DRG 194

Medical DRG

Simple Pneumonia and Pleurisy with CC

TypeMedicalMDC04Dx Codes34

What is MS-DRG 194?

MS-DRG 194 is a Medical Medicare Severity Diagnosis Related Group under Major Diagnostic Category 04 (MDC 04) with a Complication or Comorbidity (CC). It maps to 34 ICD-10-CM diagnosis codes. For FY 2026 it carries a relative weight of 0.8059 with a geometric mean length of stay of 2.8 days and an arithmetic mean of 3.4 days. Hospitals use this grouping to determine reimbursement for inpatient stays under Medicare.

Classification

Medical DRG

Diagnosis-driven grouping

MDC

Major Diagnostic Category 04

Linked Codes

34 diagnosis

Billable Dx

100%

34 of 34 shown

FY 2026 Payment Data

Official values from Table 5 of the FY 2026 IPPS Final Rule (CMS).

Relative Weight

0.8059

Payment multiplier vs. average case (1.0)

Geometric Mean LOS

2.8 days

Used for transfer payment calculations

Arithmetic Mean LOS

3.4 days

Average length of stay

Post-Acute Transfer

Yes

Subject to the post-acute care transfer policy

Related MS-DRGs in This Severity Group

The same clinical condition is split into separate DRGs by complication severity. MCC pays more than CC, which pays more than no CC/MCC.

DRG	Title	Rel. Weight	GMLOS
193	Simple Pneumonia and Pleurisy with MCC	1.3144	3.9 days
194	Simple Pneumonia and Pleurisy with CCThis page	0.8059	2.8 days
195	Simple Pneumonia and Pleurisy without CC/MCC	0.6285	2.2 days

Linked ICD-10-CM Diagnosis Mappings

B33.0
Epidemic myalgia
BillableChapter 1
J09.X1
Influenza due to identified novel influenza A virus with pneumonia
BillableChapter 10
J09.X2
Influenza due to identified novel influenza A virus with other respiratory manifestations
BillableChapter 10
J10.00
Influenza due to other identified influenza virus with unspecified type of pneumonia
BillableChapter 10
J10.01
Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia
BillableChapter 10
J10.08
Influenza due to other identified influenza virus with other specified pneumonia
BillableChapter 10
J10.1
Influenza due to other identified influenza virus with other respiratory manifestations
BillableChapter 10
J11.00
Influenza due to unidentified influenza virus with unspecified type of pneumonia
BillableChapter 10
J11.08
Influenza due to unidentified influenza virus with specified pneumonia
BillableChapter 10
J12.0
Adenoviral pneumonia
BillableChapter 10
J12.1
Respiratory syncytial virus pneumonia
BillableChapter 10
J12.2
Parainfluenza virus pneumonia
BillableChapter 10
J12.3
Human metapneumovirus pneumonia
BillableChapter 10
J12.81
Pneumonia due to SARS-associated coronavirus
BillableChapter 10
J12.82
Pneumonia due to coronavirus disease 2019
BillableChapter 10
J12.89
Other viral pneumonia
BillableChapter 10
J12.9
Viral pneumonia, unspecified
BillableChapter 10
J13
Pneumonia due to Streptococcus pneumoniae
BillableChapter 10
J14
Pneumonia due to Hemophilus influenzae
BillableChapter 10
J15.3
Pneumonia due to streptococcus, group B
BillableChapter 10
J15.4
Pneumonia due to other streptococci
BillableChapter 10
J15.7
Pneumonia due to Mycoplasma pneumoniae
BillableChapter 10
J15.9
Unspecified bacterial pneumonia
BillableChapter 10
J16.0
Chlamydial pneumonia
BillableChapter 10
J16.8
Pneumonia due to other specified infectious organisms
BillableChapter 10
J18.0
Bronchopneumonia, unspecified organism
BillableChapter 10
J18.1
Lobar pneumonia, unspecified organism
BillableChapter 10
J18.8
Other pneumonia, unspecified organism
BillableChapter 10
J18.9
Pneumonia, unspecified organism
BillableChapter 10
J92.0
Pleural plaque with presence of asbestos
BillableChapter 10
J92.9
Pleural plaque without asbestos
BillableChapter 10
J94.1
Fibrothorax
BillableChapter 10
J94.9
Pleural condition, unspecified
BillableChapter 10
R09.1
Pleurisy
BillableChapter 18