MS‑DRG 291: Heart Failure and Shock with MCC

What Medicare paid hospitals for MS‑DRG 291 in 2024: nationally, state by state and across hospitals.

Paid per case$10,0220.7× the all-DRG average

Discharges304,6946.15% of all Medicare discharges

Total paid$3.1B3rd largest MS‑DRG by spending

Hospitals2,587in 50 states and DC

Charges ÷ paid5.6×$56,495 average charge

Relative weight1.2685FY2027, 3.8-day geometric mean stay; FY2026 1.2838 (−1.2%)

In 2024 Medicare paid hospitals an average of $10,022 per discharge for MS‑DRG 291, across 304,694 fee-for-service discharges at 2,587 hospitals: 6.15% of all Medicare inpatient discharges and $3.1B in total, the 3rd largest MS‑DRG by Medicare spending.

By state, the average ran from $6,452 in Vermont to $14,503 in Alaska. Across hospitals, half were paid between $8,295 and $10,914 per case, and the median hospital $9,317; the payment moves with each hospital’s wage index, teaching and low-income share, and with outlier cases.

Hospitals charged $56,495 on average for these stays, 5.6 times what Medicare paid: charges are list prices, while Medicare pays a fixed amount per MS‑DRG.

See MS‑DRG 291 on the interactive map Price an MS‑DRG 291 claim at any hospital Every MS‑DRG

What changed in FY2027

The rates for discharges from October 1, 2026 (MS‑DRG version 44) against FY2026.

MS‑DRG 291, FY2026 and FY2027
	FY2026	FY2027	Change
Relative weight	1.2838	1.2685	−1.2%
Geometric mean stay (days)	3.8	3.8	0.0
Average stay (days)	5.0	4.9	−0.1

Not capped: the −1.2% 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)

$9,371.61

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 national base payment across the severity levels of MS‑DRG 291
MS‑DRG	Severity	Payment ($)	Step ($)
291	with MCC	9,371.61	—
292	with CC	6,365.46	−3,006.15
293	without CC/MCC	4,035.30	−5,336.31

FY2027 inpatient rates: what else changed on October 1 · Price MS‑DRG 291 at a hospital

Paid per case, by state

MS‑DRG 291 by state, 2024
State	Paid per case	Discharges	Hospitals	Charges ÷ paid
Maryland*	$15,188	7,932	41	1.2×
Alaska	$14,503	537	7	6.2×
California	$13,290	26,610	245	7.6×
New York	$12,808	16,510	121	6.3×
Wyoming	$12,750	488	8	2.6×
Hawaii	$12,607	745	11	4.1×
District of Columbia	$11,719	814	6	6.2×
Connecticut	$11,646	3,928	25	4.4×
Oregon	$11,101	2,466	28	3.7×
Massachusetts	$10,910	11,540	51	2.8×
New Jersey	$10,760	11,041	60	9.1×
Nevada	$10,564	2,321	19	9.7×
Rhode Island	$10,209	927	9	3.7×
Texas	$10,108	20,162	194	6.8×
Maine	$10,027	1,030	16	4.0×
Washington	$9,971	5,302	44	5.4×
Minnesota	$9,888	4,298	45	4.1×
Delaware	$9,753	1,767	6	3.9×
Georgia	$9,714	9,106	78	5.5×
Illinois	$9,536	15,144	105	4.8×
New Mexico	$9,480	1,162	19	5.2×
Arizona	$9,476	4,873	48	6.3×
New Hampshire	$9,449	1,723	13	4.2×
South Dakota	$9,354	888	11	4.7×
Michigan	$9,336	9,464	79	3.8×
Colorado	$9,300	2,510	38	7.7×
North Carolina	$9,195	9,559	76	3.9×
Utah	$9,131	1,228	23	4.9×
Montana	$9,131	805	10	3.4×
Idaho	$9,114	885	11	5.2×
Florida	$9,081	23,493	162	7.5×
Pennsylvania	$9,068	15,656	118	6.3×
Nebraska	$8,881	1,742	20	4.2×
North Dakota	$8,876	842	6	3.5×
Missouri	$8,867	6,883	59	5.2×
Wisconsin	$8,799	4,850	58	4.5×
Indiana	$8,760	7,335	71	4.7×
South Carolina	$8,757	5,966	47	5.2×
Virginia	$8,745	10,175	69	4.7×
Ohio	$8,558	12,342	107	5.0×
Oklahoma	$8,507	4,164	48	5.3×
Kansas	$8,470	2,692	32	6.3×
West Virginia	$8,258	2,071	21	4.7×
Iowa	$8,232	2,899	28	4.2×
Tennessee	$8,188	6,623	62	5.7×
Alabama	$8,100	4,230	49	5.5×
Kentucky	$8,066	4,869	53	5.0×
Mississippi	$8,009	3,620	39	5.5×
Louisiana	$7,984	4,664	51	5.2×
Arkansas	$7,968	3,283	34	4.7×
Vermont	$6,452	530	6	4.9×
United States	$10,022	304,694	2,587	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 291.

10th percentile	$7,578
25th percentile	$8,295
Median hospital	$9,317
75th percentile	$10,914
90th percentile	$13,098

Related analysis

DRG validation and the single-MCC claim: when one code moves the payment · Payment integrity
Transfers and the per-diem rule: when a short stay pays less than the full DRG · Inpatient DRG

The same condition at other severities

292Heart Failure and Shock with CC · $7,089

Nearby MS‑DRG numbers

Questions

What did Medicare pay for MS‑DRG 291 in 2024?

An average of $10,022 per discharge across 304,694 fee-for-service discharges at 2,587 hospitals, $3.1B in total.

Which state paid the most for MS‑DRG 291?

Alaska, at $14,503 per case; Vermont paid the least, $6,452.

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.