Other Ear, Nose, Mouth and Throat O.R. Procedures DRG Reimbursement

Summary & Overview

Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

DRG 145 groups inpatient stays for other ear, nose, mouth and throat operating room procedures without Major Complication or Comorbidity or Complication or Comorbidity; it encompasses routine operative otolaryngology cases that do not carry significant comorbid burden. This grouping matters for inpatient reimbursement because it determines the bundled Medicare payment amount and impacts how hospitals are compensated for these surgical admissions.

Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCCDRG Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCCDRG 145Diagnosis-Related GroupInpatient ReimbursementMedicareOtolaryngologyENT surgeryOperating Room procedures

DRG 145 Overview

DRG 145 covers Other Ear, Nose, Mouth and Throat Operating Room Procedures without Major Complication or Comorbidity and without Complication or Comorbidity. It groups inpatient stays for a range of otolaryngology procedures that are not associated with significant comorbid conditions. This DRG is important for Medicare payment because it defines a bundled payment category that affects hospital reimbursement for routine operative ENT care. Accurate assignment influences inpatient prospective payment and hospital revenue capture.

National Payment Rates

Across commercial payers, negotiated rates for DRG 145 run from about $370 to $39K, with payer means reported between roughly $11K and $20K. The widest spread in observed rates spans from the lowest minimum ($370) to the highest maximum ($39K). See the payer table and the chart below for payer-specific percentiles and distributions. Values shown reflect the national payer benchmark dataset provided.

Mean Rates by Payer — National — DRG 145

The CMS 2023 data represent national Medicare fee-for-service inpatient payments as published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 145. Values reflect Medicare FFS activity at the national level for the year shown.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 145 reimbursement medians span from $19K to $29K across payers, with Blue Cross Blue Shield and Anthem at $19K and Cigna at $29K. The state range is relatively tight except for Cigna’s notably higher median, which stands out versus the lower cluster. Reference the table and chart below for payer-specific distribution details.

Key Insights for Alaska

Highest payer: Cigna (median $29K) is the highest-paying payer in Alaska; Lowest payer: BCBS and Anthem (both median $19K) are the lowest-paying payers.
Alaska’s payer range is narrow overall but Cigna’s $29K median noticeably exceeds the other payers and is higher than national medians for some major payers, representing a meaningful upward deviation from national averages.

Clinical Trials

Acute surgical technique and perioperative airway management trials: randomized or observational studies that evaluate variations in operative approach, anesthesia protocols, and immediate airway management for patients undergoing non-major ENT operations (e.g., complex tympanoplasty, endoscopic sinus procedures, or minor laryngeal surgery) without major comorbid complications. These studies focus on adult and pediatric inpatients presenting for same-day or short-stay O.R. procedures to determine impacts on intraoperative airway events, operative time, and short-term complication rates. Findings are relevant to providers for optimizing perioperative safety and to payers because reductions in perioperative adverse events and shorter lengths of stay directly affect hospital resource use and reimbursement under DRG payment models.
Comparative effectiveness studies of surgical vs. less invasive interventions for symptom control and functional outcomes: prospective cohort or pragmatic randomized studies comparing different procedural options (for example, traditional open approaches versus endoscopic or minimally invasive ENT procedures) in patients without major CC/MCC who require O.R.-level care for conditions such as chronic sinus disease, cholesteatoma, or obstructive sleep–related upper airway procedures. These studies assess outcomes such as symptom relief, need for reoperation, postoperative complications, and recovery time among typical DRG 145 patients, often stratified by age and baseline functional status. Results inform clinicians about best-value procedural choices and help payers and hospitals anticipate cost-effectiveness, readmission risk, and appropriate DRG assignment for resource planning.
Post-discharge outcomes and utilization research: observational and registry-based studies tracking readmissions, complication-related returns to care, long-term functional outcomes (hearing, smell, voice) and patient-reported quality-of-life measures after discharge in patients classified under this DRG. These studies target the early post-discharge period (30–90 days) and the first year after surgery to identify predictors of readmission, unplanned outpatient or ED visits, and sustained functional deficits in a population without major comorbidities but undergoing O.R. procedures. Such evidence is important to providers for tailoring discharge planning and follow-up, and to payers and case managers for designing bundled payments, post-acute care pathways, and interventions that reduce costly readmissions and improve value under DRG-based reimbursement.

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$13K	$67K	$9.9K	840