Other Vascular Procedures without CC/MCC DRG Reimbursement

Summary & Overview

Other Vascular Procedures without CC/MCC: Inpatient Reimbursement Overview

DRG 254 encompasses inpatient admissions for other vascular procedures without a Major Complication or Comorbidity or Complication or Comorbidity, focusing on less complex vascular interventions. This classification matters for inpatient reimbursement because it assigns hospitals to a lower-severity payment category that reflects expected resource consumption for these procedures.

Other Vascular Procedures without CC/MCCDRG Other Vascular Procedures without CC/MCCDRG 254Diagnosis-Related GroupInpatient ReimbursementMedicareVascular SurgeryEndovascular ProceduresHospital CodingProcedure Grouping

DRG 254 Overview

DRG 254 covers hospital admissions for other vascular procedures without a Major Complication or Comorbidity and without a Complication or Comorbidity. This group typically includes non-arterial endovascular and open vascular interventions that do not meet higher severity levels. It matters for Medicare payment because it groups clinically similar cases to determine bundled inpatient reimbursement based on average resource use. Accurate coding and documentation of vascular procedures and comorbid conditions influence assignment to this lower-severity payment category.

National Payment Rates

Across commercial payers the observed rate range runs from about $17K to $65K, with the widest spread between Blue Cross Blue Shield and Anthem. Refer to the table and chart below for payer‑level quartiles and distributions. Large variability is apparent across Aetna, Anthem, Cigna, and BCBS benchmarks.

Mean Rates by Payer — National — DRG 254

The CMS 2023 data reflect national Medicare fee‑for‑service inpatient payments reported in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($16.5k), average submitted covered charges ($86.9k), average Medicare payment amount ($12.9k), and total discharges (6.4k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 254 mean reimbursements range from $28K to $43K across payers, with Cigna at the high end and Anthem and Blue Cross Blue Shield at the low end. The most notable deviation versus national averages is Cigna’s mean of $43K in Alaska compared with its national mean of $29K. Reference the table and chart below for payer-level distributions and percentiles.

Key Insights for Alaska

Highest payer: Cigna with a mean of $43K; Lowest payers: Anthem and Blue Cross Blue Shield (BCBS) each with a mean of $28K.
Alaska’s rate range spans from $28K to $43K, noticeably higher at the top end versus national means where Cigna’s national mean is $29K, indicating a meaningful premium for Cigna in Alaska.

Clinical Trials

Trials evaluating endovascular versus open surgical approaches for non-coronary peripheral arterial procedures: these studies compare short-term procedural success, perioperative complications, and length of stay for patients undergoing other vascular procedures (for example peripheral bypass, endarterectomy, or limb-salvage interventions) without major comorbid complications. The patient population typically includes adults with peripheral arterial disease, critical limb ischemia, or focal arterial lesions who are candidates for either minimally invasive or traditional surgery. Results inform clinicians about which technique reduces inpatient resource use and complications and help payers understand cost and utilization trade-offs for cases assigned to this DRG.
Comparative effectiveness studies of perioperative care bundles and complication prevention for vascular surgery patients without CC/MCC: these investigations test standardized preoperative optimization, intraoperative blood management, and early postoperative protocols to reduce bleeding, wound infection, and thrombotic events in a relatively lower-complexity vascular cohort. Participants are patients admitted for elective or urgent non-coronary vascular procedures without major comorbid complications; outcomes include complication rates, transfusion needs, readmissions, and length of stay. Findings are relevant to providers and payers because reductions in preventable inpatient complications and shorter stays directly affect DRG-based reimbursement and resource allocation.
Post-discharge outcomes and rehabilitation studies focusing on functional recovery and limb salvage after non-complicated vascular procedures: these observational cohorts or randomized follow-ups examine 30–90 day functional status, reintervention rates, wound healing, and outpatient resource use among patients discharged after other vascular procedures without CC/MCC. The studied population includes patients with successful index procedures but at risk for delayed wound problems or recurrent ischemia, with attention to outpatient care patterns and social determinants that affect recovery. This research helps health systems and payers predict downstream utilization, design transitional care pathways, and identify interventions that reduce readmissions and long-term costs associated with this DRG.

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Summary & Overview

Other Vascular Procedures without CC/MCC: Inpatient Reimbursement Overview

DRG 254 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