Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 216-cardiac-valve-and-other-major-cardiothoracic-procedures-with-cardiac-catheterization-with-mcc
    Ask Trek AI about this page

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

    DRG 216 encompasses cardiac valve and other major cardiothoracic procedures performed with cardiac catheterization when a Major Complication or Comorbidity is present; it defines a high-resource inpatient cohort. Proper assignment affects Medicare inpatient reimbursement because the Major Complication or Comorbidity status increases payment relative to less complex Diagnosis-Related Groups.

    Customize your policy alerts

    Sign up for drg 216 policy alerts

    Get alerted when payer policies referencing 216 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 216 Overview

    DRG 216 covers hospitalizations for cardiac valve and other major cardiothoracic procedures performed with cardiac catheterization when a Major Complication or Comorbidity is present. This group captures high-acuity surgical and interventional care involving valve repair or replacement, other major cardiothoracic operations, and concurrent diagnostic or therapeutic catheterization. It matters for Medicare payment because the presence of a Major Complication or Comorbidity substantially increases resource use and reimbursement relative to less complex cases. Accurate coding of procedures and coexisting conditions determines appropriate Medicare Severity Diagnosis-Related Group assignment and payment.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical Trials

    • Acute perioperative intervention trials assessing strategies to reduce intraoperative and immediate postoperative complications in patients undergoing cardiac valve surgery with concurrent cardiac catheterization. These studies typically enroll high-risk adults with severe valvular disease who require valve repair or replacement and concomitant diagnostic or interventional catheterization, and they test interventions such as optimized cardioplegia protocols, hemodynamic monitoring approaches, or fast-track anesthesia pathways. Findings are relevant to providers for refining surgical and anesthetic management to lower morbidity and to payers because reduced perioperative complications and shorter ICU stays can meaningfully affect cost and resource utilization for this high-cost DRG.
    • Comparative effectiveness research comparing valve procedure approaches and timing in patients who undergo combined cardiothoracic surgery and catheterization, including comparisons of surgical techniques (e.g., repair versus replacement, biologic versus mechanical prostheses) or staged versus concomitant catheter-based diagnostics/interventions. These studies enroll heterogeneous populations (elderly patients, those with multivalvular disease, or with coronary artery disease discovered at catheterization) to determine which approaches yield better survival, fewer rehospitalizations, and lower complication rates. Results inform clinical decision-making and guideline development, helping providers choose strategies that balance clinical benefit with downstream costs and readmission risk that impact payer reimbursement under bundled payments.
    • Post-discharge outcomes and care-transition studies focused on medium- to long-term recovery, anticoagulation management, and readmission prevention for patients after major cardiothoracic valve procedures with catheterization, often using registry-based cohorts or pragmatic trials of transitional care interventions. These studies examine patients discharged after complicated index admissions (including those with major complications coded as MCC), evaluating interventions such as structured follow-up, home-monitoring, or coordinated anticoagulation clinics to reduce thromboembolic events, bleeding, and early readmissions. Evidence from this research is important to providers to optimize outpatient care plans and to payers because improved post-discharge outcomes can reduce costly readmissions and improve value for episodes of care covered under DRG-based payment models.

    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

    215-OTHER-HEART-ASSIST-SYSTEM-IMPLANT

    Other Heart Assist System Implant: 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

    Showing 1–10 of 100

    • More pages

    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.
    Published by

    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.