Summary & Overview

Circulatory Disorders Except AMI with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

DRG 286 includes circulatory disorders except acute myocardial infarction with cardiac catheterization and a Major Complication or Comorbidity; it captures higher-acuity cardiac evaluations and interventions. This Diagnosis-Related Group matters for inpatient reimbursement because the combination of invasive procedure and elevated comorbidity increases resource use and affects Medicare payment weights and billing classification.

Circulatory DisordersDRG Circulatory Disorders Except AMI, with Cardiac Catheterization with MCCDRG 286Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyCardiac CatheterizationHospital BillingHealthcare Finance

DRG 286 Overview

DRG 286 covers hospital admissions for circulatory disorders other than acute myocardial infarction that include cardiac catheterization and at least one Major Complication or Comorbidity. It encompasses a range of diagnostic and interventional cardiac procedures performed to evaluate or treat ischemic, valvular, or other circulatory conditions where the presence of a Major Complication or Comorbidity increases resource use. This Diagnosis-Related Group matters for Medicare payment because the procedure intensity and higher acuity drive higher relative weights and inpatient reimbursement. Accurate assignment impacts payment, quality reporting, and case-mix measurement under Centers for Medicare & Medicaid Services rules.

National Payment Rates

Across commercial payers the paid rate distribution for DRG 286 ranges from as low as $370 (BCBS minimum) up to $79K (Anthem maximum), with mean payer averages spanning roughly $19K (BCBS) to $35K (Cigna). The widest spread between payer minimums and maximums is observed in Anthem’s range (up to $79K). See the table and chart below for payer-specific percentiles and distribution details.

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 286. These values summarize Medicare payment experience nationally for the reported period.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$21K	$110K	$17K	39K

Patient Population

This DRG’s population skews toward Medicare-age patients, reflecting a primarily older cohort rather than predominantly working-age. While commercial/private payers (Aetna, Anthem, BCBS, Cigna) do cover a portion of cases, the distribution is concentrated among Medicare beneficiaries. Expect a mixed payer mix but with Medicare as the dominant payer group for this DRG.

Summary & Overview

Circulatory Disorders Except AMI with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

DRG 286 Overview

National Payment Rates

Mean Rates by Payer — National — DRG 286

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$21K	$110K	$17K	39K

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer reimbursements for DRG 286 in Alaska span a wide range from $7.5K up to $95K across the payers shown, with mean payments clustering around $32K–$55K. Cigna stands out with a notably higher mean ($55K) compared with other local payers and versus national Cigna benchmarks. Reference the table and chart below for payer-level distributions and percentile detail.

Key Insights for Alaska

Highest-paying payer: Cigna (mean $55K); Lowest-paying payers: Anthem and Blue Cross Blue Shield (mean $32K each).
Alaska’s payers exhibit a wide rate range from $7.5K to $95K, and Cigna’s mean ($55K) is meaningfully higher than the national mean for Cigna ($35K).

Clinical Trials

Acute procedural optimization trials: Studies evaluating peri-procedural strategies to reduce complications and length of stay for patients undergoing cardiac catheterization for non–AMI circulatory disorders (eg, unstable angina, acute decompensated heart failure with suspected ischemia, arrhythmia evaluation). These trials enroll hospitalized adults who require diagnostic or interventional catheterization and test timing of catheterization, contrast-sparing protocols, or adjunctive pharmacologic management to minimize acute kidney injury, bleeding, or hemodynamic instability. Results inform in-hospital care pathways and resource utilization metrics that directly affect DRG-level reimbursement and provider decisions about procedural risk mitigation.
Comparative effectiveness and decision-making studies: Prospective observational cohorts or randomized pragmatic trials comparing diagnostic versus conservative management strategies in patients with chronic ischemic symptoms or complex multivessel disease who undergo cardiac catheterization but do not have an acute myocardial infarction. These studies focus on downstream use of revascularization, readmissions, and functional outcomes across different patient risk profiles (eg, elderly, multiple comorbidities, renal impairment), helping clinicians decide when catheterization leads to meaningful benefit. Payers and hospitals use these data to refine appropriateness criteria, care pathways, and payment models tied to case mix and expected resource consumption under DRG 286.
Post-discharge outcomes and care transition research: Studies examining 30- to 90-day outcomes, rehabilitation needs, medication adherence, and readmission prevention in patients discharged after cardiac catheterization for non-AMI circulatory conditions, including interventions like structured discharge planning, remote monitoring, and targeted education for high-risk subgroups. These trials enroll patients after index hospitalization to evaluate interventions that reduce rehospitalization, complications (eg, contrast-related nephropathy consequences), and total cost of care. Findings are highly relevant to providers and payers aiming to lower readmission penalties, optimize outpatient follow-up, and manage bundled payment or value-based contracts tied to episodes that include DRG 286 cases.

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

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.

OpenPayer

Summary & Overview

Circulatory Disorders Except AMI with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

DRG 286 Overview

National Payment Rates

Patient Population

OpenPayer

Summary & Overview

Circulatory Disorders Except AMI with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

DRG 286 Overview

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes