Medicare inpatient bundled payment
MS-DRG 193: $9,004
Simple Pneumonia And Pleurisy with 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).
Medicare national-average estimate
$9,004
CMS MS-DRG 193 bundled-payment estimate. Relative weight 1.3144 × FY2026 operating base rate ($6,850 national average).
Mean length of stay
4.9 days
Geometric mean LOS
3.9 days
What MS-DRG 193 actually covers
SIMPLE PNEUMONIA AND PLEURISY WITH 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 7 hospitals that publish MS-DRG 193 in their federally-required HPT files.
Gross charge distribution
Min
$47,473
25th percentile
$67,539
Median
$76,679
75th percentile
$99,337
Max
$143,816
Median cash / self-pay
$26,071
Median commercial negotiated
$7,717
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
- GADSDEN REGIONAL MEDICAL CENTERAL$143,816
- CRESTWOOD MEDICAL CENTERAL$110,193
- GRANDVIEW MEDICAL CENTERAL$88,480
- MEDICAL CENTER ENTERPRISEAL$76,679
- BALDWIN HEALTHAL$72,317
- FLOWERS HOSPITALAL$62,761
- MAT-SU REGIONAL MEDICAL CENTERAK$47,473
Lowest published gross
- MAT-SU REGIONAL MEDICAL CENTERAK$47,473
- FLOWERS HOSPITALAL$62,761
- BALDWIN HEALTHAL$72,317
- MEDICAL CENTER ENTERPRISEAL$76,679
- GRANDVIEW MEDICAL CENTERAL$88,480
- CRESTWOOD MEDICAL CENTERAL$110,193
- GADSDEN REGIONAL MEDICAL CENTERAL$143,816
Related DRGs
Frequently asked
What does MS-DRG 193 cover?+
MS-DRG 193 is the Medicare inpatient bundled-payment classification for simple pneumonia and pleurisy with 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 193?+
Medicare's national-average payment estimate is $9,004 (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 simple pneumonia and pleurisy with mcc so much higher than $9,004?+
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.