Other Heart Assist System Implant DRG Reimbursement Guide

Summary & Overview

Other Heart Assist System Implant: Inpatient Reimbursement Overview

DRG 215 encompasses implantations of other heart assist systems and related inpatient services, defining the clinical scope for these high-acuity cardiovascular device procedures. It matters for inpatient reimbursement because it groups the substantial surgical, critical care, and device-related costs into a single Diagnosis-Related Group payment that varies with documented complications or comorbidities.

Other Heart Assist System ImplantDRG Other Heart Assist System ImplantDRG 215Diagnosis-Related GroupInpatient ReimbursementMedicareCardiac SurgeryVentricular Assist DeviceCardiologyCardiothoracic Surgery

DRG 215 Overview

DRG 215 covers hospital admissions for implantations of other heart assist systems, including devices such as ventricular assist devices and similar circulatory support implants when not classified elsewhere. These procedures are high-cost, resource-intensive surgical interventions often requiring critical care and specialized device management. This Diagnosis-Related Group is important for Medicare payment because it groups episode cost and resource use into a single inpatient payment pathway tied to the procedure and any associated complications. Accurate coding and capture of complications or comorbidities affect the assigned payment level under Medicare inpatient prospective payment.

National Payment Rates

Across payers, negotiated rates for DRG 215 span from about $370 to $430K, with mean benchmarks ranging roughly from $99K to $160K depending on payer. The widest spread between minimum and maximum observed values is $430K (Anthem). See the table and chart below for payer-specific distributions and quartiles.

Mean Rates by Payer — National — DRG 215

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 displays average total payment ($95.3k), average submitted covered charges ($464.1k), average Medicare payment amount ($83.2k), and total discharges (3.9k). These figures summarize payments and billed charges for Medicare beneficiaries nationally.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska rates for DRG 215 span from $150K to $240K across the listed payers, with Anthem and Blue Cross Blue Shield both at $150K and Cigna at $240K. The most notable deviation from national averages is Cigna’s substantially higher mean of $240K relative to typical national medians around $150K. See the table and chart below for the payer-level breakdown.

Key Insights for Alaska

Anthem is the highest paying payer in Alaska at $150K; BCBS matches Anthem at $150K, while Cigna is higher at $240K, making Cigna the highest payer overall and Anthem/BCBS the lowest among the listed payers.
The state shows a narrow cluster at $150K for Anthem and BCBS versus a notably higher Cigna mean of $240K, which is meaningfully above national median ranges and indicates a significant upward deviation from national payer medians.

Clinical Trials

Acute device implantation and perioperative management studies: trials in this area evaluate safety and immediate efficacy of various temporary or surgically implanted mechanical circulatory support devices other than standard LVADs (for example, short-term right ventricular assist devices, extracorporeal pumps, or novel percutaneous circulatory supports) in patients with acute cardiogenic shock, refractory heart failure exacerbations, or post-cardiotomy low output syndrome. These studies enroll critically ill inpatient populations requiring emergent or urgent hemodynamic support and focus on procedural complications, short-term survival, and organ perfusion metrics. Results inform clinicians on device selection and perioperative protocols and help payers assess short-term resource utilization and justification for high-cost inpatient interventions.
Comparative effectiveness and device selection research: this research compares different types of heart assist systems or implantation strategies (for example, temporary percutaneous systems versus surgically implanted short-term devices, or variations in cannulation/site) in heterogeneous hospitalized heart failure patients who are candidates for mechanical support but not standard durable LVAD therapy. Trials measure outcomes such as hemodynamic improvement, duration of support, complication rates (bleeding, infection, thrombosis), length of stay, and costs across real-world patient subgroups including those with right versus left ventricular failure or multi-organ dysfunction. Findings are directly relevant to hospitals and payers because they guide protocolized care pathways, optimize device utilization, and can reduce avoidable complications and expensive downstream care.
Post-implant recovery, transition of care, and long-term outcomes studies: these observational cohorts or interventional trials follow patients after discharge or device explant to assess functional recovery, readmission rates, rehabilitation needs, and survival up to one year or longer, including quality-of-life and resource use metrics. Populations include survivors of acute support who were bridged to recovery, transplant-listed patients, or those requiring subsequent durable therapies; studies evaluate readmission causes, outpatient monitoring strategies, and care coordination models. This evidence helps providers and payers design post-discharge care bundles, predict long-term costs, and identify interventions that reduce readmissions and improve value for this high-acuity DRG.

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Summary & Overview

Other Heart Assist System Implant: Inpatient Reimbursement Overview

DRG 215 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