Questions & corrections

Banner University Med Center South · MS-DRG 42.00: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

$21,581.29

Source file dated 2026-10-13 · inpatient

Source note: If Eligible Billed Charges for inpatient covered services exceed the stop loss threshold limit, then the inpatient days prior to, including the date on which threshold is reached, will be reimbursed at the set per diem rate. Delays in discharge solely due to unavailability of PABHS, or delay in Company response to requests from Hospital for PABHS, are paid at an additional per diem rate. Company may determine that the Inpatient level of care provided for a given service was not Medically Necessary. If Banner Health agrees to accept Company’s level of care determination, Banner Health may resubmit the claim with Observation bill type for payment of Covered Services in accordance with the Observation Case Rate for non-rehab stays. For rehab stays, a case rate will be paid.