Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesPregnancy, Childbirth and the PuerperiumDRG 785-cesarean-section-with-sterilization-without-cc-mcc
    Ask Trek AI about this page

    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.

    Customize your policy alerts

    Sign up for drg 785 policy alerts

    Get alerted when payer policies referencing 785 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    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.

    Table of contents

    Progress1 / 5

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    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).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $8.7K$38K$6.5K190

    Patient Population

    This DRG’s population skews toward a working-age demographic with a substantial proportion covered by private/commercial payers rather than being predominantly Medicare-age. Medicare discharges are present but fewer relative to total volume, indicating a mixed payer mix leaning toward non-Medicare (commercial) coverage. Age distribution therefore reflects mostly non-elderly adults with a meaningful but smaller Medicare subset.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 785 mean payments range from $15K to $23K across major commercial payers, reflecting a relatively narrow state market spread. Cigna’s mean of $23K is the clear outlier on the high end versus Blue Cross Blue Shield and Anthem at $15K. This state pattern shows higher-than-typical payments for Cigna compared with national averages. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $23K); Lowest payer: Anthem and BCBS (both mean $15K).
    • Alaska’s rates range from $15K to $23K across major payers, with Cigna notably above the others and meaningfully higher than national means for some payers.

    Clinical Trials

    • Perioperative infection prevention trials assessing different antibiotic timing, skin preparation agents, or wound closure techniques for women undergoing cesarean section with concurrent sterilization. These studies enroll pregnant patients scheduled for cesarean delivery who elect or require tubal sterilization at the time of surgery, and measure surgical site infection rates, endometritis, and immediate postoperative complications within the inpatient stay and early postpartum period. Results are directly relevant to surgeons, obstetric teams, and hospital quality committees because reducing infections affects length of stay, readmissions, and episode costs tied to this DRG.
    • Comparative effectiveness research evaluating anesthesia approaches and analgesic regimens for cesarean with sterilization, such as neuraxial anesthesia variants, adjunct regional blocks, or multimodal opioid-sparing pain protocols. Trials focus on perioperative maternal outcomes (pain control, nausea, hemodynamic stability), neonatal safety metrics, and time to ambulation and discharge readiness among term pregnant patients undergoing combined procedures. Payers and inpatient managers use this evidence to optimize resource use, post-op recovery pathways, and billing considerations related to procedure complexity in this DRG.
    • Post-discharge outcomes and health services research tracking short- and medium-term maternal outcomes, contraceptive satisfaction, and healthcare utilization after cesarean with sterilization versus cesarean alone. Cohort studies follow patients from hospital admission through 6–12 months postpartum to capture surgical failure or complications, subsequent family planning visits, patient-reported satisfaction, and emergency or readmission events. These data inform care coordination, counseling practices, and cost-effectiveness analyses important to hospitals and insurers overseeing bundled payments and quality metrics for this DRG.

    Related Codes

    768-VAGINAL-DELIVERY-WITH-O-R-PROCEDURES-EXCEPT-STERILIZATION-AND-OR-D-C

    Vaginal Delivery with O.R. Procedures Except Sterilization and/or D&C: Inpatient Reimbursement Overview

    769-POSTPARTUM-AND-POST-ABORTION-DIAGNOSES-WITH-O-R-PROCEDURES

    Postpartum and Post Abortion Diagnoses with O.R. Procedures: Inpatient Reimbursement Overview

    770-ABORTION-WITH-D-C-ASPIRATION-CURETTAGE-OR-HYSTEROTOMY

    Abortion with D&C, Aspiration Curettage or Hysterotomy: Inpatient Reimbursement Overview

    776-POSTPARTUM-AND-POST-ABORTION-DIAGNOSES-WITHOUT-O-R-PROCEDURES

    Postpartum and Post Abortion Diagnoses without O.R. Procedures: Inpatient Reimbursement Overview

    779-ABORTION-WITHOUT-D-C

    Abortion without D&C: Inpatient Reimbursement Overview

    783-CESAREAN-SECTION-WITH-STERILIZATION-WITH-MCC

    Cesarean Section with Sterilization with MCC: Inpatient Reimbursement Overview

    784-CESAREAN-SECTION-WITH-STERILIZATION-WITH-CC

    Cesarean Section with Sterilization with CC: Inpatient Reimbursement Overview

    786-CESAREAN-SECTION-WITHOUT-STERILIZATION-WITH-MCC

    Cesarean Section without Sterilization with MCC: Inpatient Reimbursement Overview

    787-CESAREAN-SECTION-WITHOUT-STERILIZATION-WITH-CC

    Cesarean Section without Sterilization with CC: Inpatient Reimbursement Overview

    788-CESAREAN-SECTION-WITHOUT-STERILIZATION-WITHOUT-CC-MCC

    Cesarean Section without Sterilization without CC/MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 22

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Mean Rates by Payer — National — DRG 785
    Mean Rates by Payer — Alaska — DRG 785