Healthcare Insights
Top 10 DRGs by diagnosis volume
Diagnosis-related groups (DRGs) categorize patients and reflect Medicare fees and reimbursement for hospital stays. Patients are placed into a DRG category based on their primary diagnosis, procedures performed, and discharge status. DRGs ensure that Medicare reimbursements reflect a hospital’s case-mix complexity or the types and severity of patients they most often treat.
The Definitive Healthcare HospitalView product tracks Medicare inpatient procedures for more than 5,000 U.S. hospitals. DRGs are provided through the Medicare Standard Analytic Files (SAF). Complete calendar year data is typically released each fall for the preceding year. Below, we list the DRGs by total volume for 2024.
| Rank | DRG | DRG description | % of total DRG diagnoses | Explore dataset |
|---|---|---|---|---|
| 1 | 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC | 7.44% | Explore |
| 2 | 291 | HEART FAILURE & SHOCK W MCC | 4.05% | Explore |
| 3 | 885 | PSYCHOSES | 2.43% | Explore |
| 4 | 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | 1.91% | Explore |
| 5 | 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | 1.88% | Explore |
| 6 | 189 | PULMONARY EDEMA & RESPIRATORY FAILURE | 1.45% | Explore |
| 7 | 872 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC | 1.44% | Explore |
| 8 | 690 | KIDNEY & URINARY TRACT INFECTIONS W/O MCC | 1.37% | Explore |
| 9 | 392 | ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC | 1.27% | Explore |
| 10 | 57 | DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC | 1.21% | Explore |
Fig. 1. Data from Definitive Healthcare HospitalView product. Data access November 2025.
What are the most common DRGs?
The most common DRG code tracked in our database in 2024 was 871, which is used for septicemia or severe sepsis without mechanical ventilation for 96+ hours with major complications or comorbidities (MCC). It accounted for 7.4% of all DRG diagnoses in 2024.
This DRG typically applies to patients diagnosed with severe systemic infections or sepsis that require intensive medical care but do not involve extended mechanical ventilation. Major complications or comorbidities refer to additional serious conditions that can affect the patient’s care and increase the complexity of treatment. Sepsis remains one of the top infectious diseases tracked across hospitals.
Heart failure and shock with MCC ranked second, representing 4.1% of all diagnoses. This DRG applies to patients who are admitted for heart failure or shock and have major complications or comorbidities that make their treatment more complex. These may include severe infections, kidney failure, or other serious conditions that complicate care and recovery.
The third most common DRG was psychoses, which accounted for 2.4% of total diagnoses. This category includes patients admitted for acute psychiatric conditions that require inpatient stabilization and management.
Other frequently reported DRGs included respiratory infections and inflammations with MCC (1.9%), simple pneumonia and pleurisy with MCC (1.9%), and pulmonary edema and respiratory failure (1.5%), all of which reflect a continued prevalence of complex respiratory and systemic conditions requiring hospitalization.
How is a DRG calculated?
Each DRG is given a weighted value relative to the time and resources required to administer care for the average patient effectively. This value is multiplied by a preset dollar amount that reflects the hospital’s status (for example, teaching hospitals have higher reimbursements) and service area demographics (such as average local wage levels) to find the total reimbursement amount.
DRG assignment is based on:
- Principal diagnosis
- Secondary diagnoses
- Patient age and sex
- Discharge status
- Comorbidities and complications
What is an MS-DRG?
The Medicare Severity DRG (MS-DRG) system further differentiates each patient’s severity of illness and associated care costs. The original DRG case-mix system was limited to one or two levels of severity, while most MS-DRGs have three levels of severity. This allows hospitals to assess a patient’s needs more accurately without fear of hampering reimbursement.
MS-DRG severity categories include:
- Complication/comorbidity (CC)
- Major complication/comorbidity (MMC)
- Non-complication/comorbidity (Non-CC)
Learn more
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