Summary & Overview

Concomitant Aortic and Mitral Valve Procedures: Inpatient Reimbursement Overview

DRG 212 encompasses inpatient stays for concomitant aortic and mitral valve procedures, reflecting the combined operative and perioperative complexity of treating both valves during a single hospitalization. Accurate DRG assignment matters for inpatient reimbursement because payment rates are set to account for higher resource use, length of stay, and potential complications associated with dual-valve cardiac surgery.

Concomitant Aortic and Mitral Valve ProceduresDRG Concomitant Aortic and Mitral Valve ProceduresDRG 212Diagnosis-Related GroupInpatient ReimbursementMedicareCardiac SurgeryCardiothoracic SurgeryValve ReplacementValve Repair

DRG 212 Overview

DRG 212 covers hospital admissions for patients undergoing concomitant aortic and mitral valve procedures, including surgical repair or replacement of both valves during the same operative session. This Diagnosis-Related Group captures high-resource cardiovascular surgical care with increased complexity, operative time, and perioperative risk compared with single-valve procedures. It matters for Medicare payment because bundled inpatient reimbursement is calibrated to reflect the combined surgical intensity and expected resource use associated with dual-valve interventions.

National Payment Rates

Across commercial payers the observed rate range spans from about $4.1K up to $310K, with the widest spread seen between Cigna and Anthem. Refer to the table and chart below for payer-specific distributions and percentiles. Payer-level medians and quartiles highlight substantial variability between Blue Cross Blue Shield, Cigna, Aetna, and Anthem.

Mean Rates by Payer — National — DRG 212

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, average submitted covered charges, average Medicare payment, and total discharges as reported for DRG . The values reflect national-level payment and charge averages for Medicare FFS beneficiaries in 2023.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska shows a payer rate range from $170K to $260K across payers, with Cigna at the top end and Blue Cross Blue Shield and Anthem at the lower end. The state’s Cigna mean of $260K notably exceeds national Cigna averages, representing the most significant deviation from national benchmarks. See the table and chart below for payer-level detail.

Key Insights for Alaska

Cigna is the highest paying payer in Alaska with a mean of $260K, while Blue Cross Blue Shield and Anthem both report lower, identical means of $170K.
Alaska’s mean rates skew higher than national means for some payers (Cigna at $260K versus national Cigna mean $180K), indicating a meaningful upside versus national benchmarks; however BCBS/Anthem in-state means at $170K are near or above several national payer medians, highlighting payer-level variation within the state.

Clinical Trials

Perioperative outcomes and complication mitigation trials focusing on surgical techniques and intraoperative management during concomitant aortic and mitral valve procedures. These studies enroll adult cardiac surgery patients undergoing combined aortic and mitral valve repair or replacement to compare strategies such as myocardial protection protocols, cardiopulmonary bypass times, or minimally invasive versus conventional sternotomy approaches. Understanding which intraoperative practices reduce bleeding, stroke, renal injury, and operative mortality is directly relevant to surgeons and hospital payers because these factors drive length of stay, intensive care utilization, and high-cost adverse events in this high-acuity DRG.
Comparative effectiveness studies evaluating valve selection and repair versus replacement strategies in patients with coexisting aortic and mitral valve disease. These trials or registry analyses examine different prosthesis types (mechanical versus bioprosthetic where universally recognized), valve repair techniques, and combined procedure sequencing in cohorts stratified by age, frailty, left ventricular function, and comorbidity burden. Results inform long-term reoperation risk, anticoagulation needs, readmission rates, and durable functional outcomes—key inputs for clinicians and payers when assessing expected downstream costs and resource allocation for this complex patient group.
Post-discharge outcomes and care-transition research assessing rehabilitation, anticoagulation management, and readmission reduction in survivors of concomitant valve surgery. These prospective observational studies or pragmatic trials follow patients after hospital discharge to study multidisciplinary care pathways, adherence to anticoagulation or guideline-directed medical therapy, and remote monitoring to detect complications such as prosthetic valve dysfunction or heart failure. Evidence from this area is important to providers and payers because improved post-acute care can lower 30- and 90-day readmissions, reduce emergency utilization, and optimize both clinical recovery and total cost of care for patients in DRG 212.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$120K	$540K	$100K	230

Perioperative outcomes and complication mitigation trials focusing on surgical techniques and intraoperative management during concomitant aortic and mitral valve procedures. These studies enroll adult cardiac surgery patients undergoing combined aortic and mitral valve repair or replacement to compare strategies such as myocardial protection protocols, cardiopulmonary bypass times, or minimally invasive versus conventional sternotomy approaches. Understanding which intraoperative practices reduce bleeding, stroke, renal injury, and operative mortality is directly relevant to surgeons and hospital payers because these factors drive length of stay, intensive care utilization, and high-cost adverse events in this high-acuity DRG.
Comparative effectiveness studies evaluating valve selection and repair versus replacement strategies in patients with coexisting aortic and mitral valve disease. These trials or registry analyses examine different prosthesis types (mechanical versus bioprosthetic where universally recognized), valve repair techniques, and combined procedure sequencing in cohorts stratified by age, frailty, left ventricular function, and comorbidity burden. Results inform long-term reoperation risk, anticoagulation needs, readmission rates, and durable functional outcomes—key inputs for clinicians and payers when assessing expected downstream costs and resource allocation for this complex patient group.
Post-discharge outcomes and care-transition research assessing rehabilitation, anticoagulation management, and readmission reduction in survivors of concomitant valve surgery. These prospective observational studies or pragmatic trials follow patients after hospital discharge to study multidisciplinary care pathways, adherence to anticoagulation or guideline-directed medical therapy, and remote monitoring to detect complications such as prosthetic valve dysfunction or heart failure. Evidence from this area is important to providers and payers because improved post-acute care can lower 30- and 90-day readmissions, reduce emergency utilization, and optimize both clinical recovery and total cost of care for patients in DRG 212.

OpenPayer

Summary & Overview

Concomitant Aortic and Mitral Valve Procedures: Inpatient Reimbursement Overview

DRG 212 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes