Atherosclerosis with MCC DRG Reimbursement Benchmarks

Summary & Overview

Atherosclerosis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

DRG 302 addresses inpatient admissions for atherosclerosis accompanied by at least one Major Complication or Comorbidity, encompassing advanced vascular disease and related management. This Diagnosis-Related Group matters for inpatient reimbursement because the documented severity drives higher Medicare payments to reflect increased resource use and complexity.

Atherosclerosis with MCCDRG Atherosclerosis with MCCDRG 302Diagnosis-Related GroupInpatient ReimbursementMedicareVascular SurgeryCardiologyInterventional Procedures

DRG 302 Overview

DRG 302 covers hospital inpatient cases where a principal diagnosis of atherosclerosis is present along with at least one Major Complication or Comorbidity, often reflecting advanced vascular disease with higher resource needs. This Diagnosis-Related Group captures patients who require intensified medical management, potential interventional procedures, or extended monitoring related to ischemic complications. It matters for Medicare payment because the presence of a Major Complication or Comorbidity increases relative reimbursement to account for greater expected costs of care. Hospitals and coders must accurately document severity to ensure correct Diagnosis-Related Group assignment and payment alignment.

National Payment Rates

Across national payers the observed payment range runs from as low as $370 up to $39K, with mean payer benchmarks spanning roughly $10K to $19K depending on payer. The widest spread is seen between the lowest observed value ($370) and the highest ($39K). See the payer table and chart below for detailed percentiles and payer-specific distributions.

Mean Rates by Payer — National — DRG 302

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 ($12.0k), average submitted covered charges ($54.0k), average Medicare payment amount ($10.1k), and total discharges (2.2k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska for DRG 302 (Atherosclerosis with MCC), mean rates reported by payers range from $19K to $29K, with Blue Cross Blue Shield and Anthem at the low end and Cigna at the high end. Cigna's mean of $29K stands out as a notable divergence above the other Alaska payers and above many national medians. Reference the table and chart below for payer-specific quartiles and distribution.

Key Insights for Alaska

The highest payer in Alaska is Cigna (mean $29K) and the lowest are Blue Cross Blue Shield and Anthem (both mean $19K).
Alaska's payer range spans from $19K to $29K, with Cigna paying notably above the other local payers and exceeding typical national medians for some payers.
The concentration at $19K for Blue Cross Blue Shield and Anthem represents a meaningful downward deviation relative to several national benchmarks where medians and means are generally higher.

Clinical Trials

Trials evaluating intensive lipid-lowering and multifactorial risk-reduction strategies in hospitalized patients with advanced atherosclerosis and major comorbidities (for example, patients admitted with critical limb ischemia, unstable angina, or symptomatic carotid disease plus diabetes or chronic kidney disease). These studies test protocols for initiating or intensifying statins, PCSK9 inhibitors or combination therapies, smoking cessation interventions, and aggressive blood pressure or glycemic control during the index admission; the patient population is older adults with atherosclerotic disease complicated by at least one major comorbidity, and the clinical question is whether in-hospital initiation improves short-term event rates and readmissions. Results are relevant to providers for acute management pathways and to payers for value assessment of early intensive secondary prevention that may reduce costly readmissions and downstream procedures.
Comparative effectiveness trials of revascularization strategies and procedural timing in patients with symptomatic peripheral or coronary atherosclerosis who have significant comorbid conditions (for example comparing endovascular versus surgical approaches, staged versus single-setting interventions, or conservative medical management for high-risk surgical candidates). These studies enroll patients with complex anatomy and concurrent illnesses such as heart failure or advanced lung disease to determine which strategies yield better perioperative morbidity, length of stay, and functional outcomes. Findings inform clinicians about procedure selection and risk mitigation in a high-cost inpatient population and help payers and hospitals optimize resource utilization and episode-of-care reimbursement models.
Post-discharge outcomes and care-coordination trials focused on reducing readmissions and improving long-term adherence in patients discharged after an admission for atherosclerotic complications with major comorbidities (for example testing transitional care bundles, remote monitoring, or pharmacist-led medication reconciliation in patients with polypharmacy and multimorbidity). These pragmatic studies enroll patients at discharge and measure 30- to 365-day readmissions, recurrent ischemic events, and medication adherence, addressing the high risk of complications in this DRG cohort. Evidence from these trials is critical for healthcare systems and payers to design post-acute care pathways, case management programs, and reimbursement incentives that lower readmission rates and total cost of care.

Other Endovascular Cardiac Valve Procedures without MCC: Inpatient Reimbursement Overview

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Coronary Bypass with Cardiac Catheterization or Open Ablation without MCC: Inpatient Reimbursement Overview

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Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

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Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

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Cardiac Pacemaker Device Replacement without MCC: Inpatient Reimbursement Overview

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Heart Failure and Shock with MCC: Inpatient Reimbursement Overview

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Endovascular Cardiac Valve Replacement: Inpatient Reimbursement Overview

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OpenPayer

Summary & Overview

Atherosclerosis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

DRG 302 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