MS‑DRG 199: Pneumothorax with MCC
What Medicare paid hospitals for MS‑DRG 199 in 2024: nationally, state by state and across hospitals.
In 2024 Medicare paid hospitals an average of $13,958 per discharge for MS‑DRG 199, across 1,183 fee-for-service discharges at 86 hospitals: 0.02% of all Medicare inpatient discharges and $16.5M in total, the 272nd largest MS‑DRG by Medicare spending.
By state, the average ran from $11,043 in Mississippi to $18,912 in New York. Across hospitals, half were paid between $11,800 and $16,202 per case, and the median hospital $13,289; the payment moves with each hospital’s wage index, teaching and low-income share, and with outlier cases.
Hospitals charged $88,934 on average for these stays, 6.4 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 | 1.7641 | 1.7322 | −1.8% |
| Geometric mean stay (days) | 4.8 | 4.7 | −0.1 |
| Average stay (days) | 6.3 | 6.1 | −0.2 |
- Not capped: the −1.8% 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)
$12,797.41
The FY2027 weight times the operating standardized amount and the capital rate ($6,848.00 + $539.95) at a wage index of 1.0. No IME, DSH, outlier or other hospital-specific adjustment, so it is not what any hospital is paid; price it at a hospital for that.
| MS‑DRG | Severity | Payment ($) | Step ($) |
|---|---|---|---|
| 199 | with MCC | 12,797.41 | — |
| 200 | with CC | 7,959.78 | −4,837.63 |
| 201 | without CC/MCC | 5,010.51 | −7,786.90 |
FY2027 inpatient rates: what else changed on October 1 · Price MS‑DRG 199 at a hospital
Paid per case, by state
| State | Paid per case | Discharges | Hospitals | Charges ÷ paid |
|---|---|---|---|---|
| New York | $18,912 | 70 | 5 | 7.1× |
| Massachusetts | $17,205 | 100 | 7 | 3.5× |
| Maryland* | $17,201 | 35 | 3 | 1.2× |
| California | $17,025 | 73 | 6 | 9.5× |
| Missouri | $16,974 | 13 | 1 | 4.9× |
| Rhode Island | $16,398 | 14 | 1 | 2.9× |
| Pennsylvania | $14,670 | 48 | 4 | 8.1× |
| New Jersey | $14,457 | 13 | 1 | 8.8× |
| Georgia | $13,991 | 25 | 2 | 6.3× |
| Indiana | $13,920 | 51 | 3 | 6.2× |
| Minnesota | $13,845 | 36 | 3 | 3.7× |
| Texas | $13,410 | 70 | 5 | 9.9× |
| North Dakota | $13,290 | 14 | 1 | 2.4× |
| Ohio | $13,174 | 15 | 1 | 3.6× |
| Nevada | $13,156 | 40 | 3 | 8.6× |
| New Hampshire | $13,008 | 11 | 1 | 5.9× |
| Delaware | $12,917 | 27 | 2 | 2.9× |
| Virginia | $12,867 | 47 | 4 | 7.0× |
| Tennessee | $12,846 | 66 | 4 | 7.2× |
| Illinois | $12,483 | 33 | 2 | 5.9× |
| Kentucky | $12,296 | 37 | 2 | 5.2× |
| Idaho | $12,208 | 11 | 1 | 4.3× |
| Iowa | $12,099 | 22 | 2 | 6.2× |
| Florida | $12,035 | 126 | 9 | 8.6× |
| Arizona | $11,933 | 23 | 2 | 5.9× |
| Kansas | $11,656 | 57 | 4 | 8.0× |
| Oklahoma | $11,638 | 29 | 2 | 4.2× |
| North Carolina | $11,595 | 24 | 1 | 6.0× |
| Michigan | $11,464 | 12 | 1 | 4.6× |
| Arkansas | $11,082 | 27 | 2 | 4.0× |
| Mississippi | $11,043 | 14 | 1 | 3.6× |
| United States | $13,958 | 1,183 | 86 | 6.4× |
* 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 199.
| 10th percentile | $11,071 |
|---|---|
| 25th percentile | $11,800 |
| Median hospital | $13,289 |
| 75th percentile | $16,202 |
| 90th percentile | $18,193 |
Related analysis
- DRG validation and the single-MCC claim: when one code moves the payment · Payment integrity
The same condition at other severities
200Pneumothorax with CC · $8,523
More in Respiratory system
177Respiratory Infections and Inflammations with MCC193Simple Pneumonia and Pleurisy with MCC189Pulmonary Edema and Respiratory Failure190Chronic Obstructive Pulmonary Disease with MCC194Simple Pneumonia and Pleurisy with CC178Respiratory Infections and Inflammations with CC208Respiratory System Diagnosis with Ventilator Support <=96 Hours175Pulmonary Embolism with MCC or Acute Cor Pulmonale
Questions
What did Medicare pay for MS‑DRG 199 in 2024?
An average of $13,958 per discharge across 1,183 fee-for-service discharges at 86 hospitals, $16.5M in total.
Which state paid the most for MS‑DRG 199?
New York, at $18,912 per case; Mississippi paid the least, $11,043.
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.