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    v1.0.30
    OpenPayerBilling CodesPregnancy, Childbirth and the PuerperiumDRG 788-cesarean-section-without-sterilization-without-cc-mcc
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    Cesarean Section without Sterilization without CC/MCC: Inpatient Reimbursement Overview

    DRG 788 encompasses uncomplicated cesarean section admissions without sterilization and without Major Complication or Comorbidity or Complication or Comorbidity. This classification defines the expected inpatient resource use and drives Centers for Medicare & Medicaid Services payment for routine cesarean deliveries.

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    DRG 788 Overview

    DRG 788 covers inpatient hospital admissions for cesarean section without concurrent sterilization procedures and without any Major Complication or Comorbidity or Complication or Comorbidity present. This Diagnosis-Related Group applies to surgical obstetric deliveries where the patient’s course is uncomplicated by additional coded conditions that would raise resource use. It matters for Centers for Medicare & Medicaid Services payment because assignment to this DRG determines the base Medicare inpatient reimbursement and impacts hospital revenue for routine cesarean deliveries.

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    National Payment Rates

    Across commercial payers the observed rate range spans roughly from $370 to $32K, with mean payments clustering between about $8.2K and $12K depending on payer. The widest spread is between the minimum and maximum reported values (about $370 to $32K), driven largely by Anthem and Cigna extremes. See the table and chart below for payer-specific distributions and percentile detail.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments published in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($8.8k), average submitted covered charges ($37.0k), average Medicare payment ($6.2k), and total discharges (692) for DRG 788.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $8.8K$37K$6.2K690

    Patient Population

    The DRG 788 population includes a mix of Medicare and commercial payers but skews toward a working-age, commercially insured population rather than being primarily Medicare-age. Medicare discharges are present but fewer compared with typical Medicare-dominant DRGs given the procedural context and payer mix in the benchmarks. Overall, the population is mixed with a substantial portion covered by private/commercial plans such as Blue Cross Blue Shield, Cigna, Aetna, and Anthem.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    AK rates for DRG 788 span from roughly $7.5K at the lower quartiles for Blue Cross Blue Shield and Anthem up to a $41K maximum reported for Cigna, with mean/median values of $15K for BCBS and Anthem and $24K/$23K for Cigna. The most notable deviation from national averages is Cigna’s substantially higher mean and max versus national medians near $12K. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (median $23K, mean $24K), lowest payers: Blue Cross Blue Shield and Anthem (median $15K, mean $15K). Cigna pays materially more than the other major carriers in the state.
    • State range across payers runs from about $7.5K (25th percentile for BCBS/Anthem) up to $41K (Cigna max), a wider spread than typical national medians and indicating a meaningful divergence from national averages where medians cluster around ~$12K.

    Clinical Trials

    • Trials comparing surgical techniques and perioperative management during cesarean delivery: randomized or pragmatic studies assess outcomes of different incision types, methods for uterine closure, or anesthesia approaches (regional anesthesia variations and adjuncts) in term pregnant patients undergoing cesarean section without concurrent sterilization and without severe comorbidity. These studies focus on intraoperative metrics (blood loss, operative time), immediate maternal and neonatal outcomes (postpartum hemorrhage, infection, Apgar scores), and short-term resource use (length of stay, need for transfusion), informing clinicians about best practices to reduce complications and informing payers about expected costs and utilization patterns.
    • Comparative effectiveness research on strategies to prevent and manage common postoperative complications after cesarean: cohort studies or cluster-randomized trials examine interventions such as enhanced recovery protocols, antibiotic timing/duration, thromboprophylaxis strategies, or wound-care bundles in a general obstetric population without major complicating diagnoses. The goal is to quantify reductions in surgical site infection, readmission, thromboembolism, and prolonged hospitalization among typical cesarean patients, which is directly relevant to hospitals and payers trying to optimize quality metrics, reduce avoidable readmissions, and control inpatient reimbursement under the DRG.
    • Post-discharge observational and health outcomes studies evaluating maternal functional recovery, breastfeeding success, and infant health following uncomplicated cesarean: prospective registries and retrospective database analyses follow mothers and neonates from discharge through the postpartum period to measure pain trajectories, return to baseline activity, lactation outcomes, mental health, and outpatient utilization. These studies identify longer-term morbidity, outpatient service needs, and cost drivers after an uncomplicated cesarean, helping providers plan discharge counseling and care pathways and helping payers understand downstream costs associated with the index DRG admission.

    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

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

    Cesarean Section without Sterilization with CC: Inpatient Reimbursement Overview

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    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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    Mean Rates by Payer — National — DRG 788
    Mean Rates by Payer — Alaska — DRG 788