Summary & Overview

Heart Failure and Shock without CC/MCC: Inpatient Reimbursement Overview

DRG 293 encompasses heart failure and shock cases without Complication or Comorbidity or Major Complication or Comorbidity, defining a moderate-severity inpatient population relevant to Medicare payment. It matters for inpatient reimbursement because correct assignment affects hospital payment rates and resource classification within the Medicare Severity Diagnosis-Related Group framework.

Heart Failure and ShockDRG Heart Failure and Shock without CC/MCCDRG 293Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyCritical CareHospital CodingPayment Grouping

DRG 293 Overview

DRG 293 covers inpatient admissions for heart failure and shock when no Complication or Comorbidity or Major Complication or Comorbidity is coded. Typical cases include acute decompensated heart failure or cardiogenic or hypovolemic shock that do not meet severity criteria for higher-weighted groups. This Diagnosis-Related Group is important because it groups moderate-severity cardiovascular admissions for Medicare payment determination and influences hospital reimbursement and resource allocation. Accurate coding of comorbidities and severity is key to assigning the correct Diagnosis-Related Group and corresponding payment tier.

National Payment Rates

Across commercial payers the negotiated paid rates for DRG 293 range from about $370 to $24K, with payer medians and quartiles shown in the table and visualized in the chart below. The widest spread appears between Anthem (max $24K) and BCBS (min $370) reflecting a total span up to $24K. Refer to the accompanying table and chart for payer-specific median and percentile details.

Mean Rates by Payer — National — DRG 293

The CMS 2023 data shown are national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table columns display average total payment ($5.9k), average submitted covered charges ($25.8k), average Medicare payment amount ($4.2k), and total discharges (2.1k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 293 payer means range from $8.8K (Blue Cross Blue Shield and Anthem) up to $14K (Cigna), showing a wide spread across payers. Cigna’s mean at $14K represents the most notable deviation above common national medians, while BCBS and Anthem sit at the lower bound. See the table and chart below for payer-specific distributions.

Key Insights for Alaska

Highest payer: Cigna (mean $14K); Lowest payers: Blue Cross Blue Shield and Anthem (both mean $8.8K).
Alaska’s payer means range spans from $8.8K to $14K, with Cigna notably above national means for some payers and roughly aligned with higher-end national benchmarks.

Clinical Trials

Acute hemodynamic and stabilization trials: randomized or pragmatic studies testing early in-hospital interventions (for example, protocols for vasoactive support timing, noninvasive ventilation strategies, or streamlined diuresis pathways) in patients admitted with decompensated heart failure or cardiogenic shock without major comorbid complications. These trials enroll the typical inpatient cohort represented by DRG 293—older adults with primary heart failure or shock presentations but without secondary CC/MCC—and measure short-term physiologic responses, length of stay, and early readmission or escalation rates. Results inform hospital-based clinical pathways and resource use decisions that directly affect inpatient costs and reimbursement profiling.
Comparative effectiveness research on guideline-directed medical therapy optimization during hospitalization: observational cohorts or randomized comparative studies evaluating different approaches to initiating or uptitrating heart failure therapies (such as beta-blockers, ACE inhibitors/ARBs/ARNIs, mineralocorticoid receptor antagonists) while patients are still admitted for heart failure exacerbation. These studies focus on the DRG 293 population who are medically stable enough to tolerate medication adjustments but may not have major complicating conditions, assessing outcomes like medication adherence, 30- and 90-day readmissions, adverse events, and downstream utilization. Findings are directly relevant to clinicians and payers seeking to reduce preventable rehospitalizations and align inpatient treatment with long-term care management and value-based payment metrics.
Post-discharge transitional care and health services trials: randomized or implementation studies testing discharge interventions (enhanced education, early outpatient follow-up, telemonitoring, home nursing visits) tailored to patients discharged after a DRG 293 admission, measuring impacts on readmission, emergency visits, patient-reported outcomes, and total cost of care over 30–180 days. These trials typically enroll the broader, real-world heart failure population without CC/MCC and evaluate operational models for care coordination between hospital and community providers. Evidence from this research helps hospitals and payers design cost-effective discharge bundles and reduce avoidable utilization that drives reimbursement penalties and population health performance.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$5.9K	$26K	$4.2K	2.1K

Acute hemodynamic and stabilization trials: randomized or pragmatic studies testing early in-hospital interventions (for example, protocols for vasoactive support timing, noninvasive ventilation strategies, or streamlined diuresis pathways) in patients admitted with decompensated heart failure or cardiogenic shock without major comorbid complications. These trials enroll the typical inpatient cohort represented by DRG 293—older adults with primary heart failure or shock presentations but without secondary CC/MCC—and measure short-term physiologic responses, length of stay, and early readmission or escalation rates. Results inform hospital-based clinical pathways and resource use decisions that directly affect inpatient costs and reimbursement profiling.
Comparative effectiveness research on guideline-directed medical therapy optimization during hospitalization: observational cohorts or randomized comparative studies evaluating different approaches to initiating or uptitrating heart failure therapies (such as beta-blockers, ACE inhibitors/ARBs/ARNIs, mineralocorticoid receptor antagonists) while patients are still admitted for heart failure exacerbation. These studies focus on the DRG 293 population who are medically stable enough to tolerate medication adjustments but may not have major complicating conditions, assessing outcomes like medication adherence, 30- and 90-day readmissions, adverse events, and downstream utilization. Findings are directly relevant to clinicians and payers seeking to reduce preventable rehospitalizations and align inpatient treatment with long-term care management and value-based payment metrics.
Post-discharge transitional care and health services trials: randomized or implementation studies testing discharge interventions (enhanced education, early outpatient follow-up, telemonitoring, home nursing visits) tailored to patients discharged after a DRG 293 admission, measuring impacts on readmission, emergency visits, patient-reported outcomes, and total cost of care over 30–180 days. These trials typically enroll the broader, real-world heart failure population without CC/MCC and evaluate operational models for care coordination between hospital and community providers. Evidence from this research helps hospitals and payers design cost-effective discharge bundles and reduce avoidable utilization that drives reimbursement penalties and population health performance.

OpenPayer

Summary & Overview

Heart Failure and Shock without CC/MCC: Inpatient Reimbursement Overview

DRG 293 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