Intraocular Procedures without CC/MCC: Inpatient Reimbursement Overview

DRG 117 encompasses inpatient intraocular procedures performed without a Complication or Comorbidity or Major Complication or Comorbidity, representing lower-complexity eye operations relevant to hospital reimbursement. This classification matters because it determines the Medicare payment tier for these procedures and influences hospital coding, billing, and resource allocation.

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DRG 117 Overview

DRG 117 covers inpatient admissions for intraocular surgical procedures without a Complication or Comorbidity or Major Complication or Comorbidity. It typically includes straightforward cataract and other intraocular operations where complexity is low and no significant coexisting conditions are reported. This Diagnosis-Related Group matters for Medicare payment because it categorizes lower-resource ocular procedures into a payment tier that affects hospital reimbursement and resource planning. Understanding the clinical scope helps hospitals align coding and billing with expected payment levels.

National Payment Rates

Across commercial payers the observed rate range spans roughly from $370 up to $37K, with Anthem showing the highest maximum and BCBS the lowest minimum in the table below. The widest spread between payer minimums and maximums is therefore about $37K. See the payer table and accompanying chart below for the full distribution by payer and quartiles.

The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($12.3k), average submitted covered charges ($62.2k), average Medicare payment amount ($9.4k), and total discharges (113).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$12K	$62K	$9.4K	110

Patient Population

This DRG’s population includes both Medicare-age and working-age patients, reflecting a mixed payer mix rather than exclusively Medicare. Because the DRG appears in Medicare inpatient data but also has substantial commercial benchmarks, the patient population skews toward a combination of Medicare-age and non-Medicare (working-age) adults. Expect representation from both payer groups rather than a solely Medicare-age cohort.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In AK the DRG 117 mean payment range spans from $17K (Anthem and Blue Cross Blue Shield) up to $26K (Cigna), a relatively narrow state spread. Cigna stands out as the primary high outlier versus the other AK payers. This distribution deviates from national patterns where median values sit closer together; see the table and chart below for details.

Key Insights for Alaska

Highest payer: Cigna (mean $26K) — notably higher than other state payers in AK.
Lowest payers: Anthem and Blue Cross Blue Shield (mean $17K) — both at the bottom of the state range.
State mean spread ($17K–$26K) shows Cigna outlier above national median ranges, while Anthem/BCBS sit below typical national medians.

Clinical Trials

Acute perioperative intervention trials: studies assessing intraoperative techniques, anesthetic approaches, or immediate perioperative adjuncts (for example, different methods of controlling intraocular inflammation, incision closure techniques, or intraoperative antibiotic delivery) in adults undergoing intraocular procedures without major complications. These trials enroll patients at the time of surgery to evaluate short-term safety, procedural success, and reductions in early complications such as endophthalmitis, anterior chamber inflammation, or hemorrhage. Results are directly relevant to providers and payers by identifying practices that reduce length of stay, readmissions, and short-term resource utilization in this DRG cohort.
Comparative effectiveness studies of procedural approaches and devices: randomized or pragmatic trials comparing alternative intraocular procedure techniques or commonly used surgical devices (for example, different lens implantation strategies, minimally invasive instrumentation, or adjunctive viscoelastics) in patients undergoing elective intraocular surgery without complicating comorbidities. These studies focus on functional outcomes (visual acuity, refractive accuracy), complication rates, and need for additional procedures over weeks to months, addressing which standard approaches deliver the best value. Payers and hospital systems use this evidence to guide formularies, device purchasing, and bundled payment models by favoring approaches that improve outcomes while controlling costs for this DRG group.
Post-discharge outcomes and quality-of-life studies: observational cohorts or registry-based research tracking recovery trajectories, patient-reported outcomes, and late complications (such as posterior capsule opacification or secondary interventions) after uncomplicated intraocular procedures. These studies typically follow patients from discharge through months or years to capture downstream utilization (clinic visits, laser capsulotomy, secondary surgeries) and patient satisfaction, helping quantify long-term costs and benefits. Insights inform discharge planning, follow-up scheduling, and risk stratification policies used by clinicians and payers to optimize care pathways and reimbursement strategies for patients coded to this DRG.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

115-EXTRAOCULAR-PROCEDURES-EXCEPT-ORBIT

Extraocular Procedures Except Orbit: Inpatient Reimbursement Overview

116-INTRAOCULAR-PROCEDURES-WITH-CC-MCC

Intraocular Procedures with CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

124-OTHER-DISORDERS-OF-THE-EYE-WITH-MCC-OR-THROMBOLYTIC-AGENT

Other Disorders of the Eye with MCC or Thrombolytic Agent: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

References

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.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.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 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.

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National Payment Rates

Mean Rates by Payer — National — DRG 117

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$12K	$62K	$9.4K	110

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 117

Key Insights for Alaska

Highest payer: Cigna (mean $26K) — notably higher than other state payers in AK.
Lowest payers: Anthem and Blue Cross Blue Shield (mean $17K) — both at the bottom of the state range.
State mean spread ($17K–$26K) shows Cigna outlier above national median ranges, while Anthem/BCBS sit below typical national medians.

Clinical Trials

Acute perioperative intervention trials: studies assessing intraoperative techniques, anesthetic approaches, or immediate perioperative adjuncts (for example, different methods of controlling intraocular inflammation, incision closure techniques, or intraoperative antibiotic delivery) in adults undergoing intraocular procedures without major complications. These trials enroll patients at the time of surgery to evaluate short-term safety, procedural success, and reductions in early complications such as endophthalmitis, anterior chamber inflammation, or hemorrhage. Results are directly relevant to providers and payers by identifying practices that reduce length of stay, readmissions, and short-term resource utilization in this DRG cohort.
Comparative effectiveness studies of procedural approaches and devices: randomized or pragmatic trials comparing alternative intraocular procedure techniques or commonly used surgical devices (for example, different lens implantation strategies, minimally invasive instrumentation, or adjunctive viscoelastics) in patients undergoing elective intraocular surgery without complicating comorbidities. These studies focus on functional outcomes (visual acuity, refractive accuracy), complication rates, and need for additional procedures over weeks to months, addressing which standard approaches deliver the best value. Payers and hospital systems use this evidence to guide formularies, device purchasing, and bundled payment models by favoring approaches that improve outcomes while controlling costs for this DRG group.
Post-discharge outcomes and quality-of-life studies: observational cohorts or registry-based research tracking recovery trajectories, patient-reported outcomes, and late complications (such as posterior capsule opacification or secondary interventions) after uncomplicated intraocular procedures. These studies typically follow patients from discharge through months or years to capture downstream utilization (clinic visits, laser capsulotomy, secondary surgeries) and patient satisfaction, helping quantify long-term costs and benefits. Insights inform discharge planning, follow-up scheduling, and risk stratification policies used by clinicians and payers to optimize care pathways and reimbursement strategies for patients coded to this DRG.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

115-EXTRAOCULAR-PROCEDURES-EXCEPT-ORBIT

Extraocular Procedures Except Orbit: Inpatient Reimbursement Overview

116-INTRAOCULAR-PROCEDURES-WITH-CC-MCC

Intraocular Procedures with CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

124-OTHER-DISORDERS-OF-THE-EYE-WITH-MCC-OR-THROMBOLYTIC-AGENT

Other Disorders of the Eye with MCC or Thrombolytic Agent: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.