While there has been a shift in care from hospitals to outpatient facilities like ambulatory surgery centers, inpatient services still account for about half of a hospital’s net patient revenue. Additionally, Medicare patients account for more than one-third of hospital payor days, on average. Understanding inpatient hospital stays is crucial for assessing patient populations, service line needs, and financial performance.
What is a DRG in healthcare?
Diagnosis-related groups (DRGs) are used to classify patients and document their hospital stay. Medicare sets a standard amount to pay for each hospital case and adds a payment weight for each DRG.
Medicare payment weights are based on several factors, including:
- Case severity
- Geographic location
- Proportion of low-income patients in the hospital’s service area
- Patient age, sex, and comorbidities
The Definitive Healthcare HospitalView product tracks Medicare inpatient DRGs for more than 5,800 U.S. hospitals. DRGs are sourced from the Medicare Standard Analytic Files (SAF).
How many DRGs are there?
The Definitive Healthcare HospitalView product includes 760 DRG codes for the 2024 calendar year. The table below highlights the top DRG codes for Medicare inpatients through June 2024, based on estimated payments. The year-to-date Medicare data comes from the 2024 Medicare Quarterly SAF, which reflects approximately 93% claims maturity for each quarter.
Top 10 most common DRGs for 2024
| Rank | DRG code | DRG description | Percent of total DRG diagnoses |
| 1 | 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC | 4.7% |
| 2 | 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | 2.3% |
| 3 | 885 | PSYCHOSES | 2.1% |
| 4 | 003 | ECMO OR TRACH W MV 96 OR MORE HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. | 1.8% |
| 5 | 853 | INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC | 1.7% |
| 6 | 291 | HEART FAILURE & SHOCK W MCC | 1.6% |
| 7 | 274 | PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC | 1.4% |
| 8 | 790 | EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE | 1.3% |
| 9 | 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | 1.2% |
| 10 | 018 | CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES | 1.1% |
Fig 1. Data from Definitive Healthcare HospitalView product and sourced from the Medicare Quarterly Standard Analytic Files (SAF) for calendar year 2024. Accessed February 2025.
What is the most common DRG?
DRG code 871 (septicemia or severe sepsis) leads with 4.7% of estimated payments, followed by DRG code 177 (respiratory infections and inflammations) at 2.3%. Other notable codes include DRG 885 (psychoses) at 2.1% and DRG 003 (ECMO or trach with mechanical ventilation) at 1.8%. These top DRGs represent significant areas of inpatient care and can help identify trends in Medicare reimbursement.
Additional DRGs on the list include:
- DRG 291: Heart failure and shock with major complications
- DRG 274: Percutaneous intracardiac procedures without major complications
- DRG 790: Extreme immaturity or respiratory distress syndrome in neonates
- DRG 193: Simple pneumonia and pleurisy with major complications
- DRG 018: CAR T-cell therapy and other immunotherapies
Looking for more DRG data? Explore the DRGs with the highest readmission rates or the top DRGs by diagnosis volume.
Learn more
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