Summary & Overview
Vaginal Delivery without Sterilization or D&C with CC: Inpatient Reimbursement Overview
DRG 806 encompasses vaginal delivery cases without sterilization or dilation and curettage that include a Complication or Comorbidity and defines the clinical scope as childbirth with additional maternal conditions affecting resource use. It matters for inpatient reimbursement because hospitals are paid based on Diagnosis-Related Group classification that reflects case complexity and drives Medicare hospital payment for the admission.
DRG 806 Overview
DRG 806 covers inpatient admissions for vaginal delivery without concurrent sterilization or dilation and curettage when a complication or comorbidity is present. It applies to typical obstetric care where additional medical complexity increases resource use, such as mild maternal conditions or managed peripartum complications. This Diagnosis-Related Group influences Medicare payment by grouping clinical severity to determine relative reimbursement for the hospital stay. Understanding this grouping helps clarify billing classification for inpatient vaginal deliveries with added clinical complexity.
National Payment Rates
Across national commercial payers the observed rate range spans roughly from $370 to $25K, with median benchmarks between about $6.4K and $10K depending on payer. Anthem and Aetna show the highest maximums ($25K and $19K respectively), producing the widest spread between minimums and maximums. See the table and chart below for payer-specific quartiles and distribution details.
The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below reports average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 806. Values reflect national aggregates for Medicare FFS in 2023.