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    v1.0.28
    OpenPayerBilling CodesPregnancy, Childbirth and the PuerperiumDRG 807-vaginal-delivery-without-sterilization-or-d-c-without-cc-mcc
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    Vaginal Delivery without Sterilization or D&C without CC/MCC: Inpatient Reimbursement Overview

    DRG 807 addresses uncomplicated vaginal delivery without sterilization or dilation and curettage and without Complication or Comorbidity or Major Complication or Comorbidity; it encompasses routine inpatient obstetric care for term deliveries without additional documented complications. This classification matters for inpatient reimbursement because it assigns a lower payment weight reflective of typical resource use for straightforward vaginal births under Centers for Medicare & Medicaid Services payment policies.

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    DRG 807 Overview

    DRG 807 covers vaginal delivery without sterilization or dilation and curettage and without Complication or Comorbidity or Major Complication or Comorbidity. It applies to uncomplicated term deliveries where neither a concurrent sterilization procedure nor uterine curettage is performed, and no additional documented complications increase resource use. This Diagnosis-Related Group matters for Medicare payment because it classifies routine inpatient obstetric stays into a lower-weighted payment category, influencing hospital reimbursement for uncomplicated deliveries. Understanding the clinical scope helps hospitals and payers align coding and billing for straightforward vaginal births.

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    National Payment Rates

    Across payers the observed payment range runs from about $370 up to $22K, with mean values clustering between roughly $5.8K and $9.3K depending on payer; the widest spread is seen between the lowest minimum ($370) and the highest maximum ($22K). Refer to the table and chart below for payer-specific distributions and percentile detail. Payer labels shown include Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem.

    The CMS 2023 data shown are national Medicare fee-for-service inpatient payments reported in the CMS Provider Utilization and Payment Data program. The table below displays average total payment ($6.6k), average submitted covered charges ($20.6k), average Medicare payment amount ($4.4k), and total discharges (1.5k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $6.6K$21K$4.4K1.5K

    Patient Population

    This DRG’s population skews toward a mixed-age cohort rather than being predominantly Medicare-age, with many cases falling in the working-age (commercially insured) population alongside Medicare beneficiaries. As a result, the payer mix typically includes both private/commercial insurers and Medicare fee-for-service, reflecting a blend of younger adult and older adult coverage rather than a strictly Medicare-age population.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    DRG 807 rates in Alaska range from roughly $7.5K up to $29K across payers, with most commercial payers clustered around the $10K–$17K range. Cigna stands out with notably higher mean and upper-percentile values compared with Blue Cross Blue Shield and Anthem. This state-level pattern departs from national averages, where medians are generally lower; see the table and chart below for payer-specific details.

    Key Insights for Alaska

    • Highest payer: Cigna (max $29K, mean $17K) is the top-paying payer in Alaska; Lowest payer: Blue Cross Blue Shield (max $16K, mean $11K) and Anthem share the lower range (min $7.5K–$7.6K, mean $11K).
    • Alaska rates are generally higher than national medians for these payers, with Cigna in AK (median $16K) substantially above Cigna national median $9.1K, indicating a meaningful upward deviation from national rates.
    • Payer spread in AK is wide (roughly $7.5K–$29K), driven primarily by Cigna’s higher upper-end values compared with Blue Cross Blue Shield and Anthem.

    Clinical Trials

    • Studies evaluating protocols to reduce intrapartum complications and optimize labor management for low-risk vaginal deliveries: randomized or pragmatic trials compare active labor management strategies (e.g., timing of labor augmentation, criteria for operative vaginal delivery) in term, singleton, cephalic pregnancies without significant comorbidity. These trials focus on otherwise healthy obstetric patients typical of DRG 807 and assess short-term maternal and neonatal outcomes such as perineal trauma, postpartum hemorrhage, neonatal resuscitation, and length of stay. Results inform providers on best practices that can decrease maternal morbidity and resource use, and help payers predict variability in inpatient costs and avoidable interventions.
    • Comparative effectiveness research on pain management and anesthesia approaches during vaginal delivery: cohort studies or randomized trials examine outcomes of different analgesic strategies (e.g., neuraxial versus alternative pain control methods, timing and dosing of epidural analgesia) among women electing or requiring analgesia during labor. The population includes term vaginal deliveries without complicating procedures, and outcomes include maternal satisfaction, labor duration, rates of assisted delivery, and neonatal breastfeeding initiation. Findings guide clinical protocols that affect staffing, anesthesia resource allocation, and downstream costs relevant to hospital reimbursement under this DRG.
    • Post-discharge observational and quality-of-care studies assessing postpartum recovery, readmission, and breastfeeding outcomes after uncomplicated vaginal delivery: prospective cohorts and registry analyses follow patients from discharge through the early postpartum period to measure readmission rates for issues such as infection or hemorrhage, maternal mental health screening uptake, and breastfeeding success. These studies target the typical DRG 807 population to identify predictors of readmission and unmet needs in outpatient follow-up, informing discharge planning, transitional care interventions, and payer strategies to reduce avoidable readmissions and improve value-based outcomes.

    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.
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    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 807
    Mean Rates by Payer — Alaska — DRG 807