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    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 215-other-heart-assist-system-implant
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    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.

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    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.

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    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.

    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.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $95K$460K$83K3.9K

    Patient Population

    This DRG’s population skews toward Medicare-age patients, reflecting a higher proportion of older beneficiaries compared with working-age, commercially insured populations. Commercial payers like Blue Cross Blue Shield, Cigna, Aetna, and Anthem represent a smaller share of total volume relative to Medicare. Overall, the mix is weighted toward Medicare beneficiaries rather than primarily working-age patients.

    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.

    Related Codes

    209-COMPLEX-AORTIC-ARCH-PROCEDURES

    Complex Aortic Arch Procedures: Inpatient Reimbursement Overview

    212-CONCOMITANT-AORTIC-AND-MITRAL-VALVE-PROCEDURES

    Concomitant Aortic and Mitral Valve Procedures: Inpatient Reimbursement Overview

    213-ENDOVASCULAR-ABDOMINAL-AORTA-WITH-ILIAC-BRANCH-PROCEDURES

    Endovascular Abdominal Aorta with Iliac Branch Procedures: Inpatient Reimbursement Overview

    216-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

    217-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    218-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

    219-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with MCC: Inpatient Reimbursement Overview

    220-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    221-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

    228-OTHER-CARDIOTHORACIC-PROCEDURES-WITH-MCC

    Other Cardiothoracic Procedures with MCC: Inpatient Reimbursement Overview

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    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 215
    Mean Rates by Payer — Alaska — DRG 215