Summary & Overview

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.

Percutaneous Coronary Atherectomy with Intraluminal Device without MCCDRG Percutaneous Coronary Atherectomy with Intraluminal Device without MCCDRG 360Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyInterventional CardiologyCoronary Procedures

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.

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.

Mean Rates by Payer — National — DRG 360

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.

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.

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.

OpenPayer

Summary & Overview

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

DRG 360 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