Final Cost Outlier Thresholds Effective January 1, 2012
Also available as an Excel Spreadsheet XLS, 34KB
| APR-DRG | APR-DRG Description | Product Line | 2012 Cost Outlier Thresholds |
|---|---|---|---|
| 001 | Liver Transplant | Transplant Surgery | $ 813,617 |
| 002 | Heart &/or Lung Transplant | Transplant Surgery | $ 1,923,806 |
| 003 | Bone Marrow Transplant | Transplant Surgery | $ 549,836 |
| 004 | Tracheostomy W Long Term Mechanical Ventilation W Extensive Procedure | General Surgery | $ 1,144,648 |
| 005 | Tracheostomy W Long Term Mechanical Ventilation W/O Extensive Procedure | General Surgery | $ 754,666 |
| 006 | Pancreas Transplant | Transplant Surgery | $ 536,033 |
| 020 | Craniotomy for Trauma | Trauma | $ 201,962 |
| 021 | Craniotomy Except for Trauma | Neurological Surgery | $ 214,927 |
| 022 | Ventricular Shunt Procedures | Neurological Surgery | $ 309,650 |
| 023 | Spinal Procedures | Neurological Surgery | $ 181,446 |
| 024 | Extracranial Vascular Procedures | Neurological Surgery | $ 159,575 |
| 026 | Other Nervous System & Related Procedures | Neurological Surgery | $ 130,036 |
| 040 | Spinal Disorders & Injuries | Neurology | $ 88,373 |
| 041 | Nervous System Malignancy | Oncology | $ 99,961 |
| 042 | Degenerative Nervous System Disorders Exc Mult Sclerosis | Neurology | $ 47,804 |
| 043 | Multiple Sclerosis & Other Demyelinating Diseases | Neurology | $ 54,758 |
| 044 | Intracranial Hemorrhage | Neurology | $ 139,518 |
| 045 | CVA & Precerebral Occulusion w/ Infarct | Neurology | $ 70,166 |
| 046 | Nonspecific CVA & Precerebral Occlusion w/o Infarct | Neurology | $ 55,400 |
| 047 | Transient Ischemia | Neurology | $ 30,236 |
| 048 | Peripheral, Cranial & Autonomic Nerve Disorders | Neurology | $ 45,820 |
| 049 | Bacterial & Tuberculous Infections of Nervous System | Infectious Disease | $ 194,812 |
| 050 | Non-bacterial Infections of Nervous System Exc Viral Meningitis | Infectious Disease | $ 106,546 |
| 051 | Viral Meningitis | Infectious Disease | $ 41,003 |
| 052 | Nontraumatic Stupor & Coma | Neurology | $ 39,551 |
| 053 | Seizure | Neurology | $ 41,492 |
| 054 | Migraine & Other Headaches | Neurology | $ 31,296 |
| 055 | Head Trauma w/ Coma > 1 Hr or Hemorrhage | Trauma | $ 68,591 |
| 056 | Brain Contusion/Laceration & Compliated Skull FX, COMA < 1 HR OR No Coma | Neurology | $ 58,203 |
| 057 | Concussion, Closed Skull FX Nos, Uncomplicated Intracranial Injury, Coma <1 Hr or No Coma | Neurology | $ 28,058 |
| 058 | Other Disorders of Nervous System | Neurology | $ 48,289 |
| 070 | Orbital Procedures | Ophthalmology Surgery | $ 68,297 |
| 073 | Eye Procedures Except Orbit | Ophthalmology Surgery | $ 52,164 |
| 080 | Acute Major Eye Infections | Ophthalmology | $ 34,196 |
| 082 | Eye Disorders Except Major Infections | Ophthalmology | $ 34,951 |
| 089 | Major Cranial/Facial Bone Procedures | ENT Surgery | $ 159,484 |
| 090 | Major Larynx & Trachea Procedures | ENT Surgery | $ 227,320 |
| 091 | Other Major Head & Neck Procedures | ENT Surgery | $ 309,592 |
| 092 | Facial Bone Procedures Except Major Cranial/Facial Bone Procedures | ENT Surgery | $ 67,683 |
| 093 | Sinus & Mastoid Procedures | ENT Surgery | $ 61,098 |
| 095 | Cleft Lip & Palate Repair | ENT Surgery | $ 37,815 |
| 097 | Tonsill & Adenoid Procedures | ENT Surgery | $ 29,677 |
| 098 | Other Ear, Nose, Mouth & Throat Procedures | ENT Surgery | $ 46,631 |
| 110 | Ear, Nose, Mouth Throat, Cranial/Facial Malignancies | Oncology | $ 103,834 |
| 111 | Vertigo & Other Labyrinth Disorders | Otolaryngology | $ 26,495 |
| 113 | Infections Of The Upper Respiratory Tract | Otolaryngology | $ 25,767 |
| 114 | Dental & Oral Diseases & Injuries | Dental | $ 33,863 |
| 115 | Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses | Otolaryngology | $ 30,565 |
| 120 | Major Respiratory & Chest Procedures | General Surgery | $ 146,944 |
| 121 | Other Respiratory & Chest Procedures | General Surgery | $ 130,688 |
| 130 | Respiratory System Diagnosis w/ Ventilator Support 96+ Hours | Pulmonary | $ 289,264 |
| 131 | Cystic Fibrosis - Pulmonary Disease | Pulmonary | $ 135,884 |
| 132 | BPD & Oth Chronic Respiratory Dis Arising In Perinatal Period | Neonatology | $ 86,381 |
| 133 | Pulmonary Edema & Respiratory Failure | Pulmonary | $ 97,818 |
| 134 | Pulmonary Embolism | Pulmonary | $ 64,167 |
| 135 | Major Chest & Respiratory Trauma | Trauma | $ 47,038 |
| 136 | Respiratory Malignancy | Oncology | $ 104,410 |
| 137 | Major Respiratory Infections & Inflammations | Pulmonary | $ 100,909 |
| 138 | Bronchiolitis & RSV Pneumonia | Pulmonary | $ 35,618 |
| 139 | Other Pneumonia | Pulmonary | $ 42,130 |
| 140 | Chronic Obstructive Pulmonary Disease | Pulmonary | $ 43,213 |
| 141 | Asthma | Pulmonary | $ 30,238 |
| 142 | Interstitial Lung Disease | Pulmonary | $ 63,320 |
| 143 | Other Respiratory Diagnosis Except Signs, Symptoms & Minor Diagnoses | Pulmonary | $ 59,705 |
| 144 | Respiratory System Signs, Symptoms & Other Diagnoses | Pulmonary | $ 30,540 |
| 160 | Major Cardiothoracic Repair of Heart Anomaly | Open Heart Surgery | $ 329,840 |
| 161 | Cardiac Defibrillator & Heart Assist Anomaly | Open Heart Surgery | $ 325,857 |
| 162 | Cardiac Valve Procedures w/ Cardiac Catheterization | Open Heart Surgery | $ 320,148 |
| 163 | Cardiac Valve Procedures w/o Cardiac Catheterization | Open Heart Surgery | $ 255,169 |
| 165 | Coronary Bypass w/ Cardiac Cath Or Percutaneous Cardiac Procedure | Open Heart Surgery | $ 208,687 |
| 166 | Coronary Bypass w/o Cardiac Cath Or Percutaneous Cardiac Procedure | Open Heart Surgery | $ 172,957 |
| 167 | Other Cardiothoracic Procedures | Cardiovascular Surgery | $ 221,422 |
| 169 | Major Thoracic & Abdominal Vascular Procedures | Cardiovascular Surgery | $ 254,383 |
| 170 | Permanent Cardiac Pacemaker Implant w/ AMI, Heart Failure or Shock | Cardiovascular Surgery | $ 167,596 |
| 171 | Perm Cardiac Pacemaker Implant w/o AMI, Heart Failure or Shock | Cardiovascular Surgery | $ 123,925 |
| 173 | Other Vascular Procedures | Cardiovascular Surgery | $ 172,752 |
| 174 | Percutaneous Cardiovascular Procedures w/ AMI | Cardiovascular Surgery | $ 116,347 |
| 175 | Percutaneous Cardiovascular Procedures w/o AMI | Cardiovascular Surgery | $ 83,550 |
| 176 | Cardiac Pacemaker & Defibrillator Device Replacement | Cardiovascular Surgery | $ 210,208 |
| 177 | Cardiac Pacemaker & Defibrillator Revision Except Device Replacement | Cardiovascular Surgery | $ 140,312 |
| 180 | Other Circulatory System Procedures | Cardiovascular Surgery | $ 176,556 |
| 190 | Acute Myocardial Infarction | Cardiology | $ 77,655 |
| 191 | Cardiac Catheterization w/ Circ Disord Exc Ischemic Heart Disease | Cardiac Catheter | $ 86,447 |
| 192 | Cardiac Catheterization for Ischemic Heart Disease | Cardiac Catheter | $ 40,772 |
| 193 | Acute & Subacute Endocarditis | Cardiology | $ 148,667 |
| 194 | Heart Failure | Cardiology | $ 61,597 |
| 196 | Cardiac Arrest | Cardiology | $ 72,456 |
| 197 | Peripheral & Other Vascular Disorders | Cardiology | $ 56,208 |
| 198 | Angina Pectoris & Coronary Atherosclerosis | Cardiology | $ 28,124 |
| 199 | Hypertension | Cardiology | $ 30,154 |
| 200 | Cardiac Congenital & Valvular Disorders | Cardiology | $ 52,947 |
| 201 | Cardiac Arrhythmia & Conduction Disorders | Cardiology | $ 34,599 |
| 203 | Chest Pain | Cardiology | $ 22,080 |
| 204 | Syncope & Collapse | Cardiology | $ 29,600 |
| 205 | Cardiomyopathy | Cardiology | $ 41,254 |
| 206 | Malfunction, Reaction & Comp of Cardiac or Vasc Device or Proc | Cardiology | $ 87,144 |
| 207 | Other Circulatory System Diagnoses | Cardiology | $ 42,143 |
| 220 | Major Stomach, Esophageal & Duodenal Procedures | General Surgery | $ 163,225 |
| 221 | Major Small & Large Bowel Procedures | General Surgery | $ 116,977 |
| 222 | Minor Stomach, Esophageal & Duodenal Procedures | General Surgery | $ 57,032 |
| 223 | Minor Small & Large Bowel Procedures | General Surgery | $ 78,877 |
| 224 | Peritoneal Adhesiolysis | General Surgery | $ 94,260 |
| 225 | Appendectomy | General Surgery | $ 34,529 |
| 226 | Anal Procedures | General Surgery | $ 35,956 |
| 227 | Hernia Procedures Except Inguinal, Femoral & Umbilical | General Surgery | $ 64,313 |
| 228 | Inguinal, Femoral & Umbilical Hernia Procedures | General Surgery | $ 37,203 |
| 229 | Other Digestive System & Abdominal Procedures | General Surgery | $ 110,516 |
| 240 | Digestive Malignancy | Oncology | $ 102,121 |
| 241 | Peptic Ulcer & Gastritis | Gastroenterology | $ 41,372 |
| 242 | Major Esophageal Disorders | Gastroenterology | $ 64,131 |
| 243 | Other Esophageal Disorders | Gastroenterology | $ 32,738 |
| 244 | Diverticulitis & Diverticulosis | Gastroenterology | $ 31,814 |
| 245 | Inflammatory Bowel Disease | Gastroenterology | $ 53,340 |
| 246 | Gastrointestinal Vascular Insufficiency | Gastroenterology | $ 39,884 |
| 247 | Intestinal Obstruction | Gastroenterology | $ 33,982 |
| 248 | Major Gastrointestinal & Peritoneal Infections | Gastroenterology | $ 59,897 |
| 249 | Non-Bacterial Gastroenteritis, Nausea & Vomiting | Gastroenterology | $ 26,843 |
| 251 | Abdominal Pain | Gastroenterology | $ 27,901 |
| 252 | Malfunction, Reaction & Complication Of G.I. Device Or Procedure | Gastroenterology | $ 57,669 |
| 253 | Other & Unspecified Gastrointestinal Hemorrhage | Gastroenterology | $ 59,058 |
| 254 | Other Digestive System Diagnoses | Gastroenterology | $ 37,572 |
| 260 | Major Pancreas, Liver & Shunt Procedures | General Surgery | $ 205,330 |
| 261 | Major Biliary Tract Procedures | General Surgery | $ 142,908 |
| 262 | Cholecystectomy Except Laparoscopic | General Surgery | $ 98,994 |
| 263 | Laparoscopic Cholecystectomy | General Surgery | $ 49,433 |
| 264 | Other Hepatobiliary, Pancreas & Abdominal Procedures | General Surgery | $ 206,209 |
| 279 | Hepatic Coma & Other Major Acute Liver Disorders | Gastroenterology | $ 94,964 |
| 280 | Alcoholic Liver Disease | Gastroenterology | $ 85,010 |
| 281 | Malignancy of Hepatobiliary System & Pancreas | Oncology | $ 98,214 |
| 282 | Disorders of Pancreas Except Malignancy | Gastroenterology | $ 45,342 |
| 283 | Other Disorders Of The Liver | Gastroenterology | $ 65,697 |
| 284 | Disorders of the Gallbladder & Biliary Tract | Gastroenterology | $ 48,931 |
| 301 | Hip Joint Replacement | Orthopedic Surgery | $ 82,030 |
| 302 | Knee Joint Replacement | Orthopedic Surgery | $ 86,518 |
| 303 | Dorsal & Lumbar Fusion Proc for Curvature of Back | Orthopedic Surgery | $ 370,801 |
| 304 | Dorsal & Lumbar Fusion Proc Except for Curvature of Back | Orthopedic Surgery | $ 206,325 |
| 305 | Amputation of Lower Limb Except Toes | Orthopedic Surgery | $ 198,350 |
| 308 | Hip & Femur Procedures for Trauma Except Joint Replacement | Trauma | $ 99,741 |
| 309 | Hip & Femur Procedures for Non-Trauma Except Joint Replacement | Orthopedic Surgery | $ 105,657 |
| 310 | Intervertebral Disc Excision & Decompression | Orthopedic Surgery | $ 52,274 |
| 312 | Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses | Orthopedic Surgery | $ 231,334 |
| 313 | Knee & Lower Leg Procedures Except Foot | Orthopedic Surgery | $ 77,180 |
| 314 | Foot & Toe Procedures | Orthopedic Surgery | $ 83,817 |
| 315 | Shoulder, Upper Arm & Forearm Procedures | Orthopedic Surgery | $ 69,878 |
| 316 | Hand & Wrist Procedures | Orthopedic Surgery | $ 46,023 |
| 317 | Tendon, Muscle & Other Soft Tissue Procedures | Orthopedic Surgery | $ 62,272 |
| 320 | Other Musculoskeletel System & Connective Tissue Procedures | Orthopedic Surgery | $ 100,277 |
| 321 | Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp | Orthopedic Surgery | $ 97,061 |
| 340 | Fractures of Femur | Orthopedics | $ 41,583 |
| 341 | Fracture of Pelvis or Dislocation of Hip | Orthopedics | $ 47,833 |
| 342 | Fracture or Dislocation Except Femur, Pelvis & Back | Orthopedics | $ 36,684 |
| 343 | Musculoskeletal Malignancy & Pathol Fractures D/T Muscskel Malig | Oncology | $ 122,292 |
| 344 | Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections | Infectious Disease | $ 89,584 |
| 346 | Connective Tissue Disorders | Orthopedics | $ 79,195 |
| 347 | Other Back & Neck Disorders, Fractures & Injuries | Orthopedics | $ 38,790 |
| 349 | Malfunction, Reaction & Comp of Orthopedic Device or Procedure | Orthopedics | $ 63,897 |
| 351 | Other Musculoskeletal System & Connective Tissue Diagnoses | Rheumatology | $ 36,776 |
| 361 | Skin Graft for Skin & Subcutaneous Tissue Diagnoses | General Surgery | $ 109,910 |
| 362 | Mastectomy Procedures | General Surgery | $ 99,410 |
| 363 | Breast Procedures Except Mastectomy | General Surgery | $ 59,069 |
| 364 | Other Skin, Subcutaneous Tissue & Related Procedures | General Surgery | $ 58,328 |
| 380 | Skin Ulcers | Dermatology | $ 63,513 |
| 381 | Major Skin Disorders | Dermatology | $ 56,102 |
| 382 | Malignant Breast Disorders | Oncology | $ 107,015 |
| 383 | Cellulitis & Other Bacterial Skin Infections | Infectious Disease | $ 36,278 |
| 384 | Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue | Dermatology | $ 26,807 |
| 385 | Other Skin, Subcutaneous Tissue & Breast Disorders | Dermatology | $ 36,014 |
| 401 | Pituitary & Adrenal Procedures | General Surgery | $ 108,148 |
| 403 | Procedures for Obesity | General Surgery | $ 51,519 |
| 404 | Thyroid, Parathyroid & Thyroglossal Procedures | General Surgery | $ 33,563 |
| 405 | Other Procedures for Endocrine, Nutrititional & Metabolic Disorders | General Surgery | $ 194,744 |
| 420 | Diabetes | Endocrinology | $ 37,903 |
| 421 | Malnutrition, Failure To Thrive & Other Nutritional Disorders | Endocrinology | $ 74,381 |
| 422 | Hypovolemia & Related Electrolyte Disorders | Endocrinology | $ 33,447 |
| 423 | Inborn Errors of Metabolism | Endocrinology | $ 72,453 |
| 424 | Other Endocrine Disorders | Endocrinology | $ 47,343 |
| 425 | Electrolyte Disorders Except Hypovolemia Related | Endocrinology | $ 43,164 |
| 440 | Kidney Transplant | Transplant Surgery | $ 261,930 |
| 441 | Major Bladder Procedures | Urologic/Nephrologic Surgery | $ 164,618 |
| 442 | Kidney & Urinary Tract Procedures for Malignancy | Urologic/Nephrologic Surgery | $ 88,018 |
| 443 | Kidney & Urinary Tract Procedures for Nonmalignancy | Urologic/Nephrologic Surgery | $ 73,863 |
| 444 | Renal Dialysis Access Device Procedure Only | Urologic/Nephrologic Surgery | $ 176,421 |
| 445 | Other Bladder Procedures | Urologic/Nephrologic Surgery | $ 69,688 |
| 446 | Urethral & Transurethral Procedures | Urologic/Nephrologic Surgery | $ 35,407 |
| 447 | Other Kidney, Urinary Tract & Related Procedures | Urologic/Nephrologic Surgery | $ 158,525 |
| 460 | Renal Failure | Urology/Nephrology | $ 78,558 |
| 461 | Kidney & Urinary Tract Malignancy | Oncology | $ 84,352 |
| 462 | Nephritis & Nephrosis | Urology/Nephrology | $ 55,078 |
| 463 | Kidney & Urinary Tract Infections | Urology/Nephrology | $ 35,897 |
| 465 | Urinary Stones & Acquired Upper Urinary Tract Obstruction | Urology/Nephrology | $ 31,459 |
| 466 | Malfunction, Reaction & Complic of Genitourinary Device Or Proc | Urology/Nephrology | $ 77,013 |
| 468 | Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms | Urology/Nephrology | $ 46,894 |
| 480 | Major Male Pelvic Procedures | Urologic/Nephrologic Surgery | $ 45,891 |
| 481 | Penis Procedures | Urologic/Nephrologic Surgery | $ 84,231 |
| 482 | Transurethral Prostatectomy | Urologic/Nephrologic Surgery | $ 31,850 |
| 483 | Testes & Scrotal Procedures | Urologic/Nephrologic Surgery | $ 32,788 |
| 484 | Other Male Reproductive System & Related Procedures | Urologic/Nephrologic Surgery | $ 86,453 |
| 500 | Malignancy, Male Reproductive System | Oncology | $ 68,117 |
| 501 | Male Reproductive System Diagnoses Except Malignancy | Urology/Nephrology | $ 36,743 |
| 510 | Pelvic Evisceration, Radical Hysterectectomy & Radical GYN Procs | Gynecology Surgery | $ 83,425 |
| 511 | Uterine & Adnexa Procedures for Ovarian & Adnexal Malignancy | Gynecology Surgery | $ 88,080 |
| 512 | Uterine & Adnexa Procedures for Non-ovarian & Non-adnexal Malig | Gynecology Surgery | $ 60,148 |
| 513 | Uterine & Adnexa Procedures for Non-Malignancy Except Leiomyoma | Gynecology Surgery | $ 37,649 |
| 514 | Female Reproductive System Reconstructive Procedures | Gynecology Surgery | $ 38,123 |
| 517 | Dilation & Curettage For Non-Obstetric Procedures | Gynecology Surgery | $ 37,474 |
| 518 | Other Female Reproductive System & Related Procedures | Gynecology Surgery | $ 51,917 |
| 519 | Uterine & Adnexa Procedures For Leiomyoma | Gynecology Surgery | $ 40,773 |
| 530 | Female Reproductive System Malignancy | Oncology | $ 91,686 |
| 531 | Female Reproductive System Infections | Gynecology | $ 34,671 |
| 532 | Menstrual & Other Female Reproductive System Disorders | Gynecology | $ 28,093 |
| 540 | Cesarean Delivery | Obstetrics/Delivery | $ 33,589 |
| 541 | Vaginal Delivery w/ Sterilization &/or D&C | Obstetrics/Delivery | $ 29,808 |
| 542 | Vaginal Delivery w/ Complicating Procedures Exc Sterilization &/or D&C | Obstetrics/Delivery | $ 22,144 |
| 544 | D&C, Aspiration Curettage or Hysterotomy For Obstetric Diagnoses | Other Obstetrics | $ 24,969 |
| 545 | Ectopic Pregnancy Procedure | Gynecology Surgery | $ 35,249 |
| 546 | Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses | Other Obstetrics | $ 43,687 |
| 560 | Vaginal Delivery | Obstetrics/Delivery | $ 23,824 |
| 561 | Postpartum & Post Abortion Diagnoses w/o Procedure | Other Obstetrics | $ 25,051 |
| 563 | Threatened Abortion | Other Obstetrics | $ 22,597 |
| 564 | Abortion w/o D&C, Aspiration Curettage or Hysterotomy | Other Obstetrics | $ 24,659 |
| 565 | False Labor | Other Obstetrics | $ 11,707 |
| 566 | Other Antepartum Diagnoses | Other Obstetrics | $ 23,292 |
| 580 | Neonate, Transferred <5 Days Old, Not Born Here | Neonatology | $ 41,368 |
| 581 | Neonate, Transferred <5 Days Old, Born Here | Neonatology | $ 9,936 |
| 583 | Neonate, w/ ECMO | Neonatology | $ 1,180,832 |
| 588 | Neonate BWT <1500G W Major Procedure | Neonatology | $ 1,224,414 |
| 589 | Neonate BWT < 500G | Neonatology | $ 12,174 |
| 591 | Neonate, Birthwt 500-749G w/o Major Procedure | Neonatology | $ 1,574,916 |
| 593 | Neonate, Birthwt 750-999G w/o Major Procedure | Neonatology | $ 916,047 |
| 602 | Neonate, Birthwt 1000-1249G w/ Resp Dist Synd/Oth Maj Resp Or Maj Anom | Neonatology | $ 583,232 |
| 603 | Neonate, Birthwt 1000-1249G W OR W/O Other Significant Condition | Neonatology | $ 645,648 |
| 607 | Neonate, BWT 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom | Neonatology | $ 427,775 |
| 608 | Neonate, Birthwt 1250-1499G W OR W/O Other Significant Condition | Neonatology | $ 389,752 |
| 609 | Neonate, BWT 1500-2499G W Major Procedure | Neonatology | $ 684,469 |
| 611 | Neonate, Birthwt 1500-1999G W Major Anomaly | Neonatology | $ 343,623 |
| 612 | Neonate, BWT 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond | Neonatology | $ 312,264 |
| 613 | Neonate, Birthwt 1500-1999G W Congenital/Perinatal Infection | Neonatology | $ 274,822 |
| 614 | Neonate, Birthwt 1500-1999G W OR W/O Other Significant Condition | Neonatology | $ 183,749 |
| 621 | Neonate, BWT 2000-2499G W Major Anomaly | Neonatology | $ 234,748 |
| 622 | Neonate, BWT 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond | Neonatology | $ 163,080 |
| 623 | Neonate, Birthwt 2000-2499G W Congenital/Perinatal Infection | Neonatology | $ 131,252 |
| 625 | Neonate, Birthwt 2000-2499G W Other Significant Condition | Neonatology | $ 135,918 |
| 626 | Neonate, BWT 2000-2499G, Normal Newborn Or Neonate W Other Problem | Neonatology | $ 21,646 |
| 630 | Neonate, Birthwt > 2499g w/ Major Cardiovasc Procedure | Neonatology | $ 612,860 |
| 631 | Neonate, Birthwt > 2499g w/ Other Major Procedure | Neonatology | $ 514,239 |
| 633 | Neonate, Birthwt > 2499g w/ Major Anomaly | Neonatology | $ 53,480 |
| 634 | Neonate, Birthwt > 2499g W Resp Dist Synd/Oth Maj Resp Cond | Neonatology | $ 101,108 |
| 636 | Neonate, Birthwt > 2499g W Congenital/Perinatal Infection | Neonatology | $ 69,169 |
| 639 | Neonate, Birthwt > 2499g W Other Significant Condition | Neonatology | $ 48,346 |
| 640 | Neonate, Bwt > 2499g, Normal Newborn Or Neonate W Other Problem | Neonatology | $ 9,283 |
| 650 | Splenectomy | General Surgery | $ 102,025 |
| 651 | Other Procedures of Blood & Blood Forming Organs | General Surgery | $ 84,451 |
| 660 | Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul | Hematology | $ 89,240 |
| 661 | Coagulation & Platelet Disorders | Hematology | $ 87,697 |
| 662 | Sickle Cell Anemia Crisis | Hematology | $ 63,619 |
| 663 | Other Anemia & Disorders Of Blood & Blood Forming Organs | Hematology | $ 38,142 |
| 680 | Major O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | General Surgery | $ 243,767 |
| 681 | Other O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms | General Surgery | $ 138,656 |
| 690 | Acute Leukemia | Oncology | $ 581,517 |
| 691 | Lymphoma & Non-acute Leukemia | Oncology | $ 161,397 |
| 692 | Radiotherapy | Oncology | $ 59,818 |
| 693 | Chemotherapy | Oncology | $ 67,943 |
| 694 | Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior | Oncology | $ 103,523 |
| 710 | Infectious & Parasitic Diseases Including HIV W O.R. Procedure | General Surgery | $ 328,673 |
| 711 | Post-Op,Post-Trauma, Other Device Infections W O.R. Procedure | General Surgery | $ 151,193 |
| 720 | Septicemia & Disseminated Infections | Infectious Disease | $ 132,345 |
| 721 | Post-Operative, Post-Traumatic, Other Device Infections | General Medicine | $ 74,485 |
| 722 | Fever | General Medicine | $ 33,616 |
| 723 | Viral Illness | Infectious Disease | $ 30,011 |
| 724 | Other Infectious & Parasitic Diseases | Infectious Disease | $ 59,380 |
| 740 | Mental Illness Diagnosis W O.R. Procedure | General Surgery | $ 101,720 |
| 750 | Schizophrenia | Mental Health | $ 51,877 |
| 751 | Major Depressive Disorders & Other/Unspecified Psychoses | Mental Health | $ 41,373 |
| 752 | Disorders of Personality & Impulse Control | Mental Health | $ 44,782 |
| 753 | Bipolar Disorders | Mental Health | $ 33,891 |
| 754 | Depression Except Major Depressive Disorder | Mental Health | $ 24,771 |
| 755 | Adjustment Disorders & Neuroses Except Depressive Diagnoses | Mental Health | $ 33,263 |
| 756 | Acute Anxiety & Delirium States | Mental Health | $ 20,179 |
| 757 | Organic Mental Health Disturbances | Mental Health | $ 51,403 |
| 758 | Childhood Behavioral Disorders | Mental Health | $ 24,785 |
| 759 | Eating Disorders | Mental Health | $ 46,002 |
| 760 | Other Mental Health Disorders | Mental Health | $ 29,825 |
| 770 | Drug & Alcohol Abuse or Dependence, Left Against Medical Advice | Substance Abuse | $ 14,378 |
| 772 | Alcohol & Drug Dependence w/ Rehab/Detox Therapy | Substance Abuse | $ 43,354 |
| 773 | Opioid Abuse & Dependence | Substance Abuse | $ 9,049 |
| 774 | Cocaine Abuse & Dependence | Substance Abuse | $ 20,516 |
| 775 | Alcohol Abuse & Dependence | Substance Abuse | $ 29,584 |
| 776 | Other Drug Abuse & Dependence | Substance Abuse | $ 32,093 |
| 791 | O.R. Procedure For Other Complications Of Treatment | General Surgery | $ 100,279 |
| 811 | Allergic Reactions | General Medicine | $ 23,184 |
| 812 | Poisoning Of Medicinal Agents | General Medicine | $ 34,861 |
| 813 | Other Complications of Treatment | General Medicine | $ 46,483 |
| 815 | Other Injury, Poisoning & Toxic Effect Diagnoses | General Medicine | $ 32,573 |
| 816 | Toxic Effects Of Non-Medicinal Substances | General Medicine | $ 41,022 |
| 841 | Extensive 3rd Degree Burns W Skin Graft | General Surgery | $ 2,281,993 |
| 842 | Full Thickness Burns W Skin Graft | General Surgery | $ 499,241 |
| 843 | Extensive 3rd Degree Or Full Thickness Burns W/O Skin Graft | General Medicine | $ 148,308 |
| 844 | Partial Thickness Burns W Or W/O Skin Graft | General Medicine | $ 173,931 |
| 850 | Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service | General Surgery | $ 106,437 |
| 860 | Rehabilitation | Rehabilitation | $ 126,864 |
| 861 | Signs, Symptoms & Other Factors Influencing Health Status | General Medicine | $ 38,353 |
| 862 | Other Aftercare & Convalescence | General Medicine | $ 79,643 |
| 863 | Neonatal Aftercare | Neonatology | $ 125,270 |
| 890 | HIV W Multiple Major HIV Related Conditions | HIV | $ 265,552 |
| 892 | HIV W Major HIV Related Condition | HIV | $ 100,412 |
| 893 | HIV W Multiple Significant HIV Related Conditions | HIV | $ 76,959 |
| 894 | HIV W One Signif HIV Cond Or W/O Signif Related Cond | HIV | $ 50,245 |
| 910 | Craniotomy For Multiple Significant Trauma | Trauma | $ 514,259 |
| 911 | Extensive Abdominal/Thoraic Procedures For Mult Significant Trauma | Trauma | $ 448,296 |
| 912 | Musculoskeletal & Other Procedures For Multiple Significant Trauma | Trauma | $ 390,547 |
| 930 | Multiple Significant Trauma W/O O.R. Procedure | Trauma | $ 120,333 |
| 950 | Extensive Procedure Unrelated To Principal Diagnosis | General Surgery | $ 267,279 |
| 951 | Moderately Extensive Procedure Unrelated To Principal Diagnosis | General Surgery | $ 151,799 |
| 952 | Nonextensive Procedure Unrelated To Principal Diagnosis | General Surgery | $ 93,207 |
