Single Level Combined Anterior and Posterior Spinal Fusion DRG Reimbursement

Summary & Overview

Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical: Inpatient Reimbursement Overview

DRG 402 addresses single level combined anterior and posterior spinal fusion procedures except those in the cervical spine, encompassing operative complexity and resource use. Accurate classification matters for inpatient reimbursement because it determines Diagnosis-Related Group assignment and the associated Medicare Severity Diagnosis-Related Group payment for hospitals.

Single Level Combined Anterior and Posterior Spinal Fusion Except CervicalDRG Single Level Combined Anterior and Posterior Spinal Fusion Except CervicalDRG 402Diagnosis-Related GroupInpatient ReimbursementMedicareSpine SurgeryOrthopedic SurgeryNeurosurgery

DRG 402 Overview

DRG 402 covers inpatient admissions for single level combined anterior and posterior spinal fusion procedures outside the cervical region. This captures complex thoracic or lumbosacral fusion operations that involve both anterior and posterior approaches at a single spinal level. It matters for Medicare payment because the surgical approach and resource intensity influence the Diagnosis-Related Group assignment and consequent Medicare Severity Diagnosis-Related Group reimbursement. Proper classification affects hospital payment for operative care, supply use, and length of stay.

National Payment Rates

Across payers the observed rate range for DRG 402 spans from $370 (minimum observed) up to $140K, with mean payer averages ranging roughly from $22K to $70K depending on insurer. The widest spread in observed values appears for Cigna and Aetna with maximums reaching $140K while some payers report minimums near the low hundreds, indicating high variability. See the accompanying table and chart below for payer-specific percentiles and distribution details.

Mean Rates by Payer — National — DRG 402

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 402. These columns provide aggregated payment and utilization metrics at the national level for Medicare FFS inpatient claims.

State Payment Rates

State: Alaska1 / 47

Alaska Benchmarks

Alaska’s DRG 402 state benchmarks are uniform across reported payers, with rates at $63K for both Anthem and Blue Cross Blue Shield, reflecting a narrow rate range across payers. This state-level rate is notably higher than many national median values and represents a marked deviation above typical national rates. Refer to the table and chart below for payer-specific percentiles and distribution.

Key Insights for Alaska

Anthem is the highest-paying payer in Alaska at $63K, while Blue Cross Blue Shield is the lowest-paying payer at $63K (effectively all reported payers pay the same rate).
Alaska’s uniform $63K state benchmark sits well above many national median values and aligns with the upper end of national distributions, indicating a meaningful positive deviation from typical national rates.

Clinical Trials

Perioperative enhanced recovery and surgical technique optimization studies: randomized or prospective cohort studies comparing different approaches to combined anterior-posterior single‑level thoracolumbar fusion (for example variations in incision strategy, staging of anterior versus posterior components, use of minimally invasive anterior access versus open exposure, and intraoperative adjuncts like navigation or neuromonitoring). These trials enroll adults undergoing single‑level combined anterior and posterior fusion for degenerative instability, deformity, trauma, or revision indications and measure intraoperative metrics (blood loss, operative time), complication rates (vascular, neural, graft/implant issues), and 30‑ to 90‑day morbidity. Results inform surgeons and hospitals about techniques that reduce perioperative complications and resource use, and help payers assess short‑term costs and readmission risk associated with specific operative strategies.
Comparative effectiveness and implant/biologic evaluation studies: pragmatic trials and registry‑based comparative studies assessing different posterior instrumentation constructs, anterior interbody structural grafts or cages, and adjunctive biologics (bone graft extenders or osteoinductive products) on fusion rates, alignment maintenance, and need for reoperation at 1–2 years. These studies typically enroll heterogeneous adult populations indicated for single‑level combined fusion (including degenerative spondylolisthesis, adjacent segment failure, or post‑traumatic instability) and stratify by bone quality, smoking status, and prior surgery to evaluate real‑world effectiveness. Findings are crucial for providers to select implants and grafting strategies that maximize fusion success and minimize revision, and for payers to evaluate long‑term cost‑effectiveness and coverage policies for higher‑cost implants or biologic adjuncts.
Post‑discharge outcomes, rehabilitation, and value‑based care studies: prospective cohort or interventional trials testing postoperative care pathways such as intensified inpatient rehabilitation versus standard therapy, opioid‑sparing multimodal analgesia and tapering protocols, and remote monitoring for early identification of complications and functional recovery trajectories over 90 days to 1 year. These studies focus on the typical DRG population discharged after single‑level combined fusion, including older adults with comorbidities and those at higher risk of prolonged opioid use or delayed recovery, and measure functional outcomes, pain scores, quality of life, discharge disposition, and total episode‑of‑care costs. Evidence from this research guides discharge planning, rehabilitation intensity, and bundled payment models, helping providers and payers reduce readmissions, improve functional recovery, and contain post‑acute care expenditures.

Amputation for Musculoskeletal System and Connective Tissue Disorders with CC: Inpatient Reimbursement Overview

541-OSTEOMYELITIS-WITHOUT-CC-MCC

Osteomyelitis without CC/MCC: Inpatient Reimbursement Overview

561-AFTERCARE-MUSCULOSKELETAL-SYSTEM-AND-CONNECTIVE-TISSUE-WITHOUT-CC-MCC

Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC: Inpatient Reimbursement Overview

474-AMPUTATION-FOR-MUSCULOSKELETAL-SYSTEM-AND-CONNECTIVE-TISSUE-DISORDERS-WITH-MCC

Amputation for Musculoskeletal System and Connective Tissue Disorders with MCC: Inpatient Reimbursement Overview

510-SHOULDER-ELBOW-OR-FOREARM-PROCEDURES-EXCEPT-MAJOR-JOINT-PROCEDURES-WITH-MCC

Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures with MCC: Inpatient Reimbursement Overview

478-BIOPSIES-OF-MUSCULOSKELETAL-SYSTEM-AND-CONNECTIVE-TISSUE-WITH-CC

Biopsies of Musculoskeletal System and Connective Tissue with CC: Inpatient Reimbursement Overview

462-BILATERAL-OR-MULTIPLE-MAJOR-JOINT-PROCEDURES-OF-LOWER-EXTREMITY-WITHOUT-MCC

Bilateral or Multiple Major Joint Procedures of Lower Extremity without MCC: Inpatient Reimbursement Overview

430-COMBINED-ANTERIOR-AND-POSTERIOR-CERVICAL-SPINAL-FUSION-WITHOUT-MCC

Combined Anterior and Posterior Cervical Spinal Fusion without MCC: Inpatient Reimbursement Overview

470-MAJOR-HIP-AND-KNEE-JOINT-REPLACEMENT-OR-REATTACHMENT-OF-LOWER-EXTREMITY-WITHOUT-MCC

Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC: Inpatient Reimbursement Overview

458-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-SPINAL-CURVATURE-MALIGNANCY-INFECTION-OR-EXTENSIVE-FUSIONS-WITHOUT-CC-MCC

Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions without CC/MCC: Inpatient Reimbursement Overview

Showing 1–10 of 104

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.

OpenPayer

Summary & Overview

Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical: Inpatient Reimbursement Overview

DRG 402 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