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.

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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.

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, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 313. Values reflect Medicare FFS payment activity at the national level for 2023.

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

Patient Population

This DRG’s population is mixed but skews toward the Medicare-age cohort rather than exclusively working-age patients. Medicare fee-for-service discharges represent a substantial share of inpatient volume relative to commercial payers, while private/commercial coverage continues to contribute a meaningful portion of younger, working-age patients. Overall payer mix reflects both Medicare and commercial populations, with a tilt toward Medicare-age individuals.

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.

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 313

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

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 313

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.

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.