Percutaneous Coronary Atherectomy with Intraluminal Device without MCC: Inpatient Reimbursement Overview

DRG 360 encompasses percutaneous coronary atherectomy with intraluminal device placement without Major Complication or Comorbidity, covering catheter-based plaque removal in coronary arteries. Proper classification matters for inpatient reimbursement because Medicare payment is determined by Diagnosis-Related Group assignment, which groups cases of similar resource use and influences hospital payment under the inpatient prospective payment system.

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DRG 360 Overview

DRG 360 covers hospital inpatient stays for percutaneous coronary atherectomy with placement of an intraluminal device and without Major Complication or Comorbidity. This category captures procedures to mechanically remove atherosclerotic plaque in coronary arteries with device assistance and excludes cases with the highest-severity comorbid conditions. It matters for Medicare payment because it groups similar resource-intensity hospitalizations for prospective payment and affects reimbursement rates tied to procedure complexity and patient status. Understanding the clinical scope helps hospitals classify cases correctly for accurate inpatient billing.

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Percutaneous Coronary Atherectomy with Intraluminal Device without MCC: Inpatient Reimbursement Overview

Customize your policy alerts

Sign up for drg 360 policy alerts

Get alerted when payer policies referencing 360 are released or updated.

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

DRG 360 Overview

National Payment Rates

Payer-negotiated rates for DRG 360 vary widely across commercial payers, with observed mean values ranging from $11K (Anthem) to $41K (Cigna) and individual payer maximums up to $77K. The widest spread between payer means is $30K (Cigna vs. Anthem). See the table and chart below for payer-specific percentiles and the full distribution across Aetna, Blue Cross Blue Shield, Cigna, and Anthem.

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 displays average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 360. These columns allow comparison of Medicare payment levels and utilization across the sampled cases.

Patient Population

This DRG’s patient population typically includes a mix of Medicare-age and working-age adults, with a meaningful share covered by Medicare fee-for-service alongside commercially insured patients. The distribution leans toward older adults given the procedural setting, but commercial payers also represent a substantial portion of cases, reflecting a mixed-age population. Payer mix therefore spans both Medicare beneficiaries and working-age, employer-sponsored insured individuals.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska exhibits a wide rate range across payers from $7.5K to $100K, driven largely by Cigna at $100K versus Blue Cross Blue Shield and Anthem at $7.5K. This state spread is notably greater than typical national patterns, with Cigna as a pronounced high outlier. See the table and chart below for payer-specific details.

Key Insights for Alaska

Highest payer: Cigna at $100K; Lowest payer(s): Blue Cross Blue Shield and Anthem at $7.5K.
Payer range in Alaska is very wide ($7.5K–$100K), with Cigna paying substantially above national medians for this DRG.

Clinical Trials

Acute procedural optimization trials examining immediate safety and effectiveness of percutaneous coronary atherectomy with intraluminal devices: these studies enroll patients presenting with focal or diffuse coronary artery lesions (including heavily calcified or in-stent restenosis) who are judged appropriate for atherectomy during an index percutaneous coronary intervention. The objective is to define procedural endpoints such as residual stenosis, acute lumen gain, peri-procedural myocardial infarction, and short-term vascular complications, which informs device selection and intraprocedural technique. Results are directly relevant to interventional teams and hospital payers because they impact length of stay, resource use in the catheterization lab, and immediate complication rates that drive inpatient costs for this DRG.
Comparative effectiveness studies contrasting atherectomy plus adjunctive therapy versus alternative revascularization strategies in high-risk coronary disease: these observational cohorts or randomized trials focus on populations with complex lesion morphology (e.g., severe calcification, chronic total occlusions, or recurrent restenosis) and aim to compare outcomes such as procedural success, repeat revascularization, and 30‑ to 90‑day readmission rates. The findings guide clinicians on when atherectomy provides incremental benefit over other PCI techniques or referral to surgical revascularization, and help payers and hospital administrators assess downstream utilization and total episode-of-care costs associated with each strategy.
Post-discharge outcomes and quality-of-care research evaluating recovery, functional status, and economic impact after atherectomy-containing PCI episodes: these studies follow patients after hospitalization to measure mid- to long-term endpoints such as recurrent ischemia, need for repeat procedures, medication adherence, patient-reported angina and quality of life, and subsequent healthcare utilization. This research is important for care managers and payers because it identifies predictors of readmission and post-acute resource needs, informing discharge planning, bundled payment models, and targeted interventions to reduce costly downstream events for patients in this 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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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.

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National Payment Rates

Mean Rates by Payer — National — DRG 360

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 360

Key Insights for Alaska

Highest payer: Cigna at $100K; Lowest payer(s): Blue Cross Blue Shield and Anthem at $7.5K.
Payer range in Alaska is very wide ($7.5K–$100K), with Cigna paying substantially above national medians for this DRG.

Clinical Trials

Acute procedural optimization trials examining immediate safety and effectiveness of percutaneous coronary atherectomy with intraluminal devices: these studies enroll patients presenting with focal or diffuse coronary artery lesions (including heavily calcified or in-stent restenosis) who are judged appropriate for atherectomy during an index percutaneous coronary intervention. The objective is to define procedural endpoints such as residual stenosis, acute lumen gain, peri-procedural myocardial infarction, and short-term vascular complications, which informs device selection and intraprocedural technique. Results are directly relevant to interventional teams and hospital payers because they impact length of stay, resource use in the catheterization lab, and immediate complication rates that drive inpatient costs for this DRG.
Comparative effectiveness studies contrasting atherectomy plus adjunctive therapy versus alternative revascularization strategies in high-risk coronary disease: these observational cohorts or randomized trials focus on populations with complex lesion morphology (e.g., severe calcification, chronic total occlusions, or recurrent restenosis) and aim to compare outcomes such as procedural success, repeat revascularization, and 30‑ to 90‑day readmission rates. The findings guide clinicians on when atherectomy provides incremental benefit over other PCI techniques or referral to surgical revascularization, and help payers and hospital administrators assess downstream utilization and total episode-of-care costs associated with each strategy.
Post-discharge outcomes and quality-of-care research evaluating recovery, functional status, and economic impact after atherectomy-containing PCI episodes: these studies follow patients after hospitalization to measure mid- to long-term endpoints such as recurrent ischemia, need for repeat procedures, medication adherence, patient-reported angina and quality of life, and subsequent healthcare utilization. This research is important for care managers and payers because it identifies predictors of readmission and post-acute resource needs, informing discharge planning, bundled payment models, and targeted interventions to reduce costly downstream events for patients in this 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

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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.