MS‑DRG 004: Tracheostomy with MV >96 Hours or Principal Diagnosis except Face, Mouth and Neck without Major O.R. Procedures
What Medicare paid hospitals for MS‑DRG 004 in 2024: nationally, state by state and across hospitals.
In 2024 Medicare paid hospitals an average of $120,704 per discharge for MS‑DRG 004, across 3,589 fee-for-service discharges at 212 hospitals: 0.07% of all Medicare inpatient discharges and $433.2M in total, the 47th largest MS‑DRG by Medicare spending.
By state, the average ran from $60,735 in Arkansas to $183,743 in California. Across hospitals, half were paid between $83,471 and $137,917 per case, and the median hospital $110,333; the payment moves with each hospital’s wage index, teaching and low-income share, and with outlier cases.
Hospitals charged $680,475 on average for these stays, 5.6 times what Medicare paid: charges are list prices, while Medicare pays a fixed amount per MS‑DRG.
What changed in FY2027
The rates for discharges from October 1, 2026 (MS‑DRG version 44) against FY2026.
| FY2026 | FY2027 | Change | |
|---|---|---|---|
| Relative weight | 13.8514 | 13.5832 | −1.9% |
| Geometric mean stay (days) | 22.4 | 22.0 | −0.4 |
| Average stay (days) | 28.0 | 27.3 | −0.7 |
- Not capped: the −1.9% is CMS’s yearly recalibration of every weight from recent claims and cost data.
- Name, MDC and transfer status are unchanged.
FY2027 national base payment (illustration)
$100,352.00
The FY2027 weight times the operating standardized amount and the capital rate ($6,848.00 + $539.95) at a wage index of 1.0. No IME, DSH, outlier or other hospital-specific adjustment, so it is not what any hospital is paid; price it at a hospital for that.
FY2027 inpatient rates: what else changed on October 1 · Price MS‑DRG 004 at a hospital
Paid per case, by state
| State | Paid per case | Discharges | Hospitals | Charges ÷ paid |
|---|---|---|---|---|
| California | $183,743 | 352 | 22 | 7.1× |
| New York | $168,351 | 631 | 28 | 5.2× |
| Connecticut | $165,925 | 30 | 2 | 4.7× |
| Massachusetts | $144,786 | 67 | 4 | 4.0× |
| Minnesota | $143,655 | 11 | 1 | 2.7× |
| Maryland* | $139,796 | 84 | 6 | 1.2× |
| District of Columbia | $128,685 | 28 | 2 | 4.2× |
| Hawaii | $126,896 | 11 | 1 | 5.7× |
| Pennsylvania | $123,202 | 163 | 10 | 7.3× |
| Wisconsin | $118,327 | 14 | 1 | 3.6× |
| Illinois | $117,829 | 99 | 5 | 4.5× |
| New Mexico | $115,481 | 14 | 1 | 2.2× |
| New Jersey | $114,282 | 152 | 10 | 6.2× |
| Virginia | $113,420 | 73 | 5 | 5.6× |
| Colorado | $113,282 | 28 | 2 | 11.0× |
| Delaware | $108,580 | 27 | 1 | 3.2× |
| Missouri | $105,591 | 62 | 5 | 3.8× |
| Nevada | $103,421 | 51 | 4 | 11.6× |
| North Dakota | $101,190 | 23 | 1 | 3.3× |
| Arizona | $100,659 | 36 | 3 | 4.8× |
| Michigan | $99,013 | 86 | 6 | 3.9× |
| North Carolina | $96,873 | 87 | 6 | 3.5× |
| Georgia | $96,536 | 141 | 9 | 5.9× |
| South Carolina | $95,705 | 96 | 6 | 4.9× |
| Texas | $95,260 | 279 | 15 | 7.2× |
| Ohio | $90,764 | 135 | 8 | 5.1× |
| Mississippi | $89,544 | 86 | 4 | 3.5× |
| Indiana | $88,157 | 34 | 2 | 4.4× |
| Florida | $87,075 | 299 | 18 | 7.0× |
| Louisiana | $84,029 | 34 | 3 | 6.0× |
| Alabama | $83,020 | 30 | 2 | 6.1× |
| Kentucky | $82,983 | 62 | 4 | 3.8× |
| West Virginia | $82,201 | 33 | 2 | 4.1× |
| Oklahoma | $75,095 | 43 | 3 | 5.5× |
| Tennessee | $74,239 | 118 | 6 | 5.0× |
| Arkansas | $60,735 | 70 | 4 | 3.8× |
| United States | $120,704 | 3,589 | 212 | 5.6× |
* Maryland hospitals are paid under the state’s all-payer model, not the IPPS, so Maryland is left out of the state range above.
How much hospitals vary
Each hospital’s own average Medicare payment for MS‑DRG 004.
| 10th percentile | $71,754 |
|---|---|
| 25th percentile | $83,471 |
| Median hospital | $110,333 |
| 75th percentile | $137,917 |
| 90th percentile | $175,130 |
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Questions
What did Medicare pay for MS‑DRG 004 in 2024?
An average of $120,704 per discharge across 3,589 fee-for-service discharges at 212 hospitals, $433.2M in total.
Which state paid the most for MS‑DRG 004?
California, at $183,743 per case; Arkansas paid the least, $60,735.
Where do these figures come from?
From the Medicare Inpatient Hospitals - by Provider and Service (data year 2024): the published hospital-by-DRG averages of Medicare fee-for-service inpatient discharges in 2024. Cells with fewer than 11 discharges are not published, so a hospital with a handful of cases is not counted. Average Medicare payment excludes the patient’s deductible and coinsurance.