Updated April 2026
Hip and Femur Procedures Except Major Joint with MCC
DRG 480 · Orthopedic · 2,631 hospitals · 547,962 discharges
Hip and Femur Procedures Except Major Joint with MCC (DRG 480) averages $20,997 in total Medicare payment across 2,631 US hospitals, with a wide spread from $6,317 to $47,512 — about 8× cheapest to most expensive. The Medicare average for this DRG sits well above the all-procedure national mean of $15,878.
Hip and Femur Procedures Except Major Joint with MCC (DRG 480) is a Orthopedic procedure tracked in CMS Inpatient Payment files. Across the United States, 2,631 hospitals report payment data for 547,962 total discharges, with an average Medicare payment of $20,997 (median $20,343). The $6,317-to-$47,512 payment range is wide: the same DRG code can attract very different reimbursements across hospitals, reflecting differences in cost structure, patient complexity within the DRG, and regional pricing dynamics. The Medicare DRG system bundles cases by diagnosis-and-procedure groupings, so payment differences within a single DRG mostly track hospital-specific factors rather than case-mix.
Looking across all states, 2,631 hospitals report the procedure with 547,962 total documented discharges. State-by-state breakouts show wider variation than the national average suggests. For patients with elective scheduling on Hip and Femur Procedures Except Major Joint with MCC, the cost-comparison logic is straightforward: the per-procedure payment range is meaningfully wide, so the hospital chosen affects total cost. For patients in an emergency, the choice is functionally fixed — but the listed prices still matter for insurance-coverage and out-of-pocket planning.
What This DRG Covers
Musculoskeletal DRGs include hip and knee replacement, spine fusion, fracture repair, and major joint revision. Implant cost, length of stay, and rehab intensity drive most of the price variation across hospitals — DRGs 469/470 (joint replacement) are among the most-watched price benchmarks in Medicare.
Hip and Femur Procedures Except Major Joint with MCC is one of the highest-volume Medicare admissions in the country, with 547,962 reported discharges. High volume means CMS averages are statistically robust and small per-case differences add up to meaningful national spend.
Why Hospital Prices Vary
Across 2,631 hospitals, the price spread is 8× — among the widest in the Medicare dataset. Spread that large typically combines case-complexity differences with regional wage variation and outlier payments for unusually long stays.
Medicare standardizes payment using DRG weights, but the dollar figure each hospital actually receives is modulated by the regional wage index, indirect medical education adjustment for teaching hospitals, disproportionate share adjustment for safety-net facilities, and outlier payments for unusually long or complex stays. Two hospitals coding the exact same DRG can therefore report meaningfully different totals without anything “wrong” happening at either site.
For non-Medicare patients, the more relevant figure is the negotiated commercial rate or cash-pay rate — disclosed in machine-readable form under the CMS Hospital Price Transparency Rule. Many hospital systems also publish patient-friendly cost-estimation tools that combine plan-specific deductibles with the negotiated rate.
Quality Matters Alongside Price
Picking a hospital based on the lowest published price for a single DRG is rarely a complete decision. The CMS Hospital Compare (Care Compare) program publishes risk-adjusted measures of mortality, readmission, complication, infection, and patient experience for every Medicare-participating hospital. For surgical DRGs in particular, the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators flag complications that an aggregate star rating may not surface on its own.
Volume is another signal worth weighing. For complex procedures (cardiac surgery, joint replacement, major oncology), hospital-level case volume correlates with outcomes in published research, even after risk adjustment. CMS publishes case counts on Care Compare alongside outcome measures.
Lowest-Cost Reporting Hospitals
Lowest reported Medicare totals for this DRG. Pricing is informational and should be considered alongside CMS quality measures.
Highest-Cost Reporting Hospitals
Highest reported Medicare totals. High totals frequently reflect academic referral centers and complex case mix.
Frequently Asked Questions
How much does hip and femur procedures except major joint with mcc cost on Medicare?
Hip and Femur Procedures Except Major Joint with MCC (DRG 480) averages $20,997 in total Medicare payment across 2,631 US hospitals reporting this code. The 25th-percentile facility reports $16,950, the median is $20,343, and the 75th percentile is $24,078.
Why does this procedure cost so much more at one hospital than another?
The spread for Hip and Femur Procedures Except Major Joint with MCC runs from $6,317 to $47,512 — about 8× cheapest to most expensive. Variation comes from regional Medicare wage indexes, hospital case mix, teaching status, length-of-stay differences, and outlier-payment adjustments. The CMS Hospital Price Transparency Rule publishes machine-readable rate files that allow direct comparisons against negotiated rates.
Are these the prices a privately insured patient would pay?
No. Figures on this page are Medicare DRG payments — what CMS pays the hospital for treating a Medicare beneficiary. Privately insured patients are billed under their plan's negotiated network rate, which is published in each hospital's price-transparency file. For an uninsured patient, the relevant figure is the cash-pay rate, also disclosed under federal price-transparency rules.
What does the DRG code mean?
DRG 480 (Hip and Femur Procedures Except Major Joint with MCC) is a Medicare Diagnosis Related Group — the unit CMS uses to bundle similar admissions for payment. Each DRG has a fixed weight that, multiplied by the hospital's base rate, produces the standardized payment. Around 750 DRGs cover the full range of inpatient admissions; this code falls in the Orthopedic category.
Should I pick a hospital just because it has the lowest price?
No. Cost is one input — quality of care, surgeon experience, facility volume, and your specific clinical situation matter at least as much. The CMS Care Compare site publishes risk-adjusted mortality, readmission, complication, and patient-experience measures for every Medicare-participating hospital. Always discuss options with your physician before any planned admission.
See the methodology page for DRG sourcing, payment-system context, and known limitations of Medicare-only data.
Sources & Citations
- CMS Medicare Inpatient Hospital Payments (IPPS). DRG-level average covered charges, total payments, and Medicare payments per facility. data.cms.gov
- CMS Hospital Compare (Care Compare). Star ratings, mortality, readmission, safety-of-care, and patient-experience measures. medicare.gov/care-compare
- CMS Hospital Price Transparency Rule. Standard charge files required from every Medicare-participating hospital. cms.gov/hospital-price-transparency
- Agency for Healthcare Research and Quality (AHRQ). National benchmarks, quality indicators, and clinical context for hospital outcome measures. ahrq.gov
Dataset last refreshed: April 2026. Underlying CMS files are public domain. Suggested citation: “HospitalCostData, hospitalcostdata.com, accessed May 24, 2026.”
This page is informational only and does not constitute medical, legal, or financial advice. Care decisions should be made with a licensed physician.
Source: CMS Hospital Price Transparency, 2026.