Summary & Overview
Cesarean Section with Sterilization without CC/MCC: Inpatient Reimbursement Overview
DRG 785 encompasses cesarean section deliveries performed with concurrent sterilization in the absence of Major Complication or Comorbidity or Complication or Comorbidity, defining the clinical scope as surgical obstetric care with sterilization. This grouping affects inpatient reimbursement because it establishes the payment weight for the hospital stay under Diagnosis-Related Group-based Medicare payment.
DRG 785 Overview
DRG 785 covers inpatient admissions for cesarean section with concurrent sterilization procedures when no Major Complication or Comorbidity or Complication or Comorbidity is present. This Diagnosis-Related Group captures surgical deliveries where tubal ligation or other sterilization is performed during the same hospitalization. It matters for Medicare payment because the grouping determines the bundled payment amount for the hospital stay associated with the delivery and sterilization. Accurate coding and documentation of procedures and any comorbid conditions drive correct assignment to this Diagnosis-Related Group.
National Payment Rates
Across payers the reported rate range spans from about $370 to $30K, with means clustering near $11K–$12K; the widest spread is between Anthem (min $390, max $30K) and other payers, as shown in the table and chart below. Cigna, Anthem, Aetna, and BCBS exhibit similar median levels around $8.2K–$12K while maximums vary substantially. Refer to the table and chart below for payer-level percentiles and distribution detail.
The CMS 2023 data are national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($8.7k), average submitted covered charges ($37.8k), average Medicare payment amount ($6.5k), and total discharges (186).