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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 280-acute-myocardial-infarction-discharged-alive-with-mcc
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    Acute Myocardial Infarction, Discharged Alive with MCC: Inpatient Reimbursement Overview

    DRG 280 encompasses acute myocardial infarction cases discharged alive with one or more Major Complication or Comorbidity, indicating higher clinical complexity and resource use. Proper assignment affects inpatient reimbursement under the Medicare Severity Diagnosis-Related Group payment methodology because the Major Complication or Comorbidity status elevates the payment relative to less complex myocardial infarction admissions.

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    DRG 280 Overview

    DRG 280 covers inpatient admissions for acute myocardial infarction in patients who survive to discharge and have one or more Major Complication or Comorbidity present. This Diagnosis-Related Group reflects higher resource intensity due to severe cardiac complications or significant comorbid conditions that require additional diagnostics, monitoring, and therapeutic interventions. It matters for Medicare payment because the presence of a Major Complication or Comorbidity adjusts the relative weight and reimbursement level under the inpatient prospective payment system. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and thereby influence Medicare inpatient reimbursement.

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    National Payment Rates

    Across commercial payers the negotiated rate range for DRG 280 spans from roughly $15K (BCBS median) up to about $60K (Anthem max), with means clustering near the mid-$20K range; the widest spread is seen with Anthem (min-to-max up to $60K). See the payer table and accompanying chart below for payer-level percentiles and distribution comparisons. Payer variability highlights differences between national commercial contracts and Medicare benchmarks.

    The CMS 2023 data shown are national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table columns display average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 280. These values reflect aggregated payment and charge metrics for the covered Medicare population in 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $14K$73K$12K87K

    Patient Population

    This DRG’s population skews toward Medicare-age patients, with a substantial portion of discharges coming from beneficiaries rather than primarily working-age commercially insured groups. Commercial payers still cover a meaningful share, resulting in a mixed but Medicare-leaning payer mix. Age distribution therefore trends older, reflecting a Medicare-dominant population rather than predominantly working-age adults.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    For DRG 280 in Alaska, mean rates range from $25K (Anthem and Blue Cross Blue Shield) up to $39K (Cigna), showing a wide payer spread within the state. The most notable deviation from national averages is Cigna’s higher mean reimbursement, which sits well above the state’s other payers and several national medians. See the table and chart below for the payer-specific distributions.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $39K); Lowest payers: Anthem and Blue Cross Blue Shield (mean $25K).
    • Cigna’s mean in Alaska (~$39K) is notably above the provided national medians for several national payers, representing a meaningful upward deviation from the state’s other payers.

    Clinical Trials

    • Acute-phase reperfusion and complication-reduction trials: studies that evaluate timing, strategies, and adjunctive therapies for reperfusion in patients presenting with acute ST-elevation or high-risk non–ST-elevation myocardial infarction complicated by major comorbid conditions (eg, cardiogenic shock, heart failure, or significant renal dysfunction). These trials enroll patients during the initial hospitalization to compare immediate intervention approaches, procedural timing, or periprocedural management aimed at reducing in-hospital mortality and major complications. Findings inform inpatient protocols, resource utilization, and short-term payment episodes for high-acuity AMI patients with major complications.
    • Comparative effectiveness and risk-stratified management studies: pragmatic trials or observational effectiveness research that compare evidence-based inpatient care bundles, antithrombotic strategies, or care pathways across subgroups defined by age, multimorbidity, or frailty among AMI patients with major complications. These studies focus on which real-world approaches lead to lower length of stay, readmission risk, and complication rates in complex patients, helping providers choose cost-effective care models and payers design value-based reimbursement for high-cost DRG 280 cases.
    • Post-discharge transitional care and secondary prevention outcomes research: studies that follow high-risk survivors of an AMI hospitalization with major complications to test models of care coordination, medication adherence interventions, cardiac rehabilitation access, and remote monitoring aimed at reducing 30- and 90-day readmissions and mortality. These trials or cohort studies target discharged-alive patients grouped under this DRG to identify interventions that improve long-term outcomes and lower downstream utilization, directly relevant to bundled payment programs and post-acute care planning.

    Related Codes

    209-COMPLEX-AORTIC-ARCH-PROCEDURES

    Complex Aortic Arch Procedures: Inpatient Reimbursement Overview

    212-CONCOMITANT-AORTIC-AND-MITRAL-VALVE-PROCEDURES

    Concomitant Aortic and Mitral Valve Procedures: Inpatient Reimbursement Overview

    213-ENDOVASCULAR-ABDOMINAL-AORTA-WITH-ILIAC-BRANCH-PROCEDURES

    Endovascular Abdominal Aorta with Iliac Branch Procedures: Inpatient Reimbursement Overview

    215-OTHER-HEART-ASSIST-SYSTEM-IMPLANT

    Other Heart Assist System Implant: Inpatient Reimbursement Overview

    216-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-MCC

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

    217-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures with 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

    219-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with MCC: 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

    221-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

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

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    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Mean Rates by Payer — National — DRG 280
    Mean Rates by Payer — Alaska — DRG 280