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    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 410-biliary-tract-procedures-except-only-cholecystectomy-with-or-without-c-d-e-without-cc-mcc
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    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.

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    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.

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    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.

    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 410. These figures summarize national Medicare payment activity for the DRG in 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $16K$76K$12K200

    Patient Population

    This DRG’s population is mixed but skews toward the Medicare-age population given the presence of substantial Medicare inpatient utilization; many cases will be covered by Medicare fee-for-service rather than exclusively by commercial plans. Working-age commercial coverage also appears in the payer mix based on national commercial benchmarks, indicating a combination of Medicare and private/commercial payers. Overall, the patient population is best characterized as mixed with a stronger Medicare-age representation.

    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.

    Related Codes

    405-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITH-MCC

    Pancreas, Liver and Shunt Procedures with MCC: Inpatient Reimbursement Overview

    406-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITH-CC

    Pancreas, Liver and Shunt Procedures with CC: Inpatient Reimbursement Overview

    407-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITHOUT-CC-MCC

    Pancreas, Liver and Shunt Procedures without CC/MCC: Inpatient Reimbursement Overview

    408-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITH-MCC

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

    409-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITH-CC

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

    411-CHOLECYSTECTOMY-WITH-C-D-E-WITH-MCC

    Cholecystectomy with C.D.E. with MCC: Inpatient Reimbursement Overview

    412-CHOLECYSTECTOMY-WITH-C-D-E-WITH-CC

    Cholecystectomy with Common Duct Exploration with Complication or Comorbidity: Inpatient Reimbursement Overview

    413-CHOLECYSTECTOMY-WITH-C-D-E-WITHOUT-CC-MCC

    Cholecystectomy with C.D.E. without CC/MCC: Inpatient Reimbursement Overview

    414-CHOLECYSTECTOMY-EXCEPT-BY-LAPAROSCOPE-WITHOUT-C-D-E-WITH-MCC

    Cholecystectomy Except by Laparoscope without C.D.E. with MCC: Inpatient Reimbursement Overview

    415-CHOLECYSTECTOMY-EXCEPT-BY-LAPAROSCOPE-WITHOUT-C-D-E-WITH-CC

    Cholecystectomy Except by Laparoscope without C.D.E. with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 35

    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 410
    Mean Rates by Payer — Alaska — DRG 410