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    OpenPayerBilling CodesDiseases and Disorders of the Digestive SystemDRG 392-esophagitis-gastroenteritis-and-miscellaneous-digestive-disorders-without-mcc
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    Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders: Inpatient Reimbursement Overview

    DRG 392 encompasses esophagitis, gastroenteritis, and miscellaneous digestive disorders without Major Complication or Comorbidity, covering primarily non-severe inflammatory and infectious digestive conditions. This grouping matters for inpatient reimbursement because it assigns a single prospective payment for typical lower-severity digestive admissions under Medicare.

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    DRG 392 Overview

    DRG 392 covers hospitalizations for esophagitis, gastroenteritis, and a range of miscellaneous digestive disorders without a Major Complication or Comorbidity. Typical cases include inflammatory or infectious conditions of the esophagus and stomach, acute gastroenteritis, and other non-severe digestive diagnoses that do not trigger higher-severity payment. This Diagnosis-Related Group is important for Medicare payment because it groups clinically related lower-severity digestive admissions into a single prospective payment rate, affecting hospital reimbursement and resource classification. Accurate coding and documentation determine assignment to this Diagnosis-Related Group rather than higher-severity groups.

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    National Payment Rates

    Payer rates range from a low of $1.1K (BCBS p25) up to $27K (Anthem max) across the commercial benchmarks, with mean rates clustered between roughly $7.2K and $13K depending on payer. Anthem and Aetna show the highest upper-end maximums, while BCBS reports the lowest median-level values. The widest spread between payer extremes is between the $1.1K benchmark point and the $27K maximum shown in the table and chart below.

    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 ($7.5k), average submitted covered charges ($38.3k), average Medicare payment amount ($5.5k), and total discharges (91.1k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $7.5K$38K$5.5K91K

    Patient Population

    This DRG’s patient population skews toward a mixed-age cohort with a meaningful portion of Medicare-age beneficiaries alongside working-age, commercially insured patients. Medicare fee-for-service volumes are substantial but commercial payers also contribute a sizable share of discharges, indicating a mixed payer mix rather than exclusively Medicare-aged or exclusively working-age.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    State rates for DRG 392 in Alaska range from roughly $7.5K up to $33K across payers, with mean values clustering near $13K–$19K. Cigna sits at the high end (mean $19K, max $33K), while Anthem and Blue Cross Blue Shield report lower central tendencies (median $12K, p25 $7.5K). Compared with national averages, Alaska’s Cigna mean is a notable upward deviation. See the table and chart below for detailed payer-level benchmarks.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $19K, max $33K); Lowest payer: Anthem/BCBS (mean $13K, min $7.5K).
    • Alaska’s mean rates skew higher for Cigna relative to national means, with Cigna’s $19K mean notably above national Cigna mean (~$13K), indicating a meaningful positive deviation.
    • Anthem and Blue Cross Blue Shield in AK align with lower end of state distribution (medians $12K, p25 $7.5K), close to or slightly above national medians for those payers.

    Clinical Trials

    • Acute management interventional studies: Trials testing rapid symptom control strategies for hospitalized patients presenting with severe esophagitis, gastroenteritis, or other acute digestive disorders (for example, studies of antiemetic protocols, IV rehydration regimens, or endoscopic hemostasis approaches). These studies enroll patients at presentation or during the inpatient stay to evaluate short‑term clinical endpoints such as time to symptom resolution, need for intensive care, length of stay, and readmission within 30 days. Results inform inpatient care pathways and resource use, helping providers optimize acute treatment and payers anticipate and manage short‑term costs associated with this DRG.
    • Comparative effectiveness and diagnostics studies: Prospective or pragmatic trials comparing diagnostic algorithms and medical management strategies for common non‑MCC digestive conditions (for instance, comparing early endoscopy versus conservative management in esophagitis with bleeding risk, or stool testing strategies for infectious gastroenteritis). These studies focus on heterogenous adult populations admitted for digestive complaints to determine which approaches yield better diagnostic yield, fewer complications, and lower unnecessary utilization. Findings guide evidence‑based selection of tests and treatments, influencing provider decision making and payer coverage policies to reduce variation and inappropriate use of high‑cost services.
    • Post‑discharge outcomes and health services research: Cohort studies and randomized implementation trials measuring post‑discharge outcomes such as 30‑ and 90‑day readmissions, outpatient follow‑up adherence, quality of life, and costs for patients hospitalized with esophagitis, gastroenteritis, or other non‑MCC digestive disorders. These studies often evaluate transitional care interventions (discharge education, care coordination, telehealth follow‑up) in older adults and patients with comorbidities who are at higher risk of return visits. Results are relevant to hospitals and payers seeking to reduce readmissions, improve outpatient management, and align reimbursement and care pathways for this DRG.

    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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    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 392
    Mean Rates by Payer — Alaska — DRG 392