Medicare inpatient bundled payment

MS-DRG 165: $13,112

Major Chest Procedures without CC/MCC. The federally-set bundled payment under the Inpatient Prospective Payment System — covers the entire inpatient hospital stay (pre-op, OR time, recovery, in-stay drugs and supplies).

Data updated 58 days ago·Source: CMS MS-DRG (Inpatient Bundled Payment Classifications)

Medicare national-average estimate

$13,112

CMS MS-DRG 165 bundled-payment estimate. Relative weight 1.9142 × FY2026 operating base rate ($6,850 national average).

Mean length of stay

2.4 days

Geometric mean LOS

2.0 days

What MS-DRG 165 actually covers

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Under the Inpatient Prospective Payment System (42 CFR Part 412), CMS pays hospitals a single bundled rate for each inpatient stay based on the DRG assigned. The bundle includes:

  • Pre-operative work after admission
  • Operating-room time and surgical procedure
  • Drugs, supplies, and devices used during the stay
  • Routine post-operative recovery
  • Discharge planning

Separate professional fees from non-employed physicians (e.g. a surgeon billing through their private practice rather than as a hospital employee) may still be billed under CPT codes alongside the DRG bundled charge.

Hospital published prices

Aggregated across 30 hospitals that publish MS-DRG 165 in their federally-required HPT files.

Gross charge distribution

Min

$12,015

25th percentile

$80,579

Median

$92,679

75th percentile

$166,755

Max

$381,331

Median cash / self-pay

$42,832

Median commercial negotiated

$20,467

Source: each hospital’s own Hospital Price Transparency file, published under 45 CFR §180.50. Aggregated via the DoltHub HPT v3 community dataset.

Highest published gross

Lowest published gross

Related DRGs

If you have a bill from an inpatient stay

Audit every charge in the bundle — and every separately-billed item — quickly.

Upload your bill. Our system reads every line, identifies the hospital, matches the MS-DRG to its CMS bundled-payment estimate, and benchmarks the separately-billed CPTs, drugs, and supplies against six federal data sources: CMS PFS, NADAC, federally-required HPT files, the National Correct Coding Initiative, CMS Hospital Compare, and IRS Publication 78.

  • ✓Line-by-line audit, every charge benchmarked.
  • ✓Up to 5 dispute letters drafted — sign and mail.
  • ✓MS-DRG bundling-rule check (NCCI edits applied).
  • ✓30-day money-back guarantee on single audits.
Check my bill — freeFree preview, no signup. Unlock the full report + letters for $19.97 · 30-day money-back.

Frequently asked

What does MS-DRG 165 cover?+

MS-DRG 165 is the Medicare inpatient bundled-payment classification for major chest procedures without cc/mcc. Under the CMS Inpatient Prospective Payment System, a single payment covers the entire inpatient hospital stay including pre-op, OR time, drugs and supplies during the admission, and routine post-op recovery. Separate professional fees from non-employed physicians (e.g. surgeons billing through their private practice) may still be billed under CPT codes.

How much does Medicare pay for MS-DRG 165?+

Medicare's national-average payment estimate is $13,112 (DRG weight × FY2026 operating base rate ~$6,850). Hospital-specific payments vary by wage index, indirect medical education adjustments, disproportionate share hospital adjustments, and other factors. The hospital's published HPT rates for this DRG are typically higher than the Medicare benchmark.

Why is my inpatient bill for major chest procedures without cc/mcc so much higher than $13,112?+

Commercial insurance and uninsured / self-pay rates routinely run multiples of the Medicare-allowed payment. Each hospital publishes its own gross / cash / commercial-negotiated rates for every DRG in its federally-required Hospital Price Transparency file (45 CFR §180.50). The bigger the gap between what you were billed and the hospital's own published cash-pay rate, the stronger the basis for your dispute.

Can I dispute an MS-DRG charge?+

Yes. Federal and state law gives every patient the right to (1) request an itemized bill (HIPAA §164.524), (2) receive a Good Faith Estimate before scheduled care (No Surprises Act, 2022), (3) dispute charges that materially exceed the GFE by more than $400, and (4) apply for charity care if the facility is a 501(c)(3) nonprofit (ACA §501(r)). DRG bills are bundled — separately-itemized charges for drugs, supplies, or services already covered by the DRG bundle are also disputable.

What's the source of this number?+

MS-DRG codes, descriptions, and relative weights are published annually by the Centers for Medicare & Medicaid Services in the IPPS Final Rule. The hospital pricing distribution is aggregated from individual hospital Hospital Price Transparency files via the DoltHub community dataset. Source freshness: 2025-10-01.