Diagnosis-related group (DRG)
Updated September 30, 2026
Definition
A category for a hospital inpatient stay, based mainly on your diagnoses and procedures. Medicare uses it to pay hospitals a set amount for each stay.
A diagnosis-related group (DRG) is a category for a hospital inpatient stay. Medicare uses DRGs to pay hospitals a set amount for each stay, and other plans may too. The group depends mainly on your main diagnosis, your other conditions, and the procedures you had.
Each DRG has a weight based on the average care that cases like yours need. The payment is the hospital's base rate times that weight. For example, if a hospital's base rate is $6,000 and the DRG weight is 1.5, the payment is $9,000. That amount usually doesn't go up with each extra test.
You may see a DRG on an itemized bill or an explanation of benefits (EOB) for a hospital stay. If it reflects a condition or procedure you didn't have, ask the hospital to review it. See how to get an itemized bill.
Related terms
Guides that use this term
- GuideHow to get an itemized hospital bill (script and letter)Your hospital bill shows only totals? Here's how to get an itemized bill, with a phone script, a short letter, your rights, and what to check first.
- Guide12 common medical billing errors and how to spot themDuplicate charges, wrong codes, missing insurance discounts, and more. Use this checklist of 12 common medical billing errors, then learn how to fix them.
Sources
- MS-DRG classifications and software, Centers for Medicare & Medicaid Services. Accessed September 30, 2026.
- Acute inpatient PPS, Centers for Medicare & Medicaid Services. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.