Vaginal Delivery with Sterilization and/or D&C with MCC DRG Reimbursement

Summary & Overview

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.

Vaginal Delivery with Sterilization and/or D&C with MCCDRG Vaginal Delivery with Sterilization and/or D&C with MCCDRG 796Diagnosis-Related GroupInpatient ReimbursementMedicareObstetricsSterilizationDilation and CurettageMaternal Care

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.

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.

Mean Rates by Payer — National — DRG 796

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.

Cesarean Section without Sterilization with CC: Inpatient Reimbursement Overview

832-OTHER-ANTEPARTUM-DIAGNOSES-WITHOUT-O-R-PROCEDURES-WITH-CC

Other Antepartum Diagnoses without O.R. Procedures with CC: Inpatient Reimbursement Overview

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

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

831-OTHER-ANTEPARTUM-DIAGNOSES-WITHOUT-O-R-PROCEDURES-WITH-MCC

Other Antepartum Diagnoses without O.R. Procedures with MCC: Inpatient Reimbursement Overview

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

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

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

807-VAGINAL-DELIVERY-WITHOUT-STERILIZATION-OR-D-C-WITHOUT-CC-MCC

Vaginal Delivery without Sterilization or D&C without CC/MCC: Inpatient Reimbursement Overview

818-OTHER-ANTEPARTUM-DIAGNOSES-WITH-O-R-PROCEDURES-WITH-CC

Other Antepartum Diagnoses with O.R. Procedures with CC: Inpatient Reimbursement Overview

798-VAGINAL-DELIVERY-WITH-STERILIZATION-AND-OR-D-C-WITHOUT-CC-MCC

Vaginal Delivery with Sterilization and/or D&C without CC/MCC: Inpatient Reimbursement Overview

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

Cesarean Section with Sterilization with CC: Inpatient Reimbursement Overview

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Summary & Overview

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

DRG 796 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