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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Digestive SystemDRG 370-major-esophageal-disorders-without-cc-mcc
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    Major Esophageal Disorders without CC/MCC: Inpatient Reimbursement Overview

    DRG 370 encompasses major esophageal disorders without a Complication or Comorbidity or Major Complication or Comorbidity and includes conditions such as motility disorders and uncomplicated strictures that require inpatient care. It matters for inpatient reimbursement because Medicare payment is grouped by Diagnosis-Related Group to reflect expected resource use for cases without higher-severity comorbidities.

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    DRG 370 Overview

    DRG 370 covers hospital inpatient stays for major esophageal disorders that do not carry a Complication or Comorbidity or a Major Complication or Comorbidity. Typical clinical cases include esophageal motility disorders, non-perforated strictures, and other significant esophageal conditions treated medically or with non-complex procedures. This Diagnosis-Related Group matters for Medicare payment because it groups patients with similar clinical complexity and expected resource use to determine bundled reimbursement. Hospitals use the DRG assignment to anticipate payment relative to case mix and length of stay.

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    National Payment Rates

    Across payers the negotiated rates for DRG 370 range roughly from $6.2K to $27K, with the widest spread driven by Anthem versus BCBS/Cigna/Aetna. Refer to the table and chart below for payer-level quartiles and the distribution of contracted rates. Payer variability highlights differing commercial reimbursement patterns across Aetna, Anthem, BCBS, and Cigna.

    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 370. Values reflect national aggregates for Medicare beneficiaries only.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $7.2K$36K$5.2K340

    Patient Population

    The DRG 370 population typically includes a mix of Medicare-age and working-age patients, but skews more toward Medicare beneficiaries given the inpatient inpatient billing captured in CMS data. Commercial payers (Aetna, Anthem, BCBS, Cigna) cover a portion of admissions, representing working-age and employer-covered individuals. Overall, the distribution reflects both Medicare and private/commercial coverage with a Medicare predominance in inpatient utilization.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska exhibits a notable payer range for DRG 370, with Cigna paying up to $28K (mean $17K) while Anthem and Blue Cross Blue Shield are clustered at $11K across percentiles. This represents a sizable deviation from national central tendencies, where medians for comparable payers are generally lower and less dispersed. Reference the table and chart below for the full percentile breakdown by payer.

    Key Insights for Alaska

    • Highest paying payer: Cigna (max $28K, mean $17K); Lowest paying payers: Anthem and Blue Cross Blue Shield (both mean $11K, max $11K).
    • Alaska’s mean reimbursement centers around Cigna at $17K versus Anthem/BCBS at $11K, a meaningful state-level spread that exceeds typical national medians and highlights a substantial payer-driven variation.

    Clinical Trials

    • Acute endoscopic and perioperative management studies: randomized or prospective cohort studies focusing on timing, techniques, and perioperative care for patients undergoing endoscopic dilation, stenting, or surgical interventions for major esophageal disorders (eg, severe achalasia, refractory strictures, or large motility-related obstruction) during the index hospitalization. These trials enroll inpatients with acute obstructive symptoms or those requiring urgent procedural intervention and compare procedural approaches, sedation/anesthesia strategies, and short-term complication mitigation protocols. Results are directly relevant to providers and payers because they inform resource utilization, length of stay, complication rates, and immediate hospital costs tied to DRG payments.
    • Comparative effectiveness and quality-of-life trials for definitive therapies: pragmatic comparative studies evaluating longer-term outcomes of different definitive treatment strategies (eg, myotomy variants, endoscopic myotomy vs surgical options, or different dilation protocols) in patients who present electively or during hospitalization for major esophageal disease but require durable therapy. These studies follow patients across the care continuum to assess symptom control, readmission rates, downstream healthcare use, and functional outcomes over months to years, capturing real-world effectiveness rather than surrogate physiologic measures. Findings guide clinicians and payers on which approaches yield better long-term value, reduced rehospitalizations, and improved patient-reported outcomes relevant to bundled payment and post-acute care planning.
    • Post-discharge outcomes, readmission prevention, and care coordination research: observational cohorts and interventional studies testing discharge planning, outpatient monitoring, rehabilitation, and nutrition support strategies for patients discharged after treatment for major esophageal disorders, including those with feeding tube dependence or complex dysphagia. These studies target patients at high risk for early readmission, aspiration, or malnutrition and evaluate interventions such as structured follow-up, telemonitoring, and integrated multidisciplinary clinics to reduce complications after hospital discharge. This research area matters to hospital administrators and payers because reducing 30-day readmissions, preventing post-acute complications, and optimizing transitions of care can substantially affect total cost of care and DRG-based reimbursement performance.

    Related Codes

    326-STOMACH-ESOPHAGEAL-AND-DUODENAL-PROCEDURES-WITH-MCC

    Stomach, Esophageal and Duodenal Procedures with MCC: Inpatient Reimbursement Overview

    327-STOMACH-ESOPHAGEAL-AND-DUODENAL-PROCEDURES-WITH-CC

    Stomach, Esophageal and Duodenal Procedures with CC: Inpatient Reimbursement Overview

    328-STOMACH-ESOPHAGEAL-AND-DUODENAL-PROCEDURES-WITHOUT-CC-MCC

    Stomach, Esophageal and Duodenal Procedures without CC/MCC: Inpatient Reimbursement Overview

    329-MAJOR-SMALL-AND-LARGE-BOWEL-PROCEDURES-WITH-MCC

    Major Small and Large Bowel Procedures with MCC: Inpatient Reimbursement Overview

    330-MAJOR-SMALL-AND-LARGE-BOWEL-PROCEDURES-WITH-CC

    Major Small and Large Bowel Procedures with CC: Inpatient Reimbursement Overview

    331-MAJOR-SMALL-AND-LARGE-BOWEL-PROCEDURES-WITHOUT-CC-MCC

    Major Small and Large Bowel Procedures without CC/MCC: Inpatient Reimbursement Overview

    332-RECTAL-RESECTION-WITH-MCC

    Rectal Resection with MCC: Inpatient Reimbursement Overview

    333-RECTAL-RESECTION-WITH-CC

    Rectal Resection with CC: Inpatient Reimbursement Overview

    334-RECTAL-RESECTION-WITHOUT-CC-MCC

    Rectal Resection without CC/MCC: Inpatient Reimbursement Overview

    335-PERITONEAL-ADHESIOLYSIS-WITH-MCC

    Peritoneal Adhesiolysis with MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 57

    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.
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    Mean Rates by Payer — National — DRG 370
    Mean Rates by Payer — Alaska — DRG 370