Heart Failure and Shock with CC: Inpatient Reimbursement Overview

DRG 292 addresses inpatient admissions for heart failure and shock when a Complication or Comorbidity is present, capturing cases with increased clinical complexity. Assigning this Diagnosis-Related Group affects Medicare reimbursement because Complications or Comorbidities raise expected resource use and the Diagnosis-Related Group relative weight for payment.

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DRG 292 Overview

DRG 292 covers hospital admissions for heart failure and shock when a Complication or Comorbidity is present. This grouping includes patients with acute decompensated heart failure, cardiogenic shock with an associated Complication or Comorbidity, and related treatments such as diuresis, inotropic support, or hemodynamic monitoring. It matters for Medicare payment because the presence of Complications or Comorbidities increases resource use and drives higher Diagnosis-Related Group relative weights used in inpatient reimbursement. Accurate coding of the principal diagnosis and associated Complication or Comorbidity is essential for correct Medicare Severity Diagnosis-Related Group assignment.

National Payment Rates

Payer rates for DRG 292 range from about $8.5K (BCBS mean) up to $15K (Aetna mean), with Anthem and Cigna clustering near $13–14K; the widest mean spread between payers is roughly $6.5K. See the table and chart below for payer-specific percentiles and distributional detail. Payer variability is visible across the 25th–75th percentiles in the accompanying visuals.

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported 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 292. Values summarize national Medicare payments and volumes for the reporting year.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$8.5K	$37K	$6.6K	14K

Patient Population

This DRG’s population skews toward Medicare-age patients, reflecting a predominance of older adults rather than primarily working-age individuals. Commercial/private payers (Aetna, Anthem, Cigna, BCBS) still cover a portion of cases, indicating a mixed but Medicare-tilted payer mix. The distribution suggests higher utilization among Medicare beneficiaries compared with purely working-age populations.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska for DRG 292 (Heart Failure and Shock with CC), payer rates range narrowly by mean from 13K to 20K across local payers, with Anthem, Blue Cross Blue Shield, and BCBS-centered plans clustering at 13K while Cigna’s mean sits at 20K and exhibits the largest min–max spread. The most notable deviation from national averages is Cigna’s higher mean and wide max of 34K compared with national Cigna centering near the mid-teens. See the table and chart below for detailed percentile and range values.

Key Insights for Alaska

Anthem is the highest paying payer in Alaska at a mean of 13K, while Blue Cross Blue Shield is the lowest payer at a mean of 13K — overall payer means in the state are tightly clustered around 13K.
Cigna shows the widest internal spread (min 11K, max 34K, mean 20K), representing the most meaningful deviation from national patterns where Cigna’s mean is higher regionally; this suggests greater variability in negotiated rates for Cigna in Alaska compared with the other local payers.

Clinical Trials

Acute hemodynamic intervention trials: randomized or controlled studies testing short-term interventions delivered during the hospitalization for heart failure or cardiogenic shock (for example, novel inotropes, vasodilators, or mechanical circulatory support strategies) targeted to patients with decompensated heart failure and objective evidence of hypoperfusion or congestion. These trials enroll patients during the index inpatient stay and measure time‑to‑stabilization, organ perfusion markers, and in‑hospital mortality and complications. Results inform hospital-level treatment algorithms, affect resource use in the acute care episode, and are directly relevant to payers because they can change lengths of stay, ICU utilization, and costs associated with high-acuity admissions in this DRG.
Comparative effectiveness and management strategy studies: pragmatic randomized or observational studies comparing guideline-directed medical therapy pathways, diuretic strategies (e.g., bolus versus continuous infusion, high‑dose versus stepped dosing), or multidisciplinary care bundles for patients admitted with heart failure and a complication or comorbidity (the CC in this DRG). These studies commonly enroll heterogeneous inpatient populations including older adults with renal dysfunction, diabetes, or pulmonary disease, and evaluate outcomes such as readmission, in‑hospital adverse events, and transitions to outpatient care. Findings are important to clinicians and hospital administrators for optimizing inpatient protocols and to payers for identifying approaches that reduce avoidable rehospitalization and total cost of care across the episode.
Post-discharge outcomes and transitional-care trials: randomized trials and prospective cohorts testing discharge planning interventions, early post-discharge follow-up, telemonitoring, or disease‑management programs specifically for patients recently hospitalized with heart failure or shock who have at least one complicating condition. These studies focus on 30‑ to 180‑day readmission rates, medication adherence, mortality, and patient‑reported outcomes in a high‑risk subgroup that often drives readmission metrics and bundled payment performance. Evidence from these trials guides investments in transitional-care teams and remote monitoring services that can improve quality metrics and reduce downstream costs for payers managing beneficiaries coded to this DRG.

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.

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National Payment Rates

Mean Rates by Payer — National — DRG 292

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$8.5K	$37K	$6.6K	14K

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 292

Key Insights for Alaska

Anthem is the highest paying payer in Alaska at a mean of 13K, while Blue Cross Blue Shield is the lowest payer at a mean of 13K — overall payer means in the state are tightly clustered around 13K.
Cigna shows the widest internal spread (min 11K, max 34K, mean 20K), representing the most meaningful deviation from national patterns where Cigna’s mean is higher regionally; this suggests greater variability in negotiated rates for Cigna in Alaska compared with the other local payers.

Clinical Trials

Acute hemodynamic intervention trials: randomized or controlled studies testing short-term interventions delivered during the hospitalization for heart failure or cardiogenic shock (for example, novel inotropes, vasodilators, or mechanical circulatory support strategies) targeted to patients with decompensated heart failure and objective evidence of hypoperfusion or congestion. These trials enroll patients during the index inpatient stay and measure time‑to‑stabilization, organ perfusion markers, and in‑hospital mortality and complications. Results inform hospital-level treatment algorithms, affect resource use in the acute care episode, and are directly relevant to payers because they can change lengths of stay, ICU utilization, and costs associated with high-acuity admissions in this DRG.
Comparative effectiveness and management strategy studies: pragmatic randomized or observational studies comparing guideline-directed medical therapy pathways, diuretic strategies (e.g., bolus versus continuous infusion, high‑dose versus stepped dosing), or multidisciplinary care bundles for patients admitted with heart failure and a complication or comorbidity (the CC in this DRG). These studies commonly enroll heterogeneous inpatient populations including older adults with renal dysfunction, diabetes, or pulmonary disease, and evaluate outcomes such as readmission, in‑hospital adverse events, and transitions to outpatient care. Findings are important to clinicians and hospital administrators for optimizing inpatient protocols and to payers for identifying approaches that reduce avoidable rehospitalization and total cost of care across the episode.
Post-discharge outcomes and transitional-care trials: randomized trials and prospective cohorts testing discharge planning interventions, early post-discharge follow-up, telemonitoring, or disease‑management programs specifically for patients recently hospitalized with heart failure or shock who have at least one complicating condition. These studies focus on 30‑ to 180‑day readmission rates, medication adherence, mortality, and patient‑reported outcomes in a high‑risk subgroup that often drives readmission metrics and bundled payment performance. Evidence from these trials guides investments in transitional-care teams and remote monitoring services that can improve quality metrics and reduce downstream costs for payers managing beneficiaries coded to this DRG.

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.