What does the state payment index mean?

It removes case mix. A state’s index is what its hospitals were paid for their Medicare discharges divided by what the same discharges would have cost at the national average for each MS-DRG, so 1.10 means 10% above the nation for the same mix of cases.

Why are charges so much higher than payments?

Covered charges are the hospital’s list prices. Medicare pays a fixed amount per MS-DRG, so the average charge in 2024 was 6.1 times the average Medicare payment.

Where do these numbers come from?

From the Medicare Inpatient Hospitals - by Provider and Service dataset (data year 2024): the published hospital-by-DRG averages of Medicare fee-for-service inpatient discharges, with discharges, average covered charges, average total payment and average Medicare payment. Cells with fewer than 11 discharges are not published.

Do the figures include the patient’s share?

Average Medicare payment does not; average total payment adds the deductible, coinsurance and other payers.

Can I price a claim for my own hospital?

Yes: Inpatient (IPPS DRG) prices any stay at any hospital on the current rates, step by step.

DRG benchmarks

Medicare fee-for-service hospital discharges in 2024: where the inpatient dollars went, which DRGs drove them, and how much the same case pays from state to state and hospital to hospital.

The nation

Where the money went

Select a DRG to see it state by state below, or browse every MS-DRG’s page.

Table

The 25 MS-DRGs with the most Medicare spending took 51% of the $75.1B paid in 2024; Septicemia or Severe Sepsis without MV >96 Hours with MCC (871) alone was $9.0B.

DRG	Title	Discharges	Total paid	Paid per case	Charges ÷ paid
871	Septicemia or Severe Sepsis without MV >96 Hours with MCC	577,119	$9.0B	$15,524	5.8×
853	Infectious and Parasitic Diseases with O.R. Procedures with MCC	79,560	$3.2B	$40,557	5.7×
291	Heart Failure and Shock with MCC	304,694	$3.1B	$10,022	5.6×
177	Respiratory Infections and Inflammations with MCC	141,351	$1.8B	$12,668	5.6×
267	Endovascular Cardiac Valve Replacement and Supplement Procedures without MCC	39,606	$1.6B	$40,567	5.4×
274	Percutaneous and Other Intracardiac Procedures without MCC	58,174	$1.4B	$24,749	6.3×
003	ECMO or Tracheostomy with MV >96 Hours or Principal Diagnosis except Face, Mouth and Neck with Major O.R. Procedures	6,749	$1.4B	$209,580	5.5×
193	Simple Pneumonia and Pleurisy with MCC	136,649	$1.3B	$9,868	6.1×
266	Endovascular Cardiac Valve Replacement and Supplement Procedures with MCC	23,630	$1.3B	$52,995	5.4×
870	Septicemia or Severe Sepsis with MV >96 Hours	20,906	$1.2B	$58,778	5.7×
280	Acute Myocardial Infarction, Discharged Alive with MCC	83,841	$1.0B	$12,400	6.2×
481	Hip and Femur Procedures except Major Joint with CC	62,753	$991.58M	$15,801	6.4×
064	Intracranial Hemorrhage or Cerebral Infarction with MCC	62,599	$982.50M	$15,695	6.5×
698	Other Kidney and Urinary Tract Diagnoses with MCC	74,188	$970.12M	$13,077	5.7×
329	Major Small and Large Bowel Procedures with MCC	24,579	$900.68M	$36,644	6.0×
189	Pulmonary Edema and Respiratory Failure	89,991	$897.57M	$9,974	5.8×
219	Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with MCC	12,333	$855.75M	$69,387	5.7×
470	Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC	59,121	$844.79M	$14,289	6.5×
682	Renal Failure with MCC	73,354	$840.43M	$11,457	5.9×
872	Septicemia or Severe Sepsis without MV >96 Hours without MCC	103,998	$798.85M	$7,681	6.4×
025	Craniotomy and Endovascular Intracranial Procedures with MCC	20,790	$786.37M	$37,824	6.1×
640	Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC	73,514	$782.35M	$10,642	5.8×
377	Gastrointestinal Hemorrhage with MCC	51,100	$730.81M	$14,302	6.1×
689	Kidney and Urinary Tract Infections with MCC	79,740	$704.75M	$8,838	5.9×
321	Percutaneous Cardiovascular Procedures with Intraluminal Device with MCC or 4+ Arteries/Intraluminal Devices	30,999	$687.90M	$22,191	7.4×

Same cases, different states

Table

For the same mix of cases, California hospitals were paid the most against the national DRG averages (1.33) and Vermont the least (0.68), across 50 states and DC; Maryland (*) is paid under its own all-payer model.

State	Discharges	Hospitals	Paid per case	Payment index	Charges ÷ paid
Maryland*	130,650	44	$21,742	1.560	1.21×
California	462,315	272	$20,814	1.333	7.33×
Alaska	9,804	8	$20,576	1.305	6.61×
New York	328,890	125	$19,954	1.270	6.13×
Wyoming	5,987	9	$15,844	1.239	3.33×
Hawaii	11,470	11	$17,932	1.174	4.41×
Connecticut	53,479	25	$17,095	1.148	4.14×
District of Columbia	16,270	6	$25,244	1.142	5.59×
Massachusetts	183,218	54	$16,808	1.133	3.15×
Oregon	36,581	31	$18,546	1.108	3.77×
New Jersey	176,887	61	$14,948	1.039	7.94×
Rhode Island	13,973	9	$14,231	1.036	3.42×
Minnesota	74,740	45	$17,953	1.015	4.09×
New Hampshire	25,764	13	$14,477	1.011	4.76×
Nevada	43,206	21	$14,927	1.003	10.75×
Washington	83,621	45	$16,003	0.998	5.48×
Delaware	27,539	6	$13,962	0.984	4.18×
Maine	14,554	17	$14,410	0.977	4.56×
Arizona	96,271	60	$14,870	0.951	6.57×
Pennsylvania	223,776	127	$14,128	0.951	7.10×
New Mexico	19,057	23	$14,134	0.946	5.02×
Georgia	129,123	87	$14,064	0.941	6.23×
Illinois	216,831	115	$13,734	0.941	5.43×
Utah	23,818	29	$16,501	0.928	4.41×
Colorado	44,567	47	$16,064	0.926	8.72×
Michigan	130,044	86	$13,170	0.918	4.18×
South Dakota	21,042	15	$14,658	0.915	5.06×
Texas	334,970	241	$14,372	0.912	8.17×
North Carolina	149,256	78	$13,590	0.910	4.69×
Idaho	17,464	15	$14,324	0.907	5.15×
Wisconsin	64,901	64	$14,038	0.900	4.83×
Montana	15,714	10	$14,135	0.889	3.33×
Indiana	107,459	80	$12,794	0.886	5.47×
Missouri	105,310	62	$13,381	0.883	5.45×
Virginia	153,759	71	$13,249	0.882	5.80×
North Dakota	15,904	7	$13,686	0.875	3.81×
Florida	444,244	165	$12,479	0.872	8.51×
South Carolina	91,788	51	$13,063	0.872	6.50×
Nebraska	32,058	24	$14,858	0.871	4.61×
Ohio	174,926	114	$13,070	0.852	5.38×
Oklahoma	70,610	63	$12,942	0.837	6.19×
Iowa	45,476	30	$12,861	0.835	4.74×
Kansas	52,642	43	$13,586	0.834	7.14×
West Virginia	36,604	23	$11,251	0.813	5.41×
Kentucky	73,307	58	$11,675	0.807	6.01×
Tennessee	116,069	75	$12,787	0.807	6.28×
Louisiana	60,578	74	$11,330	0.795	6.08×
Alabama	67,132	69	$11,843	0.791	7.03×
Mississippi	55,291	51	$11,191	0.788	5.35×
Arkansas	54,526	41	$12,010	0.783	4.71×
Vermont	9,016	6	$9,753	0.676	5.76×
* Maryland is not paid under IPPS (all-payer model): left out of the map colors and the highest and lowest.

One DRG

Paid per case, by state

Table

How much hospitals vary

Hospitals in each payment band
Middle half of hospitals
Median

Table

For MS-DRG 871, half of hospitals were paid between $12,587 and $16,770 per case and the median hospital $14,100.

Paid per case	Hospitals
$10,407 to $11,597	286
$11,597 to $12,788	469
$12,788 to $13,978	527
$13,978 to $15,168	390
$15,168 to $16,359	258
$16,359 to $17,549	194
$17,549 to $18,740	144
$18,740 to $19,930	119
$19,930 to $21,121	80
$21,121 to $22,311	49
$22,311 to $23,502	32
$23,502 to $24,692	28
$24,692 to $25,882	19
$25,882 to $27,073	66
10th / 25th / median / 75th / 90th percentile	$11,535 / $12,587 / $14,100 / $16,770 / $19,999

What changes in FY2027

Largest MS-DRG weight changes, FY2026 to FY2027

Weight up
Weight down

Table

751 of 752 MS-DRGs carry a new weight in FY2027 (347 up, 404 down); the largest rise is MS-DRG 465 (+36.1%), and 38 fell by the full 10% the cap allows.

DRG	Title	FY2026	FY2027	Change
465	Wound Debridement or Skin Graft except Hand for Musculoskeletal and Connective Tissue Disorders without CC/MCC	1.8237	2.4822	+36.1%
927	Extensive Burns or Full Thickness Burns with MV >96 Hours with Skin Graft	21.3505	27.8460	+30.4%
488	Knee Procedures without Principal Diagnosis of Infection with CC/MCC	1.7689	2.2211	+25.6%
425	Other Hepatobiliary or Pancreas O.R. Procedures without CC/MCC	1.5003	1.8827	+25.5%
761	Menstrual and Other Female Reproductive System Disorders without CC/MCC	0.5705	0.7041	+23.4%
297	Cardiac Arrest, Unexplained with CC	0.6340	0.7776	+22.6%
950	Aftercare without CC/MCC	0.6277	0.7664	+22.1%
779	Abortion without D&c	0.8413	1.0203	+21.3%
970	HIV with Extensive O.R. Procedures without MCC	2.6374	3.1469	+19.3%
935	Non-Extensive Burns	2.0600	2.4243	+17.7%
320	Other Endovascular Cardiac Valve Procedures without MCC	2.4053	2.1648	−10.0%
290	Acute and Subacute Endocarditis without CC/MCC	0.9297	0.8367	−10.0%
289	Acute and Subacute Endocarditis with CC	1.7069	1.5362	−10.0%
285	Acute Myocardial Infarction, Expired without CC/MCC	0.5989	0.5390	−10.0%
265	AICD Lead Procedures	3.6182	3.2564	−10.0%
137	Mouth Procedures with CC/MCC	1.4932	1.3439	−10.0%
116	Intraocular Procedures with CC/MCC	1.8081	1.6273	−10.0%
096	Bacterial and Tuberculous Infections of Nervous System without CC/MCC	2.5792	2.3213	−10.0%
081	Nontraumatic Stupor and Coma without MCC	0.8956	0.8060	−10.0%
017	Autologous Bone Marrow Transplant without CC/MCC	5.4323	4.8891	−10.0%

Most-priced MS-DRGs

The 12 MS-DRGs with the most Medicare discharges in 2024, the most common inpatient claims. Each has its own page, state by state; every MS-DRG has one.

DRG benchmarks

The nation

Where the money went

Same cases, different states

One DRG

Paid per case, by state

How much hospitals vary

What changes in FY2027

Largest MS-DRG weight changes, FY2026 to FY2027

Most-priced MS-DRGs

About these figures

Reading Medicare's inpatient payments

Questions