Acute Myocardial Infarction, Expired without CC/MCC: Inpatient Reimbursement Overview

DRG 285 addresses inpatient stays for patients who die from acute myocardial infarction without Major Complication or Comorbidity or Complication or Comorbidity, focusing on the clinical scenario of a fatal myocardial infarct. Proper grouping matters for inpatient reimbursement because it determines the Centers for Medicare & Medicaid Services prospective payment and aligns payment with documented clinical severity and resource use.

Customize your policy alerts

Sign up for drg 285 policy alerts

Get alerted when payer policies referencing 285 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

DRG 285 Overview

DRG 285 covers inpatient hospitalizations for patients with acute myocardial infarction who expire during the admission and do not have a Major Complication or Comorbidity or a Complication or Comorbidity. This Diagnosis-Related Group captures cases where the primary clinical event is fatal acute myocardial infarction and resource use is influenced by end-of-life care, diagnostic evaluation, and any interventions attempted prior to death. It matters for Medicare payment because classification into this Diagnosis-Related Group determines the prospective payment and reflects clinical and coding documentation tied to mortality and resource consumption. Accurate assignment affects hospital reimbursement under Centers for Medicare & Medicaid Services inpatient prospective payment policies.

National Payment Rates

Across commercial payers the observed payment range runs from about $370 to $21K, with payer means spanning roughly $5.6K to $10K. The widest single-payer spread appears with Anthem (min $390 to max $21K). See the payer table and chart below for payer-specific quartiles and full distributions for Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem.

The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($5.4k), average submitted covered charges ($30.7k), average Medicare payment ($3.8k), and total discharges (131).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$5.4K	$31K	$3.8K	130

Patient Population

This DRG’s population skews toward older adults and is more concentrated in the Medicare-age cohort than in working-age commercial populations. While commercial payers (Blue Cross Blue Shield, Cigna, Aetna, Anthem, etc.) cover a share of cases, the majority of hospitalizations in this DRG involve Medicare beneficiaries. The payer mix is therefore Medicare-dominant with a smaller, mixed working-age commercial component.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

DRG 285 reimbursement means in Alaska range from $9.3K (Blue Cross Blue Shield and Anthem) up to $14K (Cigna), with Cigna driving the upper bound. This distribution shows a concentrated low-end around $9.3K and a single higher outlier at $14K. The table and chart below provide the payer-level breakdown and visual context.

Key Insights for Alaska

Highest payer: Cigna (mean $14K); Lowest payers: Blue Cross Blue Shield and Anthem (each mean $9.3K).
Cigna’s mean in Alaska (~$14K) is notably above the state’s other payers and exceeds the national BCBS/Cigna/Anthem medians, indicating a meaningful upward deviation from national central tendencies.

Clinical Trials

Acute-phase interventional trials evaluating timing and methods of reperfusion and supportive care in patients with fatal acute myocardial infarction: these studies focus on immediate hospital management strategies for patients presenting with ST-elevation or large non–ST-elevation myocardial infarction who are hemodynamically unstable and at highest short-term mortality risk. Investigators compare protocols for rapid coronary reperfusion, adjunctive antithrombotic strategies, and ICU-level supportive measures to determine impact on in-hospital survival and organ failure; results inform acute care pathways and resource allocation decisions for providers and payers caring for high-risk AMI patients.
Comparative effectiveness and prognostic cohort studies of comorbidity-driven care bundles in elderly or multimorbid AMI patients: these observational or pragmatic randomized studies examine how different inpatient care bundles (for example, protocols that integrate heart failure management, renal protection, and delirium prevention) affect short-term mortality and complications among older adults or those with significant comorbid conditions who experience AMI and die during hospitalization. These trials address which integrated approaches reduce length of stay, complications, and downstream costs, providing actionable evidence for clinicians and payers to optimize care for complex patients commonly grouped in this DRG.
Post-mortem and quality-of-care review studies linking prehospital and in-hospital processes to mortality outcomes for AMI patients: these investigations analyze registry, chart review, and system-level data to identify delays in symptom recognition, EMS response, door-to-treatment times, and in-hospital decision points associated with in-hospital death without major complications recorded. By characterizing preventable process failures and variation across hospitals, this research supports quality improvement programs and payer-driven performance incentives aimed at reducing preventable AMI deaths and aligning reimbursement and care pathways with best practices.

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

Showing 1–10 of 100

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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.

Explore openpayer tools

View all tools