCOPE & COLLAPSE | $23,341.06 | $5,492.43 | $4,210.72 | 103,285 |
| 897 - ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC | $16,995.59 | $5,369.13 | $4,154.44 | 40,017 |
| 563 - FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC | $22,041.10 | $5,536.93 | $4,099.80 | 24,475 |
| 392 - ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC | $23,058.78 | $5,469.29 | $4,078.81 | 199,292 |
| 948 - SIGNS & SYMPTOMS W/O MCC | $21,132.65 | $5,244.86 | $4,020.43 | 47,393 |
| 069 - TRANSIENT ISCHEMIA | $23,895.48 | $5,332.85 | $4,005.57 | 73,512 |
| 641 - MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS /ELECTROLYTES W/O MCC | $20,245.90 | $5,122.48 | $3,916.06 | 122,133 |
| 379 - G.I. HEMORRHAGE W/O CC/MCC | $20,096.04 | $5,113.04 | $3,800.32 | 32,724 |
| 536 - FRACTURES OF HIP & PELVIS W/O MCC | $19,740.02 | $5,053.84 | $3,764.12 | 26,905 |
| 192 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC | $19,989.79 | $5,034.55 | $3,754.48 | 91,034 |
| 293 - HEART FAILURE & SHOCK W/O CC/MCC | $19,038.15 | $4,829.45 | $3,749.59 | 72,323 |
| 195 - SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC | $19,693.93 | $4,990.20 | $3,684.10 | 71,357 |
| 918 - POISONING & TOXIC EFFECTS OF DRUGS W/O MCC | $19,246.91 | $4,780.17 | $3,588.06 | 32,292 |
| 684 - RENAL FAILURE W/O CC/MCC | $17,615.70 | $4,645.47 | $3,424.71 | 27,574 |
| 305 - HYPERTENSION W/O MCC | $19,739.35 | $4,592.42 | $3,261.53 | 28,760 |
| 390 - G.I. OBSTRUCTION W/O CC/MCC | $18,782.84 | $4,646.79 | $3,237.73 | 38,025 |
| 303 - ATHEROSCLEROSIS W/O MCC | $19,218.62 | $4,316.92 | $3,187.75 | 24,826 |
| 313 - CHEST PAIN | $19,867.13 | $4,265.12 | $3,028.74 | 82,573 |
| 310 - CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC | $16,583.40 | $3,987.66 | $2,670.93 | 100,868 |
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