MS‑DRG 454: Combined Anterior and Posterior Spinal Fusion with CC
What Medicare paid hospitals for MS‑DRG 454 in 2024: nationally, state by state and across hospitals.
MS‑DRG 454 was retired for discharges from October 1, 2024 (FY2025, v42); these figures are for the 2024 data-year stays it still grouped. Where these stays group now.
In 2024 Medicare paid hospitals an average of $49,529 per discharge for MS‑DRG 454, across 13,779 fee-for-service discharges at 491 hospitals: 0.28% of all Medicare inpatient discharges and $682.5M in total, the 26th largest MS‑DRG by Medicare spending.
By state, the average ran from $22,783 in Vermont to $70,259 in New Mexico. Across hospitals, half were paid between $39,671 and $52,532 per case, and the median hospital $44,445; the payment moves with each hospital’s wage index, teaching and low-income share, and with outlier cases.
Hospitals charged $289,584 on average for these stays, 5.8 times what Medicare paid: charges are list prices, while Medicare pays a fixed amount per MS‑DRG.
Where these stays group now
From October 1, 2024 (MS‑DRG version 42) these stays group to the MS‑DRGs below, by spinal region, fusion levels and severity. Price a claim under the one that applies.
402Single Level Combined Anterior and Posterior Spinal Fusion except Cervical2024 paymentsPrice MS‑DRG 402426Multiple Level Combined Anterior and Posterior Spinal Fusion except Cervical with MCCPrice MS‑DRG 426427Multiple Level Combined Anterior and Posterior Spinal Fusion except Cervical with CC2024 paymentsPrice MS‑DRG 427428Multiple Level Combined Anterior and Posterior Spinal Fusion except Cervical without CC/MCCPrice MS‑DRG 428429Combined Anterior and Posterior Cervical Spinal Fusion with MCCPrice MS‑DRG 429430Combined Anterior and Posterior Cervical Spinal Fusion without MCCPrice MS‑DRG 430
What changed in FY2027
The rates for discharges from October 1, 2026 (MS‑DRG version 44) against FY2026.
- Retired before FY2026: no FY2026 or FY2027 weight.
Paid per case, by state
| State | Paid per case | Discharges | Hospitals | Charges ÷ paid |
|---|---|---|---|---|
| New Mexico | $70,259 | 11 | 1 | 4.8× |
| California | $68,548 | 1,512 | 44 | 6.2× |
| Maryland* | $68,107 | 284 | 8 | 1.2× |
| New York | $64,718 | 643 | 19 | 4.8× |
| District of Columbia | $59,738 | 98 | 3 | 5.9× |
| Massachusetts | $56,758 | 323 | 11 | 2.4× |
| Alaska | $54,467 | 75 | 2 | 12.1× |
| Oregon | $52,854 | 150 | 7 | 3.6× |
| Nevada | $52,219 | 108 | 4 | 7.9× |
| Arizona | $51,881 | 458 | 17 | 6.3× |
| Montana | $51,643 | 30 | 2 | 3.0× |
| Connecticut | $50,293 | 149 | 7 | 3.5× |
| New Jersey | $49,511 | 72 | 3 | 4.5× |
| Pennsylvania | $48,570 | 563 | 22 | 4.8× |
| Minnesota | $48,452 | 464 | 13 | 3.2× |
| Illinois | $48,273 | 432 | 17 | 4.7× |
| Delaware | $48,161 | 56 | 1 | 3.3× |
| Iowa | $47,942 | 57 | 2 | 3.3× |
| Washington | $47,937 | 352 | 15 | 4.7× |
| Colorado | $47,214 | 490 | 14 | 8.9× |
| Wisconsin | $46,864 | 88 | 5 | 3.9× |
| Virginia | $46,665 | 508 | 16 | 6.4× |
| North Carolina | $46,401 | 492 | 16 | 5.0× |
| Idaho | $46,063 | 132 | 3 | 5.5× |
| Texas | $44,794 | 1,168 | 36 | 11.1× |
| Indiana | $44,711 | 235 | 12 | 5.8× |
| Georgia | $44,637 | 304 | 14 | 6.0× |
| Michigan | $44,482 | 345 | 18 | 3.7× |
| South Carolina | $44,203 | 214 | 11 | 6.6× |
| Utah | $44,014 | 177 | 7 | 3.7× |
| Kentucky | $43,929 | 161 | 4 | 6.5× |
| Missouri | $43,917 | 247 | 10 | 4.5× |
| Arkansas | $43,309 | 76 | 3 | 2.7× |
| Rhode Island | $43,263 | 40 | 2 | 3.3× |
| Florida | $43,190 | 1,080 | 40 | 7.6× |
| North Dakota | $42,368 | 66 | 4 | 2.5× |
| South Dakota | $42,313 | 75 | 4 | 4.1× |
| West Virginia | $41,759 | 13 | 1 | 7.1× |
| Ohio | $41,663 | 637 | 19 | 4.5× |
| Tennessee | $40,280 | 433 | 15 | 6.1× |
| Kansas | $40,233 | 219 | 9 | 5.4× |
| Oklahoma | $39,552 | 229 | 8 | 5.5× |
| Nebraska | $39,259 | 149 | 5 | 5.6× |
| Mississippi | $39,228 | 12 | 1 | 2.5× |
| Alabama | $37,789 | 190 | 10 | 7.6× |
| Louisiana | $35,342 | 150 | 5 | 5.5× |
| Vermont | $22,783 | 12 | 1 | 7.2× |
| United States | $49,529 | 13,779 | 491 | 5.8× |
* 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 454.
| 10th percentile | $36,181 |
|---|---|
| 25th percentile | $39,671 |
| Median hospital | $44,445 |
| 75th percentile | $52,532 |
| 90th percentile | $62,719 |
The same condition at other severities
More in Musculoskeletal system and connective tissue
481Hip and Femur Procedures except Major Joint with CC470Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC552Medical Back Problems without MCC522Hip Replacement with Principal Diagnosis of Hip Fracture without MCC480Hip and Femur Procedures except Major Joint with MCC460Spinal Fusion except Cervical without MCC563Fracture, Sprain, Strain and Dislocation except Femur, Hip, Pelvis and Thigh without MCC467Revision of Hip or Knee Replacement with CC
Questions
What did Medicare pay for MS‑DRG 454 in 2024?
An average of $49,529 per discharge across 13,779 fee-for-service discharges at 491 hospitals, $682.5M in total.
Which state paid the most for MS‑DRG 454?
New Mexico, at $70,259 per case; Vermont paid the least, $22,783.
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.