Summary & Overview

Chest Pain: Inpatient Reimbursement Overview

DRG 313 Chest Pain covers inpatient admissions focused on evaluation of chest pain without major cardiac complications; it includes resource use for diagnostic testing and observation. This Diagnosis-Related Group matters for inpatient reimbursement because assignment determines the bundled Medicare payment for the episode and affects hospital financial and clinical workflow.

Chest PainDRG Chest PainDRG 313Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyEmergency MedicineHospital Revenue

DRG 313 Overview

DRG 313 Chest Pain encompasses hospital inpatient admissions primarily for evaluation and management of chest pain without a qualifying acute myocardial infarction, arrhythmia, or heart failure. This Diagnosis-Related Group captures resource use for diagnostic testing, observation, and short inpatient stays aimed at determining cardiac versus noncardiac causes. It matters for Medicare payment because classification into DRG 313 determines bundled reimbursement for the inpatient encounter and influences hospital revenue and length-of-stay management. Accurate coding of diagnoses and procedures is key to appropriate assignment to this Diagnosis-Related Group.

National Payment Rates

Across payers the observed rate range spans roughly $370 to $25K, with the widest spread between the lowest and highest reported payer values shown in the table and chart below. Among named payers, Aetna, Anthem, Blue Cross Blue Shield (BCBS), and Cigna display median and quartile differences that drive much of this range. Refer to the payer table and accompanying chart for detailed percentile breakdowns by payer.

Mean Rates by Payer — National — DRG 313

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska, rates for DRG 313 range from $11K (Anthem and Blue Cross Blue Shield) to $17K (Cigna), a spread of about $6K across payers. Cigna’s mean sits above the state peers and represents the most notable deviation from the lower Anthem/BCBS rates. Reference the table and chart below for payer-level detail and distribution.

Key Insights for Alaska

Highest payer: Cigna at $17K; Lowest payer: Anthem and BCBS at $11K each.
Cigna in Alaska pays notably above Anthem/BCBS by about $6K, and Cigna’s $17K mean is roughly in line with national Cigna benchmarks but higher than the state’s other payers.

Clinical Trials

Acute diagnostic and risk-stratification trials: studies testing rapid diagnostic algorithms, point-of-care biomarkers, and imaging strategies in adult emergency department patients presenting with non-traumatic chest pain and suspected acute coronary syndrome. These trials enroll heterogeneous ED cohorts, often including low- to intermediate-risk patients, to evaluate time-to-diagnosis, safe discharge rates, and reductions in unnecessary hospital admissions. Results inform protocols that can reduce inpatient utilization and costs while ensuring high-risk patients are identified early, which is critical for both clinicians managing immediate care and payers controlling short-stay admissions for this DRG.
Comparative effectiveness studies of inpatient management pathways: randomized or observational studies comparing different inpatient care bundles (for example, observation-unit protocols versus full admission, expedited cardiology consultation versus standard care, or variations in telemetry and testing intensity) in patients admitted primarily for chest pain without initial evidence of myocardial infarction. These trials focus on length of stay, downstream testing, readmission rates, and diagnostic yield across typical chest-pain admission populations, including older adults and those with multiple comorbidities. Findings guide best practices for resource utilization and appropriate level-of-care decisions, directly impacting reimbursement, DRG assignment, and cost-containment strategies used by hospitals and payers.
Post-discharge outcomes and secondary prevention research: longitudinal cohort studies and interventional trials that follow patients discharged after a chest pain admission to evaluate adherence to follow-up testing, cardiovascular risk modification programs, and rates of major adverse cardiovascular events or repeat ED visits. These studies often target subgroups identified during the index visit (e.g., patients with non-obstructive coronary disease, unstable angina diagnosis, or multiple risk factors) to assess which discharge planning and outpatient interventions reduce recurrence and rehospitalization. Results are relevant to clinicians and payers because improved post-discharge management can lower readmission penalties, reduce long-term costs, and improve risk-adjusted outcomes associated with the DRG.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$6.9K	$37K	$5.2K	22K

Acute diagnostic and risk-stratification trials: studies testing rapid diagnostic algorithms, point-of-care biomarkers, and imaging strategies in adult emergency department patients presenting with non-traumatic chest pain and suspected acute coronary syndrome. These trials enroll heterogeneous ED cohorts, often including low- to intermediate-risk patients, to evaluate time-to-diagnosis, safe discharge rates, and reductions in unnecessary hospital admissions. Results inform protocols that can reduce inpatient utilization and costs while ensuring high-risk patients are identified early, which is critical for both clinicians managing immediate care and payers controlling short-stay admissions for this DRG.
Comparative effectiveness studies of inpatient management pathways: randomized or observational studies comparing different inpatient care bundles (for example, observation-unit protocols versus full admission, expedited cardiology consultation versus standard care, or variations in telemetry and testing intensity) in patients admitted primarily for chest pain without initial evidence of myocardial infarction. These trials focus on length of stay, downstream testing, readmission rates, and diagnostic yield across typical chest-pain admission populations, including older adults and those with multiple comorbidities. Findings guide best practices for resource utilization and appropriate level-of-care decisions, directly impacting reimbursement, DRG assignment, and cost-containment strategies used by hospitals and payers.
Post-discharge outcomes and secondary prevention research: longitudinal cohort studies and interventional trials that follow patients discharged after a chest pain admission to evaluate adherence to follow-up testing, cardiovascular risk modification programs, and rates of major adverse cardiovascular events or repeat ED visits. These studies often target subgroups identified during the index visit (e.g., patients with non-obstructive coronary disease, unstable angina diagnosis, or multiple risk factors) to assess which discharge planning and outpatient interventions reduce recurrence and rehospitalization. Results are relevant to clinicians and payers because improved post-discharge management can lower readmission penalties, reduce long-term costs, and improve risk-adjusted outcomes associated with the DRG.

OpenPayer

Summary & Overview

Chest Pain: Inpatient Reimbursement Overview

DRG 313 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