Percutaneous Cardiovascular Procedures without Intraluminal Device with MCC DRG Reimbursement

Summary & Overview

Percutaneous Cardiovascular Procedures without Intraluminal Device with MCC: Inpatient Reimbursement Overview

DRG 250 covers percutaneous cardiovascular procedures without placement of an intraluminal device when a Major Complication or Comorbidity is present, encompassing diagnostic and therapeutic catheter-based interventions complicated by severe coexisting conditions. This grouping matters for inpatient reimbursement because the Major Complication or Comorbidity component drives higher Medicare Severity Diagnosis-Related Group payment relative to less complex cases.

Percutaneous Cardiovascular Procedures without Intraluminal Device with MCCDRG Percutaneous Cardiovascular Procedures without Intraluminal Device with MCCDRG 250Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyInterventional CardiologyVascular SurgeryCatheterization

DRG 250 Overview

DRG 250 groups inpatient cases for percutaneous cardiovascular procedures without implantation of an intraluminal device when a Major Complication or Comorbidity is present. This includes transcatheter diagnostic or therapeutic vascular interventions performed without placing stents or other intraluminal devices and complicated by significant comorbid conditions. It matters for Medicare payment because the presence of a Major Complication or Comorbidity increases resource use and typically results in higher Diagnosis-Related Group reimbursement relative to cases without such complications. Accurate coding of the principal procedure and the Major Complication or Comorbidity is essential for correct assignment of the Diagnosis-Related Group and associated payment.

National Payment Rates

Across commercial payers, negotiated rates for DRG 250 range from as low as $370 (BCBS minimum) up to $91K (Anthem maximum), with mean payer averages clustering between $22K and $35K; the widest spread in observed allowed amounts is between BCBS and Anthem. See the payer-specific table and chart below for full distribution and quartiles by Aetna, Cigna, BCBS, and Anthem.

Mean Rates by Payer — National — DRG 250

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 shows average total payment ($21.8k), average submitted covered charges ($128.1k), average Medicare payment ($18.3k), and total discharges (3.5k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Across payers in Alaska, mean rates span from $33K (Blue Cross Blue Shield and Anthem) up to $54K (Cigna), with a median near $34K for the lower-paying plans. The most notable deviation from national averages is Cigna’s higher mean of $54K compared with national Cigna measures, while BCBS and Anthem in Alaska sit close to their national medians. See the table and chart below for payer-level detail.

Key Insights for Alaska

Highest payer: Cigna with a mean of $54K; Lowest payer: BCBS and Anthem tied with a mean of $33K.
Alaska’s payer mean range ($33K–$54K) shows Cigna paying meaningfully above the other local payers and above the national means for several payers, while BCBS/Anthem align closely with national averages.

Clinical Trials

Acute periprocedural safety and hemodynamic stabilization studies: trials focusing on immediate percutaneous interventions (such as balloon angioplasty without stent placement) in critically ill patients with complex coronary or peripheral vascular occlusions examine strategies to minimize intraprocedural complications, bleeding, and contrast-induced kidney injury. These studies enroll patients with high acuity, multiple comorbidities, or procedure-related major complications (the MCC population) to evaluate protocols for sedation, antithrombotic management, and rapid complication recognition. Findings are directly relevant to hospitalists and interventional teams because they inform protocols that can reduce length of stay, intensive care utilization, and short-term costs important to payers and inpatient reimbursement models.
Comparative effectiveness trials of device-less percutaneous approaches versus alternative revascularization or conservative strategies in high-risk patients: randomized or pragmatic studies compare outcomes of percutaneous procedures performed without intraluminal devices to medically managed care or surgical revascularization in patients with severe comorbidity burden (e.g., heart failure, chronic kidney disease, recent MI). The objective is to determine which patients derive net clinical benefit from a less-device approach versus alternative strategies across endpoints such as mortality, major adverse cardiovascular events, need for repeat procedures, and resource use. Payers and clinicians use this evidence to guide utilization management, DRG-related case mix considerations, and to optimize care pathways that balance clinical benefit with inpatient costs for the MCC subgroup.
Post-discharge outcomes and readmission-reduction studies targeting high-risk patients after percutaneous vascular procedures without implanted devices: observational cohorts and interventional trials evaluate transitional care interventions (enhanced discharge planning, early outpatient follow-up, remote monitoring, medication reconciliation) for patients with major complications or multiple comorbidities who are at high risk for 30-day readmission and adverse events. These studies focus on functional recovery, complication surveillance (e.g., access-site hematoma, renal impairment), and total post-acute care utilization across home health, skilled nursing, and readmission rates. Results inform case management, bundled payment programs, and quality improvement efforts aimed at reducing costly readmissions and improving outcomes for the DRG 250 population.

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Summary & Overview

Percutaneous Cardiovascular Procedures without Intraluminal Device with MCC: Inpatient Reimbursement Overview

DRG 250 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