MS-DRG 168: $9,360

MS-DRG 168 is the Medicare inpatient bundled-payment classification for other respiratory system o.r. 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.

Medicare's national-average payment estimate is $9,360 (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.

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.

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.

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.