Summary & Overview

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

DRG 797 addresses vaginal delivery cases that include sterilization and/or dilation and curettage with a Complication or Comorbidity, defining the clinical scope for payment. This classification matters for inpatient reimbursement because it alters the Diagnosis-Related Group weight and thus affects hospital Medicare payment for the admission.

Vaginal Delivery with Sterilization and/or D&C with CCDRG Vaginal Delivery with Sterilization and/or D&C with CCDRG 797Diagnosis-Related GroupInpatient ReimbursementMedicareObstetricsGynecologySterilizationDilation and Curettage

DRG 797 Overview

DRG 797 covers inpatient admissions for vaginal delivery combined with sterilization and/or dilation and curettage with the presence of a Complication or Comorbidity. It captures cases where additional procedures during the admission increase resource use beyond a routine vaginal delivery. This Diagnosis-Related Group matters for Medicare payment because the presence of a Complication or Comorbidity adjusts the relative payment weight and influences hospital reimbursement. Accurate coding and documentation of the procedures and associated conditions determine assignment to this Diagnosis-Related Group.

National Payment Rates

Across national commercial payers the observed rate distribution runs from a low of $370 up to $31K, with payer medians ranging roughly from $7.3K to $14K. The widest spread between minimum and maximum reported rates is $31K (Anthem). See the table and chart below for payer-specific percentiles and distributions.

Mean Rates by Payer — National — DRG 797

The CMS 2023 data represent national Medicare fee-for-service inpatient payments from the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($8.6k), average submitted covered charges ($36.5k), average Medicare payment amount ($6.5k), and total discharges (41).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska exhibits a narrow rate band for DRG 797, with Anthem and Blue Cross Blue Shield clustered at $16K and Cigna notably higher at a mean of $24K (max $40K). This represents a meaningful upward deviation for Cigna from many national medians, while Anthem/Blue Cross Blue Shield remain below typical national levels. See the table and chart below for payer-specific distributions.

Key Insights for Alaska

Anthem is the lowest payer in Alaska at $16K, while Cigna is the highest with a mean of $24K (range up to $40K).
Alaska’s payer range ($16K–$24K) is compressed compared with national spreads; Cigna’s mean at $24K meaningfully exceeds national averages for several payers, while Anthem and Blue Cross Blue Shield sit below typical national medians.

Clinical Trials

Acute perioperative safety and complication reduction studies: Trials focusing on immediate intraoperative and early postoperative outcomes for patients undergoing vaginal delivery combined with sterilization or dilation and curettage (D&C). These studies enroll patients who elect for sterilization at the time of vaginal delivery or require D&C for retained products, and evaluate interventions such as standardized surgical checklists, local hemostatic techniques, or optimized anesthesia protocols to reduce hemorrhage, infection, and procedure-related morbidity. Findings are relevant to clinicians and payers because reducing short-term complications can decrease length of stay, readmissions, and resource utilization associated with this DRG.
Comparative effectiveness and timing research on sterilization approaches: Prospective comparative studies that evaluate different timing strategies (immediate postpartum sterilization versus delayed interval sterilization) and different procedural approaches performed in the setting of a vaginal delivery with concurrent D&C. These trials enroll birthing persons considering permanent contraception and compare outcomes including procedure success, patient satisfaction, unintended pregnancy rates, and system-level barriers such as consent timing and access; they are important to providers and payers because optimal timing and approach can influence operative time, need for additional procedures, and downstream costs for family planning services.
Post-discharge recovery, health economics, and quality-of-life cohorts: Observational and pragmatic studies that follow patients after hospital discharge to measure recovery trajectories, postpartum mental health, lactation outcomes, and health-care utilization for those who had vaginal delivery with sterilization and/or D&C with complications (CC). These studies often include patient-reported outcomes and cost analyses over 30–365 days to capture readmissions, outpatient visits, and contraceptive counseling needs; results inform care pathways, resource allocation, and reimbursement planning by identifying drivers of prolonged recovery and opportunities to reduce avoidable downstream costs associated with this DRG.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$8.6K	$37K	$6.5K	41

Acute perioperative safety and complication reduction studies: Trials focusing on immediate intraoperative and early postoperative outcomes for patients undergoing vaginal delivery combined with sterilization or dilation and curettage (D&C). These studies enroll patients who elect for sterilization at the time of vaginal delivery or require D&C for retained products, and evaluate interventions such as standardized surgical checklists, local hemostatic techniques, or optimized anesthesia protocols to reduce hemorrhage, infection, and procedure-related morbidity. Findings are relevant to clinicians and payers because reducing short-term complications can decrease length of stay, readmissions, and resource utilization associated with this DRG.
Comparative effectiveness and timing research on sterilization approaches: Prospective comparative studies that evaluate different timing strategies (immediate postpartum sterilization versus delayed interval sterilization) and different procedural approaches performed in the setting of a vaginal delivery with concurrent D&C. These trials enroll birthing persons considering permanent contraception and compare outcomes including procedure success, patient satisfaction, unintended pregnancy rates, and system-level barriers such as consent timing and access; they are important to providers and payers because optimal timing and approach can influence operative time, need for additional procedures, and downstream costs for family planning services.
Post-discharge recovery, health economics, and quality-of-life cohorts: Observational and pragmatic studies that follow patients after hospital discharge to measure recovery trajectories, postpartum mental health, lactation outcomes, and health-care utilization for those who had vaginal delivery with sterilization and/or D&C with complications (CC). These studies often include patient-reported outcomes and cost analyses over 30–365 days to capture readmissions, outpatient visits, and contraceptive counseling needs; results inform care pathways, resource allocation, and reimbursement planning by identifying drivers of prolonged recovery and opportunities to reduce avoidable downstream costs associated with this DRG.

OpenPayer

Summary & Overview

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

DRG 797 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