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    v1.0.30
    OpenPayerBilling CodesPregnancy, Childbirth and the PuerperiumDRG 787-cesarean-section-without-sterilization-with-cc
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    Cesarean Section without Sterilization with CC: Inpatient Reimbursement Overview

    DRG 787 applies to cesarean section cases without sterilization when a complication or comorbidity is documented, defining the clinical scope for inpatient maternal surgical care with elevated resource needs. This matters for inpatient reimbursement because the presence of a Complication or Comorbidity places the case in a higher-paying Diagnosis-Related Group compared with uncomplicated cesarean deliveries.

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    DRG 787 Overview

    DRG 787 covers inpatient stays for patients undergoing cesarean section without concurrent sterilization procedures when a complication or comorbidity is present. It encompasses surgical delivery and related maternal care for conditions that increase resource use but do not rise to the level of a Major Complication or Comorbidity. This Diagnosis-Related Group affects payment relative to lower-acuity cesarean groups because the presence of a Complication or Comorbidity increases average costs and length of stay. Medicare payment determinations reference this grouping when assigning case weights for inpatient reimbursement.

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    National Payment Rates

    Across payers, negotiated rates for DRG 787 range from a low of $370 (BCBS) up to $38K (Anthem), with a mean-centered spread across major commercial payers between approximately $9.6K and $15K. The widest payer spread in the benchmark set is $37.6K (Anthem max $38K vs BCBS min $370). See the table and chart below for payer-specific quartiles and distributions (Cigna, Aetna, Anthem, BCBS).

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($11.4k), average submitted covered charges ($44.3k), average Medicare payment amount ($8.0k), and total discharges (978).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $11K$44K$8K980

    Patient Population

    This DRG’s population skews toward a mixed-age cohort but includes a substantial share of working-age patients alongside Medicare-age beneficiaries, reflecting utilization across payer types. Commercial payers (Cigna, Aetna, Anthem, BCBS) represent a large portion of non-Medicare activity, while Medicare covers an important minority of inpatient volume. The result is a mixed payer mix rather than being predominantly Medicare-age.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska exhibits a payer rate range from $17K to $27K across payers, with Cigna standing out as a higher-paying outlier and both Blue Cross Blue Shield and Anthem clustered at the low end. The state’s spread is driven by Cigna’s higher mean and a $45K max that departs from the tighter national distributions for this DRG. See the table and chart below for detailed payer-level benchmarks.

    Key Insights for Alaska

    • Cigna is the highest-paying payer in Alaska with a mean of $27K, while BCBS and Anthem are the lowest at $17K each.
    • Alaska’s rates are skewed upward by Cigna’s higher mean and max ($45K), producing a state mean spread (~$10K) that notably exceeds typical national clustering where means are closer together.

    Clinical Trials

    • Randomized comparative trials of surgical techniques and perioperative management for Cesarean Section without Sterilization with CC focus on immediate intraoperative and early postoperative outcomes. These studies enroll pregnant patients undergoing cesarean delivery who have complicating comorbid conditions (for example hypertensive disorders of pregnancy, obesity, or anemia) and compare approaches such as different uterine incision techniques, use of regional anesthesia protocols, or enhanced recovery pathways. Results are relevant to providers and payers because they inform choices that can reduce operative time, blood loss, transfusion needs, and length of stay—factors driving resource use and DRG-level costs.
    • Comparative effectiveness studies evaluating obstetric complication prevention and management strategies during cesarean delivery for patients with coexisting conditions. These observational or pragmatic randomized studies examine interventions like prophylactic measures for hemorrhage (e.g., uterotonics, tranexamic acid in protocolized use), standardized blood management algorithms, or optimized hypertensive control in the peripartum period among higher-risk cesarean patients. Findings guide clinicians on protocols that decrease severe maternal morbidity and readmission risk and help payers assess which care pathways yield better outcomes and lower downstream expenditures within this DRG.
    • Post-discharge outcomes and health services research assessing maternal recovery, readmission, and long-term morbidity after Cesarean Section without Sterilization with CC. These cohort or registry-based studies follow patients with complicating conditions through the postpartum period to measure wound complications, thromboembolic events, breastfeeding success, mental health outcomes, and healthcare utilization over weeks to months. This research helps providers identify patients who need enhanced follow-up and helps payers predict post-acute care needs, readmission drivers, and the value of investments in transitional care or outpatient support programs.

    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

    785-CESAREAN-SECTION-WITH-STERILIZATION-WITHOUT-CC-MCC

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

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

    Cesarean Section without Sterilization with MCC: 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.
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    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 787
    Mean Rates by Payer — Alaska — DRG 787