Summary & Overview
Cesarean Section with Sterilization without CC/MCC: Inpatient Reimbursement Overview
DRG 785 encompasses cesarean section deliveries performed with concurrent sterilization in the absence of Major Complication or Comorbidity or Complication or Comorbidity, defining the clinical scope as surgical obstetric care with sterilization. This grouping affects inpatient reimbursement because it establishes the payment weight for the hospital stay under Diagnosis-Related Group-based Medicare payment.
DRG 785 Overview
DRG 785 covers inpatient admissions for cesarean section with concurrent sterilization procedures when no Major Complication or Comorbidity or Complication or Comorbidity is present. This Diagnosis-Related Group captures surgical deliveries where tubal ligation or other sterilization is performed during the same hospitalization. It matters for Medicare payment because the grouping determines the bundled payment amount for the hospital stay associated with the delivery and sterilization. Accurate coding and documentation of procedures and any comorbid conditions drive correct assignment to this Diagnosis-Related Group.
National Payment Rates
Across payers the reported rate range spans from about $370 to $30K, with means clustering near $11K–$12K; the widest spread is between Anthem (min $390, max $30K) and other payers, as shown in the table and chart below. Cigna, Anthem, Aetna, and BCBS exhibit similar median levels around $8.2K–$12K while maximums vary substantially. Refer to the table and chart below for payer-level percentiles and distribution detail.
The CMS 2023 data are national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($8.7k), average submitted covered charges ($37.8k), average Medicare payment amount ($6.5k), and total discharges (186).
State Payment Rates
State: Alaska1 / 49
Alaska Benchmarks
Alaska’s DRG 785 mean payments range from $15K to $23K across major commercial payers, reflecting a relatively narrow state market spread. Cigna’s mean of $23K is the clear outlier on the high end versus Blue Cross Blue Shield and Anthem at $15K. This state pattern shows higher-than-typical payments for Cigna compared with national averages. See the table and chart below for payer-level detail.
Key Insights for Alaska
- Highest payer: Cigna (mean $23K); Lowest payer: Anthem and BCBS (both mean $15K).
- Alaska’s rates range from $15K to $23K across major payers, with Cigna notably above the others and meaningfully higher than national means for some payers.
Clinical Trials
- Perioperative infection prevention trials assessing different antibiotic timing, skin preparation agents, or wound closure techniques for women undergoing cesarean section with concurrent sterilization. These studies enroll pregnant patients scheduled for cesarean delivery who elect or require tubal sterilization at the time of surgery, and measure surgical site infection rates, endometritis, and immediate postoperative complications within the inpatient stay and early postpartum period. Results are directly relevant to surgeons, obstetric teams, and hospital quality committees because reducing infections affects length of stay, readmissions, and episode costs tied to this DRG.
- Comparative effectiveness research evaluating anesthesia approaches and analgesic regimens for cesarean with sterilization, such as neuraxial anesthesia variants, adjunct regional blocks, or multimodal opioid-sparing pain protocols. Trials focus on perioperative maternal outcomes (pain control, nausea, hemodynamic stability), neonatal safety metrics, and time to ambulation and discharge readiness among term pregnant patients undergoing combined procedures. Payers and inpatient managers use this evidence to optimize resource use, post-op recovery pathways, and billing considerations related to procedure complexity in this DRG.
- Post-discharge outcomes and health services research tracking short- and medium-term maternal outcomes, contraceptive satisfaction, and healthcare utilization after cesarean with sterilization versus cesarean alone. Cohort studies follow patients from hospital admission through 6–12 months postpartum to capture surgical failure or complications, subsequent family planning visits, patient-reported satisfaction, and emergency or readmission events. These data inform care coordination, counseling practices, and cost-effectiveness analyses important to hospitals and insurers overseeing bundled payments and quality metrics for this DRG.
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