Medicare inpatient bundled payment
MS-DRG 259: $13,851
Cardiac Pacemaker Device Replacement without 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
$13,851
CMS MS-DRG 259 bundled-payment estimate. Relative weight 2.0221 × FY2026 operating base rate ($6,850 national average).
Mean length of stay
2.8 days
Geometric mean LOS
2.4 days
What MS-DRG 259 actually covers
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT 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 1 hospital that publish MS-DRG 259 in their federally-required HPT files.
Gross charge distribution
Min
$44,810
25th percentile
$44,810
Median
$44,810
75th percentile
$44,810
Max
$44,810
Median cash / self-pay
$20,164
Median commercial negotiated
$32,733
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
- DRG 209COMPLEX AORTIC ARCH PROCEDURES
- DRG 212CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
- DRG 213ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
- DRG 215OTHER HEART ASSIST SYSTEM IMPLANT
- DRG 216CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA…
- DRG 217CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA…
Frequently asked
What does MS-DRG 259 cover?+
MS-DRG 259 is the Medicare inpatient bundled-payment classification for cardiac pacemaker device replacement without 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 259?+
Medicare's national-average payment estimate is $13,851 (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 cardiac pacemaker device replacement without mcc so much higher than $13,851?+
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.