Percutaneous and Other Intracardiac Procedures DRG Reimbursement

Summary & Overview

Percutaneous and Other Intracardiac Procedures without MCC: Inpatient Reimbursement Overview

DRG 274 encompasses percutaneous and other intracardiac procedures performed without Major Complication or Comorbidity, including catheter-based valve and intracardiac device interventions. This Diagnosis-Related Group matters for inpatient reimbursement because it groups similar resource-intense cardiac procedures to determine Medicare payment and hospital case mix contributions.

Percutaneous and Other Intracardiac Procedures without MCCDRG Percutaneous and Other Intracardiac Procedures without MCCDRG 274Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyInterventional CardiologyTranscatheter Procedures

DRG 274 Overview

DRG 274 covers percutaneous and other intracardiac procedures without Major Complication or Comorbidity and includes catheter-based interventions such as transcatheter valve repairs and other intracardiac device procedures performed without severe comorbid conditions. This Diagnosis-Related Group groups cases by resource use and clinical similarity, influencing Medicare inpatient payment rates and hospital case mix considerations. Accurate coding of principal procedure and comorbid diagnoses determines assignment to this DRG and the associated payment weight. Facilities and coders monitor this DRG because it affects reimbursement for high-cost cardiac catheterization and intracardiac device services.

National Payment Rates

Payer rates in the benchmark table range from as low as $370 (BCBS) up to $110K (Anthem), with mean payer reimbursements spanning roughly $28K to $54K across payers. The widest spread is seen between the lowest reported rate and Anthem’s high of $110K. See the payer table and chart below for payer-specific quartiles and distribution details.

Mean Rates by Payer — National — DRG 274

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 ($27.5k), average submitted covered charges ($146.5k), average Medicare payment ($24.8k), and total discharges (53.9k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s payer means for DRG 274 range from $51K (Blue Cross Blue Shield and Anthem) up to $79K (Cigna), showing a substantial spread across payers. Cigna’s $79K mean represents the most notable deviation, sitting well above the other state payers. Reference the table and chart below for payer-specific percentiles and distribution.

Key Insights for Alaska

Highest payer: Cigna at $79K mean; Lowest payers: BCBS and Anthem at $51K mean.
Cigna’s mean of $79K notably exceeds national medians for this DRG, representing a meaningful premium versus other payers in Alaska.

Clinical Trials

Acute procedural safety and efficacy studies of percutaneous intracardiac interventions: randomized or observational trials assessing immediate procedural outcomes, complication rates (bleeding, vascular injury, cardiac tamponade), and in-hospital recovery for patients undergoing percutaneous intracardiac procedures without major comorbid complications (no MCC). These studies typically enroll patients presenting with isolated structural or electrophysiologic indications (e.g., catheter-based closure of atrial septal defects, transcatheter valve-in-valve for small lesions, or electrophysiology ablations) and focus on peri-procedural management strategies and device/technique performance. Results inform clinicians on short-term risk–benefit profiles, procedural protocols, and resource needs that directly affect inpatient length of stay and immediate reimbursement drivers for this DRG.
Comparative effectiveness research on procedural approaches and perioperative pathways: noninferiority or pragmatic trials and large registry analyses comparing different percutaneous techniques, anesthesia strategies, or same-day versus overnight observation pathways in lower-risk intracardiac procedure patients. Patient populations include adults without significant MCCs who might be eligible for less invasive approaches, different device types, or streamlined post-procedure care; the studies measure outcomes such as readmission, functional status, and total cost of care. Findings are highly relevant to hospitals and payers seeking to optimize care pathways, reduce unnecessary inpatient days, and align reimbursement with evidence-based resource utilization for DRG 274 cases.
Post-discharge outcomes and health services research focusing on longer-term functional outcomes, quality of life, and health care utilization after percutaneous intracardiac procedures: prospective cohort studies and registry follow-up that track 30- to 365-day complications, arrhythmia recurrence, device durability, outpatient visits, and rehospitalizations in patients initially coded to this DRG. These studies enroll patients who were stable enough to undergo percutaneous procedures without major complications and examine how discharge planning, outpatient monitoring, and comorbidity management affect downstream outcomes and total cost. Such evidence helps payers and providers design post-acute care models, determine appropriate follow-up intensity, and evaluate the value of the index hospitalization under bundled payment or DRG-based reimbursement models.

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$28K	$150K	$25K	54K