Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • 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.

    v1.0.28
    OpenPayerBilling CodesPregnancy, Childbirth and the PuerperiumDRG 796-vaginal-delivery-with-sterilization-and-or-d-c-with-mcc
    Ask Trek AI about this page

    Vaginal Delivery with Sterilization and/or D&C with MCC: Inpatient Reimbursement Overview

    DRG 796 describes vaginal deliveries combined with sterilization and/or dilation and curettage when a Major Complication or Comorbidity is present, encompassing higher-complexity obstetric cases. Accurate assignment affects inpatient reimbursement because payment is adjusted upward to reflect the additional procedures and the presence of a Major Complication or Comorbidity.

    Customize your policy alerts

    Sign up for drg 796 policy alerts

    Get alerted when payer policies referencing 796 are released or updated.

    Monitor payer policy activity

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

    DRG 796 Overview

    DRG 796 covers inpatient hospitalizations for vaginal delivery that include permanent sterilization procedures and/or dilation and curettage when a Major Complication or Comorbidity is present. This Diagnosis-Related Group groups cases with higher resource use due to the concurrent sterilization and/or uterine procedure plus the presence of a Major Complication or Comorbidity. It matters for Medicare payment because cases assigned to this Diagnosis-Related Group receive higher reimbursement relative to uncomplicated vaginal deliveries to reflect increased clinical complexity and resource needs. Hospitals and coders must accurately document procedures and diagnoses that justify 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
    • 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 commercial payers the reported allowed rates span from about $370 to $47K, with median/typical values ranging from roughly $8.7K to $16K depending on payer — see the table and chart below for payer-specific percentiles. The widest spread is observed for Anthem (min $390 to max $47K), indicating the largest range between low and high allowed amounts. Payer medians cluster in the low- to mid-teens of thousands for most commercial carriers.

    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 ($13.0k), average submitted covered charges ($42.5k), average Medicare payment amount ($11.0k), and total discharges (14). These figures reflect Medicare FFS activity at the national level for the DRG.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $13K$42K$11K14

    Patient Population

    This DRG’s population skews toward a mixed-age cohort rather than being predominantly Medicare-age or exclusively working-age. Medicare cases are present but many admissions are expected to come from commercially insured, working-age patients, yielding a mix of payers. Overall, the payer mix tends to include both Medicare and private/commercial coverage rather than being dominated solely by Medicare-age beneficiaries.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 796 rates cluster tightly for Anthem and BCBS at $18K, while Cigna’s mean sits higher at $28K with a max reaching $47K, creating the primary range across payers from $18K to $47K. This represents a notable upward deviation from national medians, where typical national medians are lower, particularly relative to Cigna’s Alaska median of $28K. See the table and chart below for payer-level detail and distribution.

    Key Insights for Alaska

    • Anthem is the highest-paying payer in Alaska with a mean of $18K, while Blue Cross Blue Shield is tied at the lowest mean of $18K (effectively all reported payers converge at $18K for some benchmarks, though Cigna shows a wider distribution up to $47K).
    • Cigna displays the most meaningful deviation from national rates, with Alaska-level medi an/mean benchmarks concentrated at $28K versus national medians substantially lower, indicating a higher local ceiling and upper-quartile than national reference points.

    Clinical Trials

    • Acute procedural safety and anesthesia optimization studies: Trials focusing on intraoperative and perioperative management during vaginal delivery combined with sterilization or dilation and curettage (D&C), including comparisons of regional versus general anesthesia protocols, analgesic regimens, and blood loss mitigation strategies. These studies enroll pregnant patients undergoing planned or immediate postpartum sterilization or D&C for retained products, and measure outcomes such as procedure-related hemorrhage, anesthesia-related complications, operative time, and short-term maternal morbidity. Findings are directly relevant to clinical teams and payers because optimizing anesthesia and procedural safety can reduce complications, length of stay, and resource utilization in this high-acuity inpatient DRG.
    • Comparative effectiveness research on timing and method of sterilization and uterine evacuation: Comparative studies examine immediate postpartum versus interval sterilization approaches and different techniques for D&C or suction aspiration in the context of vaginal delivery, assessing rates of successful contraception, reoperation, infection, and patient-centered outcomes like satisfaction and contraceptive continuity. These trials typically include birthing patients who desire sterilization or require uterine evacuation after delivery, addressing questions about the trade-offs between combined procedures at delivery versus separate outpatient scheduling. Results inform provider decision-making and payer policy by clarifying which approaches yield better effectiveness, fewer readmissions, and more efficient use of inpatient services for this DRG.
    • Post-discharge recovery, health services utilization, and equity studies: Observational cohorts and pragmatic trials investigate postpartum recovery trajectories, readmission rates, wound or infection surveillance, and access disparities among patients who had vaginal delivery with sterilization and/or D&C with major complications, including analyses by comorbidity, socioeconomic status, and geographic access to care. These studies follow patients through the early postpartum period to quantify follow-up care needs, emergency visits, and longer-term reproductive health outcomes, providing data on resource use and unmet care needs. Payers and health systems use this evidence to design targeted transitional care programs, preventive strategies, and coverage policies aimed at reducing costly readmissions and improving equitable outcomes 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

    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

    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 796
    Mean Rates by Payer — Alaska — DRG 796