MS‑DRG 435: Malignancy of Hepatobiliary System or Pancreas with MCC
What Medicare paid hospitals for MS‑DRG 435 in 2024: nationally, state by state and across hospitals.
In 2024 Medicare paid hospitals an average of $15,237 per discharge for MS‑DRG 435, across 7,905 fee-for-service discharges at 391 hospitals: 0.16% of all Medicare inpatient discharges and $120.4M in total, the 116th largest MS‑DRG by Medicare spending.
By state, the average ran from $9,347 in Mississippi to $20,825 in California. Across hospitals, half were paid between $11,894 and $16,292 per case, and the median hospital $13,757; the payment moves with each hospital’s wage index, teaching and low-income share, and with outlier cases.
Hospitals charged $103,233 on average for these stays, 6.8 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 | 1.8367 | 1.8430 | +0.3% |
| Geometric mean stay (days) | 4.8 | 4.7 | −0.1 |
| Average stay (days) | 6.3 | 6.3 | 0.0 |
- Not capped: the +0.3% 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)
$13,615.99
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 ($) |
|---|---|---|---|
| 435 | with MCC | 13,615.99 | — |
| 436 | with CC | 8,292.24 | −5,323.75 |
| 437 | without CC/MCC | 5,970.20 | −7,645.79 |
FY2027 inpatient rates: what else changed on October 1 · Price MS‑DRG 435 at a hospital
Paid per case, by state
| State | Paid per case | Discharges | Hospitals | Charges ÷ paid |
|---|---|---|---|---|
| Maryland* | $26,036 | 195 | 13 | 1.2× |
| California | $20,825 | 945 | 45 | 8.2× |
| New York | $18,903 | 666 | 26 | 8.4× |
| District of Columbia | $17,834 | 55 | 3 | 8.1× |
| New Hampshire | $17,792 | 17 | 1 | 3.6× |
| Rhode Island | $17,366 | 11 | 1 | 3.1× |
| Massachusetts | $17,278 | 367 | 13 | 3.5× |
| Connecticut | $17,065 | 84 | 4 | 4.1× |
| Utah | $16,176 | 19 | 1 | 3.9× |
| Colorado | $15,517 | 41 | 2 | 8.7× |
| Nevada | $15,240 | 45 | 3 | 9.3× |
| Oregon | $15,177 | 97 | 7 | 3.8× |
| New Jersey | $15,056 | 420 | 21 | 8.6× |
| Minnesota | $14,379 | 102 | 6 | 3.8× |
| Maine | $14,243 | 13 | 1 | 3.9× |
| Washington | $14,153 | 192 | 9 | 5.9× |
| Illinois | $14,089 | 466 | 23 | 5.6× |
| Pennsylvania | $14,067 | 397 | 21 | 9.0× |
| Michigan | $13,956 | 205 | 9 | 4.2× |
| Missouri | $13,901 | 112 | 4 | 5.3× |
| Wisconsin | $13,681 | 80 | 4 | 7.6× |
| North Carolina | $13,637 | 242 | 12 | 4.7× |
| Delaware | $13,621 | 57 | 2 | 4.3× |
| Georgia | $13,532 | 174 | 10 | 6.6× |
| Indiana | $13,474 | 110 | 5 | 5.4× |
| Texas | $13,173 | 455 | 23 | 9.2× |
| Idaho | $13,109 | 48 | 3 | 4.7× |
| Arizona | $12,713 | 179 | 10 | 6.1× |
| Arkansas | $12,638 | 51 | 3 | 5.0× |
| Iowa | $12,612 | 49 | 2 | 5.4× |
| West Virginia | $12,590 | 22 | 1 | 4.3× |
| South Carolina | $12,577 | 91 | 6 | 5.8× |
| Florida | $12,565 | 617 | 31 | 8.2× |
| Oklahoma | $12,466 | 109 | 5 | 8.7× |
| Vermont | $12,445 | 19 | 1 | 5.7× |
| Virginia | $12,375 | 269 | 15 | 5.6× |
| South Dakota | $11,857 | 17 | 1 | 5.4× |
| Kansas | $11,811 | 100 | 5 | 10.4× |
| Ohio | $11,791 | 262 | 12 | 6.2× |
| North Dakota | $11,772 | 12 | 1 | 3.3× |
| Kentucky | $11,734 | 106 | 5 | 6.4× |
| Tennessee | $11,517 | 188 | 9 | 6.7× |
| Alabama | $11,433 | 53 | 3 | 9.9× |
| New Mexico | $11,424 | 28 | 1 | 4.2× |
| Louisiana | $11,162 | 53 | 4 | 4.7× |
| Nebraska | $11,054 | 29 | 2 | 5.1× |
| Hawaii | $10,856 | 18 | 1 | 8.9× |
| Mississippi | $9,347 | 18 | 1 | 5.8× |
| United States | $15,237 | 7,905 | 391 | 6.8× |
* 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 435.
| 10th percentile | $10,913 |
|---|---|
| 25th percentile | $11,894 |
| Median hospital | $13,757 |
| 75th percentile | $16,292 |
| 90th percentile | $19,198 |
Related analysis
- DRG validation and the single-MCC claim: when one code moves the payment · Payment integrity
More in Hepatobiliary system and pancreas
418Laparoscopic Cholecystectomy without CDE with CC432Cirrhosis and Alcoholic Hepatitis with MCC445Disorders of the Biliary Tract with CC441Disorders of Liver except Malignancy, Cirrhosis or Alcoholic Hepatitis with MCC439Disorders of Pancreas except Malignancy with CC444Disorders of the Biliary Tract with MCC442Disorders of Liver except Malignancy, Cirrhosis or Alcoholic Hepatitis with CC417Laparoscopic Cholecystectomy without CDE with MCC
Questions
What did Medicare pay for MS‑DRG 435 in 2024?
An average of $15,237 per discharge across 7,905 fee-for-service discharges at 391 hospitals, $120.4M in total.
Which state paid the most for MS‑DRG 435?
California, at $20,825 per case; Mississippi paid the least, $9,347.
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.