Cardiac Valve and Other Major Cardiothoracic Procedures DRG Reimbursement

Summary & Overview

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

DRG 220 encompasses cardiac valve and other major cardiothoracic procedures without cardiac catheterization when a Complication or Comorbidity is present; it addresses the inpatient surgical and perioperative care for complex cardiac operations. This Diagnosis-Related Group matters for inpatient reimbursement because it reflects higher resource utilization and risk profiles that affect Medicare payment rates.

Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CCDRG Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CCDRG 220Diagnosis-Related GroupInpatient ReimbursementMedicareCardiac SurgeryCardiothoracic SurgeryValve ReplacementValve Repair

DRG 220 Overview

DRG 220 covers cardiac valve and other major cardiothoracic procedures performed without cardiac catheterization in patients who have a Complication or Comorbidity. Typical cases include valve repair or replacement and other major open heart operations where an additional Complication or Comorbidity increases resource use. This Diagnosis-Related Group matters for Medicare payment because it groups clinically similar high-cost surgical cases to determine inpatient reimbursement levels and influences expected hospital resources and payment severity.

National Payment Rates

Commercial payer rates for DRG 220 span from about $370 (BCBS minimum) up to $190K (Anthem maximum) across the sample, with median/50th-percentile commercial rates clustering near $48K–$82K depending on payer. The widest payer spread observed is between the lowest reported value ($370) and the highest ($190K). See the table and chart below for payer-specific quartiles and distributions.

Mean Rates by Payer — National — DRG 220

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer rates in Alaska for DRG 220 range from $83K to $130K, with Cigna showing the highest mean and Blue Cross Blue Shield and Anthem the lowest. The state’s upper-range Cigna mean of $130K stands out as a notable deviation above national averages for this DRG. See the table and chart below for detailed payer distributions.

Key Insights for Alaska

Cigna is the highest paying payer in Alaska at $130K (max $210K), while Blue Cross Blue Shield and Anthem are the lowest payers at $83K each.
Alaska’s payer rates cluster higher than some national medians, with Cigna’s mean of $130K notably above national averages for this DRG, indicating a meaningful upward deviation from national rates.

Clinical Trials

Acute perioperative intervention trials: studies evaluating intraoperative or immediate postoperative strategies to reduce complications (for example, hemodynamic management protocols, myocardial protection techniques, bleeding control measures, or infection prevention bundles) in patients undergoing valve repair/replacement or other major cardiothoracic procedures with significant comorbidity. These trials enroll adults admitted for planned or urgent open cardiac valve surgery or complex thoracic operations who are at high risk for cardiac, pulmonary, or renal complications, and they often use short-term endpoints such as major adverse cardiac and cerebrovascular events, transfusion requirements, and length of ICU stay. Results inform surgeon and anesthesiologist practice, help risk-stratify patients, and are directly relevant to payers because reductions in ICU days, complications, and readmissions can lower inpatient costs for this high-cost DRG.
Comparative effectiveness studies of surgical approaches and timing: investigator-initiated or registry-based studies comparing different operative techniques (for example, valve repair versus replacement, mechanical versus bioprosthetic valves, or minimally invasive versus full sternotomy) and timing strategies in subgroups such as elderly patients or those with multiple comorbidities. These studies examine medium-term outcomes including in-hospital morbidity, device-related complications, need for reintervention, and cumulative resource use during the index hospitalization and subsequent 30–90 days. Findings guide surgical decision-making tailored to patient characteristics and inform payers and hospital administrators about procedure selection that balances clinical benefit against inpatient resource utilization and long-term cost implications.
Post-discharge outcomes and care transitions research: prospective cohort studies and quality improvement trials that evaluate discharge planning, rehabilitation pathways, medication reconciliation, and remote monitoring programs aimed at reducing readmissions, late complications (eg, prosthetic valve dysfunction, endocarditis), and improving functional recovery after major cardiothoracic procedures. These studies focus on the transition from hospital to home or skilled nursing facilities in older adults and those with heart failure or chronic lung disease, using outcomes such as 30- and 90-day readmission rates, patient-reported functional status, and post-acute care costs. Evidence from this research is critical for providers optimizing discharge practices and for payers designing bundled payment models or targeted interventions to reduce avoidable post-discharge expenditures associated with this DRG.

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Summary & Overview

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

DRG 220 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