Summary & Overview

Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E.: Inpatient Reimbursement Overview

DRG 410 encompasses biliary tract procedures other than only cholecystectomy performed without Complication or Comorbidity or Major Complication or Comorbidity, focusing on biliary stone extraction and related interventions. It matters for inpatient reimbursement because the Diagnosis-Related Group assignment defines the Medicare payment bundle and reflects expected resource use for surgical and gastroenterology care.

Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. without CC/MCCDRG Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. without CC/MCCDRG 410Diagnosis-Related GroupInpatient ReimbursementMedicareSurgeryGastroenterologyBile Duct Procedures

DRG 410 Overview

DRG 410 covers inpatient admissions for biliary tract procedures other than isolated cholecystectomy, including procedures with or without common duct exploration, when no Complication or Comorbidity or Major Complication or Comorbidity is present. These cases typically include endoscopic or open biliary stone removal, bile duct repair, or drainage procedures without additional severe diagnoses. This Diagnosis-Related Group determines bundled hospital payment under Medicare based on the primary procedure and associated resource use. Accurate grouping affects reimbursement and administrative billing for surgical and gastroenterology services.

National Payment Rates

Payer rates for DRG 410 range from around $370 (BCBS minimum) up to $61K (Anthem maximum) across the national benchmarks shown in the table and chart below, with mean payer amounts spanning roughly $15K (BCBS) to $26K (Aetna/Cigna). The widest spread is between the lowest observed BCBS value and the highest observed Anthem value (about $60.6K). See the table and chart below for the full distribution by payer.

Mean Rates by Payer — National — DRG 410

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

The state payer mean range for DRG 410 spans from $25K to $38K, with Anthem and Blue Cross Blue Shield at the low end and Cigna at the high end. Cigna’s mean of $38K is the most notable deviation, sitting well above the other Alaska payers and above several national averages. See the table and chart below for the full payer-level distribution.

Key Insights for Alaska

Highest paying payer: Cigna (mean $38K) — substantially above other state payers.
Lowest paying payers: Anthem and Blue Cross Blue Shield (both mean $25K) — clustered at the low end of the state range.
State mean range ($25K–$38K) shows Cigna meaningfully above the Anthem/BCBS cluster and also above national means for several payers.

Clinical Trials

Randomized acute perioperative intervention trials assessing minimally invasive biliary tract procedures (endoscopic or laparoscopic bile duct exploration vs open surgical approaches) in adults undergoing biliary tract procedures except isolated cholecystectomy. These studies enroll patients with common bile duct stones, obstructive cholangitis, or benign/malignant biliary strictures requiring biliary tract intervention to compare immediate procedure-related outcomes such as procedure success, complication rates (bleeding, bile leak, infection), and length of stay. Results inform surgeons, interventional endoscopists, and hospital administrators about which approaches reduce complications and resource use in the index admission for DRG 410 patients.
Comparative effectiveness studies of perioperative bundles and care pathways (antibiotic timing/duration, ERAS protocols, and early mobilization) for patients with biliary tract procedures excluding only cholecystectomy, typically prospective cohort or pragmatic randomized studies. These trials focus on adults with acute cholangitis, choledocholithiasis, or biliary obstruction undergoing operative or endoscopic biliary interventions, measuring outcomes such as readmission, postoperative infection, intravenous antibiotic days, and total inpatient costs. Findings are directly relevant to payers and inpatient care teams seeking to standardize care, lower complication-driven CC/MCC escalation, and shorten length of stay under DRG-based reimbursement.
Post-discharge outcomes and health services research examining longer-term outcomes, quality of life, and readmission drivers after index biliary tract procedures in mixed adult populations including those with comorbidities (e.g., diabetes, liver disease). These observational or registry-based studies evaluate rates and causes of 30- and 90-day readmission, need for repeat biliary interventions, downstream outpatient resource utilization, and patient-reported functional recovery. Such evidence helps case managers and payers identify high-risk subgroups for transitional care programs, anticipate post-acute costs, and design interventions to reduce costly readmissions among DRG 410 cases.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$16K	$76K	$12K	200

Randomized acute perioperative intervention trials assessing minimally invasive biliary tract procedures (endoscopic or laparoscopic bile duct exploration vs open surgical approaches) in adults undergoing biliary tract procedures except isolated cholecystectomy. These studies enroll patients with common bile duct stones, obstructive cholangitis, or benign/malignant biliary strictures requiring biliary tract intervention to compare immediate procedure-related outcomes such as procedure success, complication rates (bleeding, bile leak, infection), and length of stay. Results inform surgeons, interventional endoscopists, and hospital administrators about which approaches reduce complications and resource use in the index admission for DRG 410 patients.
Comparative effectiveness studies of perioperative bundles and care pathways (antibiotic timing/duration, ERAS protocols, and early mobilization) for patients with biliary tract procedures excluding only cholecystectomy, typically prospective cohort or pragmatic randomized studies. These trials focus on adults with acute cholangitis, choledocholithiasis, or biliary obstruction undergoing operative or endoscopic biliary interventions, measuring outcomes such as readmission, postoperative infection, intravenous antibiotic days, and total inpatient costs. Findings are directly relevant to payers and inpatient care teams seeking to standardize care, lower complication-driven CC/MCC escalation, and shorten length of stay under DRG-based reimbursement.
Post-discharge outcomes and health services research examining longer-term outcomes, quality of life, and readmission drivers after index biliary tract procedures in mixed adult populations including those with comorbidities (e.g., diabetes, liver disease). These observational or registry-based studies evaluate rates and causes of 30- and 90-day readmission, need for repeat biliary interventions, downstream outpatient resource utilization, and patient-reported functional recovery. Such evidence helps case managers and payers identify high-risk subgroups for transitional care programs, anticipate post-acute costs, and design interventions to reduce costly readmissions among DRG 410 cases.

OpenPayer

Summary & Overview

Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E.: Inpatient Reimbursement Overview

DRG 410 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