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 Digestive SystemDRG 378-gastrointestinal-hemorrhage-with-cc
    Ask Trek AI about this page

    Gastrointestinal Hemorrhage with CC: Inpatient Reimbursement Overview

    DRG 378 addresses inpatient admissions for gastrointestinal hemorrhage with a Complication or Comorbidity, defining the clinical scope for cases with additional complexity that increase resource use. Correct assignment impacts Medicare payment because the Diagnosis-Related Group determines bundled reimbursement for the hospital stay under Centers for Medicare & Medicaid Services grouping rules.

    Customize your policy alerts

    Sign up for drg 378 policy alerts

    Get alerted when payer policies referencing 378 are released or updated.

    Monitor payer policy activity

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

    DRG 378 Overview

    DRG 378 covers hospital inpatient cases for gastrointestinal bleeding when a Complication or Comorbidity is present. Typical clinical examples include upper or lower gastrointestinal hemorrhage with associated conditions that increase resource use, such as anemia or anticoagulation management. This Diagnosis-Related Group matters for Medicare payment because it groups clinically similar cases to determine bundled reimbursement based on expected resource consumption during the inpatient stay. Accurate coding of the bleeding diagnosis and any Complication or Comorbidity influences the payment classification under Centers for Medicare & Medicaid Services rules.

    Table of contents

    Progress1 / 5

    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

    National Payment Rates

    Across payers the observed mean payment benchmarks range from about $9.3K (BCBS) to $16K (Cigna and Aetna), with payer-level medians spanning roughly $9.3K to $17K; the full range across the sample runs approximately $370 up to $36K. The widest spread is seen with Anthem (min $390 to max $36K), indicating substantial variability in negotiated rates; see the table and chart below for payer-level percentiles. Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem are shown in the visuals.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($9.0k), average submitted covered charges ($45.9k), average Medicare payment amount ($7.1k), and total discharges (82.6k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $9K$46K$7.1K83K

    Patient Population

    This DRG’s population includes a mix of Medicare-age and working-age adults, but claims and utilization tend to skew toward Medicare beneficiaries given the prominence of inpatient stays in older age groups. Commercial payers cover a portion of the caseload through working-age adults and dependents, resulting in a mixed payer distribution. The overall mix typically reflects higher representation of Medicare-aged patients relative to purely commercial cohorts.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 378 payer means range from $15K (Blue Cross Blue Shield and Anthem) up to $24K (Cigna), with observed payments spanning $15K–$39K across payers. The most notable deviation from national averages is Cigna’s higher mean and upper tail, producing a substantially larger max ($39K) than typical national maxima. See the table and chart below for payer-specific percentiles and distribution.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $24K); Lowest payers: BCBS and Anthem (both mean $15K).
    • Alaska’s rate range is relatively wide ($15K–$39K) driven by Cigna’s higher max and mean, representing a meaningful upward deviation versus national medians where most payers cluster around $15K–$17K.

    Clinical Trials

    • Acute hemostatic intervention trials: randomized or controlled studies evaluating endoscopic, interventional radiology, or pharmacologic strategies to achieve rapid control of active gastrointestinal bleeding in hospitalized patients. These studies typically enroll patients admitted with upper or lower GI hemorrhage who have hemodynamic instability or high-risk stigmata on endoscopy, and compare time-to-hemostasis, transfusion requirements, and in-hospital complications across interventions. Findings inform inpatient clinical pathways, resource utilization (e.g., need for ICU, repeat procedures), and short-term reimbursement implications tied to length of stay and procedure coding.
    • Comparative effectiveness and risk-stratification studies in anticoagulated or comorbid populations: observational cohort studies or pragmatic trials assessing different management algorithms for patients on antithrombotic therapy or with significant comorbidities (cardiovascular disease, renal failure, cirrhosis) who present with GI bleeding. Research questions include optimal timing of anticoagulation reversal or resumption, risk prediction of rebleeding versus thrombotic events, and tailoring endoscopic approaches in higher-risk groups. Results are relevant to clinicians and payers because they affect readmission risk, rates of CC/MCC capture, and decisions about monitoring intensity and discharge planning that drive inpatient costs.
    • Post-discharge outcomes and care-transition studies: prospective studies or quality-improvement trials testing interventions such as structured follow-up, outpatient endoscopy scheduling, or medication reconciliation to reduce readmissions and late rebleeding after an inpatient stay for gastrointestinal hemorrhage. These studies enroll survivors of an index hospitalization (often older adults with multiple comorbidities) and measure 30–90 day readmission, outpatient procedure completion, and patient-centered outcomes like functional status. Evidence from this research guides resource allocation for discharge planning, case management, and bundled-payment models by demonstrating which post-acute strategies lower downstream utilization and improve value for payers and providers.

    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.
    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.

    Mean Rates by Payer — National — DRG 378
    Mean Rates by Payer — Alaska — DRG 378