Ultrasound Accelerated and Other Thrombolysis DRG Payment Rates

Summary & Overview

Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structures with MCC: Inpatient Reimbursement Overview

DRG 278 addresses inpatient admissions for ultrasound-accelerated and other thrombolysis of peripheral vascular structures when a Major Complication or Comorbidity is present, covering catheter-directed thrombolytic therapies for acute limb ischemia and complex peripheral thrombosis. Proper identification and coding of the procedure and the Major Complication or Comorbidity affect Diagnosis-Related Group assignment and therefore the Medicare inpatient reimbursement level.

Ultrasound Accelerated ThrombolysisDRG Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structures with MCCDRG 278Diagnosis-Related GroupInpatient ReimbursementMedicareVascular SurgeryInterventional RadiologyThrombolysisPeripheral Vascular Disease

DRG 278 Overview

DRG 278 covers inpatient cases involving ultrasound-accelerated and other thrombolysis procedures directed at peripheral vascular structures when a Major Complication or Comorbidity is present. These cases typically involve catheter-directed thrombolytic therapy for acute limb ischemia or extensive peripheral venous thrombosis complicated by significant comorbid conditions. This Diagnosis-Related Group matters for Medicare payment because the presence of a Major Complication or Comorbidity increases expected resource use and drives higher reimbursement relative to similar procedures without such severity. Accurate coding of the thrombolysis procedure and the Major Complication or Comorbidity is essential for correct Medicare Severity Diagnosis-Related Group assignment and payment.

National Payment Rates

Across payers in the benchmark dataset, negotiated rates range roughly from $19K to $160K, with the widest spread seen between the lowest Aetna value and the highest Cigna value. The payer-level distribution in the table and chart below highlights notable variability between commercial plans such as Cigna, Aetna, Anthem, and Blue Cross Blue Shield. This spread reflects differences in negotiated prices across these major national payers.

Mean Rates by Payer — National — DRG 278

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 278 rates vary across payers, with most reported values concentrated at $87K for Anthem and Blue Cross Blue Shield, while Cigna displays a substantially higher mean of $130K and a maximum of $220K. The rate range across payers therefore spans from $87K up to $220K, driven primarily by Cigna’s higher reimbursements. This represents a notable deviation above national medians shown in the reference data. See the table and chart below for detailed payer-level benchmarks.

Key Insights for Alaska

Anthem is the highest-paying payer at $87K, while Blue Cross Blue Shield is tied at the lowest reported rate of $87K; Cigna shows a wider spread with a mean of $130K and a maximum of $220K indicating payer-level variability.
The state’s observed mean rates cluster tightly at $87K for Anthem and BCBS, but Cigna’s mean of $130K represents a meaningful upward deviation from the other state payers and from typical national medians.

Clinical Trials

Trials evaluating acute procedural strategies for catheter-directed thrombolysis (including ultrasound-accelerated techniques) in patients with acute severe peripheral arterial or venous thrombosis complicated by end-organ ischemia or limb-threatening ischemia. These studies enroll hospitalized patients presenting with large-burden clot, significant ischemic symptoms, or failed systemic therapy to compare time-to-recanalization, complication rates (bleeding, distal embolization), and short-term limb salvage; they are relevant because procedural success and periprocedural complications drive length of stay, resource utilization, and high-cost MCCs captured in this DRG.
Comparative effectiveness studies assessing catheter-directed thrombolysis versus alternative revascularization strategies (surgical thrombectomy, percutaneous mechanical thrombectomy, or primary medical management) in subgroups such as elderly patients, those with renal impairment, or patients with sepsis/MCCs. These trials focus on functional outcomes (limb salvage, amputation-free survival), in-hospital complications, and need for repeat procedures, informing clinicians and payers about which patient profiles derive net benefit from invasive thrombolytic approaches and how to allocate inpatient resources.
Post-discharge outcomes and health-services research examining readmission rates, long-term limb function, anticoagulation adherence, and costs after hospitalizations that included ultrasound-accelerated or other catheter-directed thrombolysis with major complications. Cohort or registry-based studies follow patients after discharge to quantify downstream utilization (rehabilitation, reinterventions, chronic wound care) and predictors of poor outcomes, providing data important for discharge planning, bundled payments, and risk-adjusted reimbursement decisions for this high-acuity DRG.

Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

263-VEIN-LIGATION-AND-STRIPPING

Vein Ligation and Stripping: Inpatient Reimbursement Overview

325-CORONARY-INTRAVASCULAR-LITHOTRIPSY-WITHOUT-INTRALUMINAL-DEVICE

Coronary Intravascular Lithotripsy without Intraluminal Device: Inpatient Reimbursement Overview

297-CARDIAC-ARREST-UNEXPLAINED-WITH-CC

Cardiac Arrest, Unexplained with CC: Inpatient Reimbursement Overview

245-AICD-GENERATOR-PROCEDURES

AICD Generator Procedures: Inpatient Reimbursement Overview

264-OTHER-CIRCULATORY-SYSTEM-O-R-PROCEDURES

Other Circulatory System O.R. Procedures: Inpatient Reimbursement Overview

304-HYPERTENSION-WITH-MCC

Hypertension with Major Complication or Comorbidity: 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

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

314-OTHER-CIRCULATORY-SYSTEM-DIAGNOSES-WITH-MCC

Other Circulatory System Diagnoses with MCC: Inpatient Reimbursement Overview

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Summary & Overview

Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structures with MCC: Inpatient Reimbursement Overview

DRG 278 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