Cesarean Section without Sterilization with CC DRG Reimbursement

Summary & Overview

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.

Cesarean Section without Sterilization with CCDRG Cesarean Section without Sterilization with CCDRG 787Diagnosis-Related GroupInpatient ReimbursementMedicareObstetricsMaternal CareSurgical Delivery

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.

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).

Mean Rates by Payer — National — DRG 787

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).

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.

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Summary & Overview

Cesarean Section without Sterilization with CC: Inpatient Reimbursement Overview

DRG 787 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes