MS‑DRG 469: Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity with MCC or Total Ankle Replacement
What Medicare paid hospitals for MS‑DRG 469 in 2024: nationally, state by state and across hospitals.
In 2024 Medicare paid hospitals an average of $28,095 per discharge for MS‑DRG 469, across 1,160 fee-for-service discharges at 70 hospitals: 0.02% of all Medicare inpatient discharges and $32.6M in total, the 229th largest MS‑DRG by Medicare spending.
By state, the average ran from $16,753 in Tennessee to $42,406 in Colorado. Across hospitals, half were paid between $21,617 and $30,015 per case, and the median hospital $24,448; the payment moves with each hospital’s wage index, teaching and low-income share, and with outlier cases.
Hospitals charged $180,053 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 | 3.0332 | 3.1085 | +2.5% |
| Geometric mean stay (days) | 3.3 | 3.3 | 0.0 |
| Average stay (days) | 4.4 | 4.5 | +0.1 |
- Not capped: the +2.5% 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)
$22,965.44
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 ($) |
|---|---|---|---|
| 469 | with MCC | 22,965.44 | — |
| 470 | without MCC | 14,453.05 | −8,512.39 |
FY2027 inpatient rates: what else changed on October 1 · Price MS‑DRG 469 at a hospital
Paid per case, by state
| State | Paid per case | Discharges | Hospitals | Charges ÷ paid |
|---|---|---|---|---|
| Colorado | $42,406 | 37 | 3 | 7.4× |
| California | $38,621 | 155 | 9 | 6.8× |
| New York | $33,824 | 179 | 6 | 6.1× |
| Minnesota | $31,637 | 29 | 2 | 2.8× |
| Pennsylvania | $29,593 | 41 | 3 | 5.8× |
| Washington | $28,730 | 23 | 2 | 5.0× |
| Ohio | $28,409 | 12 | 1 | 4.1× |
| Utah | $28,170 | 14 | 1 | 3.0× |
| Wisconsin | $27,918 | 14 | 1 | 3.5× |
| Alaska | $27,455 | 11 | 1 | 11.1× |
| Massachusetts | $26,652 | 107 | 4 | 3.2× |
| North Carolina | $25,891 | 58 | 4 | 4.8× |
| New Jersey | $24,682 | 34 | 3 | 5.9× |
| Illinois | $24,563 | 91 | 6 | 4.2× |
| Nevada | $23,257 | 17 | 1 | 11.7× |
| Kansas | $22,956 | 24 | 2 | 8.5× |
| Michigan | $22,414 | 31 | 2 | 4.6× |
| West Virginia | $22,340 | 11 | 1 | 4.2× |
| South Dakota | $22,336 | 23 | 2 | 5.2× |
| Indiana | $22,127 | 14 | 1 | 3.8× |
| Iowa | $21,255 | 15 | 1 | 5.2× |
| Virginia | $20,924 | 25 | 2 | 15.0× |
| Texas | $20,169 | 83 | 5 | 14.9× |
| Florida | $19,312 | 76 | 4 | 9.5× |
| Missouri | $18,378 | 14 | 1 | 4.9× |
| Oklahoma | $17,944 | 11 | 1 | 4.6× |
| Tennessee | $16,753 | 11 | 1 | 4.5× |
| United States | $28,095 | 1,160 | 70 | 6.4× |
How much hospitals vary
Each hospital’s own average Medicare payment for MS‑DRG 469.
| 10th percentile | $19,386 |
|---|---|
| 25th percentile | $21,617 |
| Median hospital | $24,448 |
| 75th percentile | $30,015 |
| 90th percentile | $34,979 |
Related analysis
The same condition at other severities
More in Musculoskeletal system and connective tissue
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Questions
What did Medicare pay for MS‑DRG 469 in 2024?
An average of $28,095 per discharge across 1,160 fee-for-service discharges at 70 hospitals, $32.6M in total.
Which state paid the most for MS‑DRG 469?
Colorado, at $42,406 per case; Tennessee paid the least, $16,753.
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.