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    v1.0.28
    OpenPayerBilling CodesPre-MDCDRG 003-ecmo-or-tracheostomy-with-mv-96-hours-or-principal-diagnosis-except-face-mouth-and-neck-with-major-o-r-procedures
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    ECMO or Tracheostomy with MV >96 Hours: Inpatient Reimbursement Overview

    DRG 003 encompasses extracorporeal membrane oxygenation or tracheostomy with mechanical ventilation greater than 96 hours, or principal diagnoses (except face, mouth, and neck) with major operating room procedures, and represents high-acuity inpatient care. This Diagnosis-Related Group is important for inpatient reimbursement because it captures cases with significant resource intensity that influence Medicare Severity Diagnosis-Related Group payment levels.

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    DRG 003 Overview

    DRG 003 covers hospitalizations involving extracorporeal membrane oxygenation or tracheostomy with mechanical ventilation beyond 96 hours, or admissions with a principal diagnosis outside the face, mouth, and neck that include major operating room procedures. This Diagnosis-Related Group groups high-acuity surgical and respiratory support cases with substantial resource use. It matters for Medicare payment because it identifies cases with intensive care, prolonged ventilation, and major procedures that drive higher Medicare Severity Diagnosis-Related Group payments. Accurate clinical coding and documentation determine assignment to this Diagnosis-Related Group and therefore affect inpatient reimbursement.

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    National Payment Rates

    Across payers the documented rate range spans from about $370 up to $690K, with the widest spread of roughly $689.6K observed between the lowest and highest reported values; see the table and chart below for payer-level detail. Payer benchmarks include Cigna, Blue Cross Blue Shield, Anthem, and Aetna, with mean values clustering between approximately $170K and $350K. These benchmarks illustrate substantial variation in allowed or negotiated rates across commercial payers.

    The CMS 2023 figures represent national Medicare fee-for-service inpatient payments reported in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($212.3k), average submitted covered charges ($988.2k), average Medicare payment amount ($183.9k), and total discharges (10.4k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $210K$990K$180K10K

    Patient Population

    The DRG 003 population generally includes a mix of Medicare-age and working-age patients, with a notable portion of cases falling into the Medicare population given the complexity and resource intensity associated with services captured in this DRG. As a result, payer mix often reflects both Medicare fee-for-service and commercial/private coverage rather than being exclusively one or the other. Age distribution typically skews toward older adults but includes a meaningful share of non-Medicare working-age beneficiaries.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s reported mean payments for DRG 003 range from $330K to $510K across the three payers in the state data. Blue Cross Blue Shield and Anthem are both at $330K, while Cigna stands out at $510K, representing the most notable deviation from the state cluster. This Cigna mean is also higher than many national median benchmarks. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Anthem is the highest paying payer in Alaska at a mean of $330K, while BCBS and Anthem share identical reported means; Cigna shows a higher mean at $510K, making Cigna the true highest payer and Anthem/Blue Cross Blue Shield the lowest at $330K.
    • Alaska’s payer means cluster tightly at $330K for Anthem and BCBS, but Cigna deviates meaningfully above the state cluster at $510K, which is notably higher than typical national medians for comparable payers.

    Clinical Trials

    • Acute organ-support intervention trials: studies assessing new techniques or protocols for extracorporeal membrane oxygenation (ECMO) initiation, cannulation strategies, anticoagulation regimens, or ventilator management bundles in patients requiring ECMO or prolonged mechanical ventilation (>96 hours), including patients with severe respiratory failure, cardiogenic shock, or perioperative needs after major thoracic or cardiac surgery. These trials focus on short-term physiologic endpoints (survival to decannulation or ventilator liberation, bleeding/thrombotic complications, ICU length of stay) and are highly relevant to clinicians managing complex critical care pathways and to payers because changes in complication rates and ICU days materially affect resource utilization and reimbursement under high-cost DRGs.
    • Comparative effectiveness studies of tracheostomy timing and technique: prospective cohort or randomized studies comparing early versus late tracheostomy, percutaneous versus surgical approaches, and standardized weaning protocols in patients anticipated to require >96 hours of mechanical ventilation or who undergo airway procedures during major operations. These studies evaluate outcomes such as time to liberation from ventilation, incidence of ventilator-associated pneumonia, long-term functional status, and hospital readmissions; they inform best practices for procedural choice and timing that can reduce complications, shorten lengths of stay, and guide payer policies around bundle payments and care pathways.
    • Post-discharge recovery and long-term outcomes research: longitudinal observational studies and pragmatic trials following survivors of ECMO, prolonged MV, or tracheostomy to assess physical, cognitive, and respiratory recovery, rates of rehospitalization, need for home mechanical ventilation or outpatient therapies, and cost trajectories over 6–24 months. This research addresses rehabilitation needs, discharge planning, and durable resource use—critical for providers designing post-ICU care pathways and for payers estimating long-term costs and evaluating value of early interventions that may reduce downstream utilization.

    Related Codes

    001-HEART-TRANSPLANT-OR-IMPLANT-OF-HEART-ASSIST-SYSTEM-WITH-MCC

    Heart Transplant or Implant of Heart Assist System with MCC: Inpatient Reimbursement Overview

    002-HEART-TRANSPLANT-OR-IMPLANT-OF-HEART-ASSIST-SYSTEM-WITHOUT-MCC

    Heart Transplant or Implant of Heart Assist System without MCC: Inpatient Reimbursement Overview

    004-TRACHEOSTOMY-WITH-MV-96-HOURS-OR-PRINCIPAL-DIAGNOSIS-EXCEPT-FACE-MOUTH-AND-NECK-WITHOUT-MAJOR-O-R-PROCEDURES

    Tracheostomy with Mechanical Ventilation >96 Hours: Inpatient Reimbursement Overview

    005-LIVER-TRANSPLANT-WITH-MCC-OR-INTESTINAL-TRANSPLANT

    Liver Transplant with MCC or Intestinal Transplant: Inpatient Reimbursement Overview

    006-LIVER-TRANSPLANT-WITHOUT-MCC

    Liver Transplant without Major Complication or Comorbidity: Inpatient Reimbursement Overview

    007-LUNG-TRANSPLANT

    Lung Transplant: Inpatient Reimbursement Overview

    008-SIMULTANEOUS-PANCREAS-AND-KIDNEY-TRANSPLANT

    Simultaneous Pancreas and Kidney Transplant: Inpatient Reimbursement Overview

    010-PANCREAS-TRANSPLANT

    Pancreas Transplant: Inpatient Reimbursement Overview

    011-TRACHEOSTOMY-FOR-FACE-MOUTH-AND-NECK-DIAGNOSES-OR-LARYNGECTOMY-WITH-MCC

    Tracheostomy/Laryngectomy with MCC: Inpatient Reimbursement Overview

    012-TRACHEOSTOMY-FOR-FACE-MOUTH-AND-NECK-DIAGNOSES-OR-LARYNGECTOMY-WITH-CC

    Tracheostomy and Laryngectomy with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 16

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Mean Rates by Payer — National — DRG 003
    Mean Rates by Payer — Alaska — DRG 003