Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 314-other-circulatory-system-diagnoses-with-mcc
    Ask Trek AI about this page

    Other Circulatory System Diagnoses with MCC: Inpatient Reimbursement Overview

    DRG 314 includes other circulatory system diagnoses with a Major Complication or Comorbidity, representing higher-severity cardiovascular and vascular inpatient cases that drive greater resource use. It matters for inpatient reimbursement because the Major Complication or Comorbidity designation increases the Diagnosis-Related Group assignment and prospective payment from the Centers for Medicare & Medicaid Services.

    Customize your policy alerts

    Sign up for drg 314 policy alerts

    Get alerted when payer policies referencing 314 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 314 Overview

    DRG 314 covers inpatient admissions for other circulatory system diagnoses when a Major Complication or Comorbidity is present, encompassing a range of non-specific cardiac and vascular conditions that require significant resource use. This Diagnosis-Related Group groups higher-severity circulatory cases to adjust payment for increased clinical complexity and care intensity. It is important for Medicare payment because the presence of a Major Complication or Comorbidity increases the relative weight and thereby the prospective payment for the hospitalization. Hospitals and coders must accurately capture principal diagnosis and comorbid conditions to align clinical documentation with payment.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical Trials

    • Acute procedural and device trials assessing hemodynamic support or interventional techniques for critically ill patients with complex circulatory diagnoses: these studies enroll hospitalized adults with severe heart failure decompensation, cardiogenic shock, acute valvular pathology, or other high-acuity circulatory conditions requiring urgent catheter-based or mechanical support. The objective is to evaluate short-term safety and efficacy of interventions (for example modes of temporary mechanical circulatory support, refined percutaneous repair techniques, or optimized intraprocedural strategies) in stabilizing physiology and reducing in-hospital mortality and complication rates. Findings inform inpatient care pathways, resource utilization, and payer considerations around high-cost procedures and intensive care length of stay for DRG 314 patients.
    • Comparative effectiveness and care-delivery studies comparing medical management strategies and in-hospital pathways for complex circulatory diagnoses with major complications or comorbidities: these trials typically randomize or observationally compare different guideline-based pharmacologic protocols, timing of escalation to invasive therapies, or structured multidisciplinary heart team approaches in older adults and multimorbid patients who comprise much of the DRG 314 population. The focus is on outcomes such as in-hospital events, readmission rates, complication profiles, and cost-effectiveness of alternative treatment algorithms. Results are directly relevant to clinicians optimizing acute care decisions and to payers and hospitals aiming to reduce preventable complications, resource intensity, and variation in reimbursement-sensitive outcomes.
    • Post-discharge and transitional-care outcome studies targeting readmission prevention and rehabilitation in survivors of severe circulatory system events with major complications: these prospective cohort studies or randomized interventions enroll patients discharged after a DRG 314 hospitalization to test structured discharge planning, early outpatient follow-up, remote monitoring, cardiac rehabilitation enrollment, or home-based medication management. The research question centers on whether these post-acute interventions reduce 30- and 90-day readmissions, mortality, and downstream healthcare spending among a population with high comorbidity burden. Evidence from these studies guides hospitals and payers in designing transitional-care programs that can lower readmission penalties and improve long-term outcomes for this high-risk DRG group.

    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

    • More pages

    References

    1. 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. 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. 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.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.