Circulatory Disorders Except AMI w/ Cardiac Catheterization DRG Reimbursement

Summary & Overview

Circulatory Disorders Except AMI, with Cardiac Catheterization without MCC: Inpatient Reimbursement Overview

DRG 287 addresses circulatory disorders, excluding acute myocardial infarction, when cardiac catheterization is performed without a Major Complication or Comorbidity; it encompasses diagnostic and therapeutic catheter-based cardiac procedures. This grouping matters for inpatient reimbursement because procedure coding and comorbidity documentation determine placement in this mid-level payment category under the Diagnosis-Related Group framework.

Circulatory Disorders Except AMI, with Cardiac Catheterization without MCCDRG Circulatory Disorders Except AMI, with Cardiac Catheterization without MCCDRG 287Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyCardiac CatheterizationHospital CodingClinical Documentation

DRG 287 Overview

DRG 287 covers inpatient admissions for circulatory system disorders excluding acute myocardial infarction that include a cardiac catheterization procedure and do not have a Major Complication or Comorbidity. This group captures a spectrum of diagnostic and interventional catheter-based evaluations for ischemic and nonischemic cardiac conditions. It is important for Medicare payment because the presence of cardiac catheterization raises resource use relative to noninvasive management, while the absence of a Major Complication or Comorbidity places cases in a mid-range reimbursement tier. Accurate coding of the catheterization and comorbid conditions directly affects grouping and payment under the Diagnosis-Related Group system.

National Payment Rates

Across commercial payers the observed rate range runs from about $11K to $24K across the middle quartiles, with payer maximums in the dataset up to $42K; the widest spread in observed payments appears between Anthem and BCBS in the full distribution. See the table and chart below for payer-level detail and percentile spreads. Note that payer names in the chart are shown as Aetna, Cigna, BCBS, and Anthem.

Mean Rates by Payer — National — DRG 287

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 ($10.2k), average submitted covered charges ($61.0k), average Medicare payment ($7.5k), and total discharges (33.3k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 287 mean rates span from $17K to $26K across payers, with Anthem and Blue Cross Blue Shield clustered at $17K and Cigna at $26K. The state range is relatively compressed compared with national dispersion, and Cigna represents the most notable upward deviation from national averages. See the table and chart below for payer-level detail.

Key Insights for Alaska

Highest-paying payer: Cigna (mean $26K); Lowest-paying payers: Anthem and BCBS (mean $17K).
Alaska’s payer means range is narrow ($17K–$26K) with Cigna notably above both local peers and the national mean for some payers, indicating a meaningful upward deviation vs. the $18K national mean for select payers.

Clinical Trials

Acute procedural optimization studies: randomized or prospective observational trials testing variations in cardiac catheterization technique, periprocedural antithrombotic strategies, vascular access management, or immediate adjunctive imaging in patients admitted with non–ST-elevation circulatory disorders (for example unstable angina, symptomatic ischemia but not AMI). These studies enroll inpatients undergoing diagnostic or therapeutic catheterization to evaluate short-term procedural outcomes (bleeding, contrast nephropathy, procedural success) and early resource utilization. Findings are directly relevant to clinicians and hospital payers because they can inform protocols that reduce complications, length of stay, and costly readmissions for this DRG cohort.
Comparative effectiveness and care pathway trials: pragmatic trials or registry-linked comparative studies evaluating different inpatient management pathways (early catheterization versus delayed/conservative strategies, standardized chest pain observation protocols, or care bundles for patients with heart failure exacerbation who undergo cath). These studies target heterogeneous patients under DRG 287 who have circulatory disorders excluding AMI and seek to determine which pathways produce better in-hospital outcomes, lower complication rates, and more efficient use of catheterization resources. Results guide hospitals and payers in pathway selection and reimbursement planning by identifying approaches that maintain quality while reducing unnecessary testing, procedure utilization, and excess inpatient days.
Post-discharge outcomes and transitional care research: cohort studies or randomized trials focused on discharge planning, medication reconciliation, cardiac rehabilitation enrollment, and outpatient follow-up timing for patients discharged after catheterization for non-AMI circulatory conditions. These studies assess medium- to long-term outcomes such as recurrent ischemic events, readmissions, adherence to secondary prevention, and cost-effectiveness of intensive transitional interventions. This area is crucial for payers and providers because improved post-discharge care can lower readmission rates and downstream costs for the DRG population while informing bundled payment and value-based reimbursement strategies.

Related Codes

263-VEIN-LIGATION-AND-STRIPPING

Vein Ligation and Stripping: Inpatient Reimbursement Overview

276-CARDIAC-DEFIBRILLATOR-IMPLANT-WITH-MCC-OR-CAROTID-SINUS-NEUROSTIMULATOR

Cardiac Defibrillator Implant with MCC or Carotid Sinus Neurostimulator: Inpatient Reimbursement Overview

268-AORTIC-AND-HEART-ASSIST-PROCEDURES-EXCEPT-PULSATION-BALLOON-WITH-MCC

Aortic and Heart Assist Procedures Except Pulsation Balloon with MCC: Inpatient Reimbursement Overview

215-OTHER-HEART-ASSIST-SYSTEM-IMPLANT

Other Heart Assist System Implant: Inpatient Reimbursement Overview

241-AMPUTATION-FOR-CIRCULATORY-SYSTEM-DISORDERS-EXCEPT-UPPER-LIMB-AND-TOE-WITHOUT-CC-MCC

Amputation for Circulatory System Disorders Except Upper Limb and Toe without CC/MCC: Inpatient Reimbursement Overview

272-OTHER-MAJOR-CARDIOVASCULAR-PROCEDURES-WITHOUT-CC-MCC

Other Major Cardiovascular Procedures without CC/MCC: Inpatient Reimbursement Overview

233-CORONARY-BYPASS-WITH-CARDIAC-CATHETERIZATION-OR-OPEN-ABLATION-WITH-MCC

Coronary Bypass with Cardiac Catheterization or Open Ablation with MCC: Inpatient Reimbursement Overview

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

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

262-CARDIAC-PACEMAKER-REVISION-EXCEPT-DEVICE-REPLACEMENT-WITHOUT-CC-MCC

Cardiac Pacemaker Revision Except Device Replacement without CC/MCC: Inpatient Reimbursement Overview

242-PERMANENT-CARDIAC-PACEMAKER-IMPLANT-WITH-MCC

Permanent Cardiac Pacemaker Implant with 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 without MCC: Inpatient Reimbursement Overview

DRG 287 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