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    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 219-cardiac-valve-and-other-major-cardiothoracic-procedures-without-cardiac-catheterization-with-mcc
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    Cardiac Valve and Other Major Cardiothoracic Procedures with MCC: Inpatient Reimbursement Overview

    DRG 219 encompasses cardiac valve and other major cardiothoracic procedures without cardiac catheterization when a Major Complication or Comorbidity is present, covering complex surgical admissions with significant additional diagnoses. This Diagnosis-Related Group matters for inpatient reimbursement because the Major Complication or Comorbidity status increases expected resource consumption and thus influences Medicare payment levels.

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    DRG 219 Overview

    DRG 219 covers hospital admissions for cardiac valve and other major cardiothoracic procedures performed without cardiac catheterization when a Major Complication or Comorbidity is present. Typical cases include valve repair or replacement and major mediastinal or thoracic operations complicated by significant comorbid conditions that increase resource use. This Diagnosis-Related Group matters for Medicare inpatient payment because the presence of a Major Complication or Comorbidity elevates the reimbursement relative to lower-severity groups, reflecting higher expected costs and length of stay. Accurate coding of principal procedures and Major Complication or Comorbidity diagnoses directly affects assignment to this Diagnosis-Related Group and resulting payment.

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    National Payment Rates

    Payer-negotiated rates for DRG 219 span a wide range across commercial insurers, from as low as $64K (reported by Cigna) up to $280K (Anthem). The mean contractual rates cluster around $68K–$120K depending on payer, with Anthem showing the widest spread between its minimum and maximum values. See the table and chart below for payer-level detail and percentile distributions.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments 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 219. These values reflect national FFS Medicare activity for the reporting year.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $82K$380K$69K14K

    Patient Population

    This DRG’s population skews toward Medicare-age patients, with a substantial share of encounters coming from the 65+ Medicare demographic rather than primarily working-age commercial members. Commercial/managed care payers still account for a meaningful minority of cases, producing a mixed but Medicare-leaning payer mix. Payer mix and age distribution influence utilization and payment patterns reflected in the benchmarks above.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Payer-reported means in Alaska for DRG 219 span from $120K to $180K, with Blue Cross Blue Shield and Anthem at the low end and Cigna at the high end. The range is relatively modest but Cigna’s $180K stands out as above common national medians (~$120K). See the table and chart below for payer-specific distributions.

    Key Insights for Alaska

    • Cigna is the highest-paying payer in Alaska with a mean of $180K, while Blue Cross Blue Shield and Anthem both report the lowest mean at $120K.
    • Alaska’s payer mean range ($120K–$180K) is narrower but shifted higher than several national medians; Cigna’s $180K notably exceeds typical national medians around $120K, representing the most meaningful deviation.

    Clinical Trials

    • Acute perioperative intervention trials: randomized or pragmatic studies testing intraoperative or immediate post-operative strategies (for example, myocardial protection techniques, transfusion thresholds, or hemodynamic management protocols) in adult patients undergoing major cardiothoracic operations for valvular disease or complex cardiac surgery with high acuity and complications (the MCC population). These studies focus on short-term endpoints such as operative mortality, major morbidity (stroke, renal failure, prolonged ventilation), and ICU length of stay to identify interventions that reduce immediate complications. Results are directly relevant to providers and payers because reductions in perioperative adverse events and ICU utilization can improve patient outcomes and substantially lower episode-of-care costs for this high-resource DRG.
    • Comparative effectiveness studies of surgical approaches and timing: observational cohort studies or randomized trials comparing valve repair versus replacement, different prosthesis types, or staged versus immediate combined procedures in patients with complex valvular pathology and significant comorbidities (the subgroup with MCC). These investigations evaluate mid-term outcomes such as reoperation rates, functional status, readmissions, and cost-effectiveness across heterogeneous high-risk patients to determine which approaches provide the best trade-off of durability and resource use. Such evidence helps clinicians tailor surgical plans for high-risk cases and helps payers and hospital administrators forecast resource needs and justify coverage or care pathways for expensive procedures.
    • Post-discharge outcomes and care-transition research: prospective cohort studies and quality-improvement trials assessing multidisciplinary discharge planning, early outpatient surveillance, rehabilitation, and readmission-reduction bundles for survivors of major cardiothoracic surgery with complications. These studies enroll patients discharged after complex valve or cardiothoracic procedures complicated by major comorbid events and measure 30–90 day readmissions, functional recovery, medication adherence, and total post-acute costs to identify effective strategies for reducing downstream utilization. Findings inform clinicians and payers about interventions that improve recovery, lower avoidable readmissions, and shift costly readmission or prolonged SNF use into more efficient outpatient management.

    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

    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

    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 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 219
    Mean Rates by Payer — Alaska — DRG 219