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

DRG 413 encompasses cholecystectomy with common duct exploration without Complication or Comorbidity or Major Complication or Comorbidity and represents a defined surgical cohort for inpatient claims. Accurate coding of the cholecystectomy, common duct exploration, and absence of Complication or Comorbidity or Major Complication or Comorbidity is essential because it affects Diagnosis-Related Group assignment and Medicare inpatient reimbursement.

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DRG 413 Overview

DRG 413 covers inpatient admissions for cholecystectomy with common duct exploration without Complication or Comorbidity or Major Complication or Comorbidity. It includes surgical management of gallbladder disease when a common bile duct procedure is performed and no additional Complication or Comorbidity or Major Complication or Comorbidity is coded. This Diagnosis-Related Group matters for Medicare inpatient payment because it groups cases with similar resource use for prospective payment. Correct coding of procedures and principal diagnosis determines assignment to this Diagnosis-Related Group and influences reimbursement.

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

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DRG 413 Overview

National Payment Rates

Across commercial payers the observed rate range runs from about $15K (BCBS minimum) up to $62K (Anthem maximum), with mean payer rates clustering between $15K and $27K. The widest spread appears between Anthem (max $62K) and BCBS (min $15K). See the table and chart below for payer‑level detail and distribution.

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 ($14.4k), average submitted covered charges ($82.1k), average Medicare payment ($11.3k), and total discharges (107) for DRG 413.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$14K	$82K	$11K	110

Patient Population

This DRG’s population is mixed but skews toward working‑age adults rather than exclusively Medicare‑age patients. Commercial payers (Cigna, Aetna, Anthem, BCBS) capture a substantial portion of encounters, indicating a notable non‑Medicare (working‑age) component alongside Medicare beneficiaries. The presence of 107 Medicare discharges in the CMS data indicates meaningful Medicare representation but not dominance.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska, DRG 413 payments range from roughly $7.5K at the low end to about $71K at the high end across payers, with state medians clustering near $26K for BCBS/Anthem and about $40K for Cigna. Cigna stands out as the notable deviation from broader national patterns, paying substantially higher medians and maximums in this state. Reference the table and chart below for payer-level distributions and percentiles.

Key Insights for Alaska

Highest payer: Cigna (median $40K; max $71K) — pays materially above other local payers.
Lowest payer: BCBS/Anthem (median $26K; min $7.5K) — clustered at lower end of the state range.
Alaska’s payers skew higher than national medians for some payers (notably Cigna’s median ~ $40K versus national medians around $25–$28K), while BCBS/Anthem in AK align with or slightly above national medians for those payers.

Clinical Trials

Perioperative analgesia and opioid-sparing protocols: randomized and pragmatic clinical studies evaluating multimodal analgesic regimens, regional anesthesia (e.g., nerve blocks), or non-opioid medications during and immediately after laparoscopic cholecystectomy with common duct exploration. These trials enroll adult inpatients undergoing cholecystectomy with CDE to quantify pain control, opioid consumption, complication rates, and length of stay. Results inform providers on safer, recovery-accelerating anesthesia strategies and help payers anticipate resource use and readmission risk tied to perioperative pain management.
Comparative effectiveness of surgical approaches and intraoperative imaging strategies: prospective cohort studies and randomized trials comparing laparoscopic versus mini-open approaches, single- versus multi-port techniques, or the use of routine intraoperative cholangiography/fluoroscopy versus selective imaging during cholecystectomy with CDE. These studies focus on operative time, bile duct injury, retained stones, conversion rates, and short-term morbidity in typical adult surgical populations with gallstone disease and common bile duct stones. Evidence from this research guides surgeons on technique choices that reduce complications and re-interventions, and provides payers with data on procedure-related costs and downstream utilization.
Post-discharge recovery, complication surveillance, and health services outcomes: observational studies and registry analyses tracking readmissions, postoperative infections, retained stone management, functional recovery, and patient-reported outcomes for 30–90 days after discharge following cholecystectomy with CDE. These investigations target real-world patients including older adults and those with comorbidities to identify predictors of adverse outcomes and resource-intensive post-acute care needs. Findings are relevant to hospital quality improvement, discharge planning, and payer assessments of bundled payments or case-mix adjustments based on risk of post-discharge utilization.

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

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

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

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

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

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References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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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.

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National Payment Rates

Mean Rates by Payer — National — DRG 413

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$14K	$82K	$11K	110

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 413

Key Insights for Alaska

Highest payer: Cigna (median $40K; max $71K) — pays materially above other local payers.
Lowest payer: BCBS/Anthem (median $26K; min $7.5K) — clustered at lower end of the state range.
Alaska’s payers skew higher than national medians for some payers (notably Cigna’s median ~ $40K versus national medians around $25–$28K), while BCBS/Anthem in AK align with or slightly above national medians for those payers.

Clinical Trials

Perioperative analgesia and opioid-sparing protocols: randomized and pragmatic clinical studies evaluating multimodal analgesic regimens, regional anesthesia (e.g., nerve blocks), or non-opioid medications during and immediately after laparoscopic cholecystectomy with common duct exploration. These trials enroll adult inpatients undergoing cholecystectomy with CDE to quantify pain control, opioid consumption, complication rates, and length of stay. Results inform providers on safer, recovery-accelerating anesthesia strategies and help payers anticipate resource use and readmission risk tied to perioperative pain management.
Comparative effectiveness of surgical approaches and intraoperative imaging strategies: prospective cohort studies and randomized trials comparing laparoscopic versus mini-open approaches, single- versus multi-port techniques, or the use of routine intraoperative cholangiography/fluoroscopy versus selective imaging during cholecystectomy with CDE. These studies focus on operative time, bile duct injury, retained stones, conversion rates, and short-term morbidity in typical adult surgical populations with gallstone disease and common bile duct stones. Evidence from this research guides surgeons on technique choices that reduce complications and re-interventions, and provides payers with data on procedure-related costs and downstream utilization.
Post-discharge recovery, complication surveillance, and health services outcomes: observational studies and registry analyses tracking readmissions, postoperative infections, retained stone management, functional recovery, and patient-reported outcomes for 30–90 days after discharge following cholecystectomy with CDE. These investigations target real-world patients including older adults and those with comorbidities to identify predictors of adverse outcomes and resource-intensive post-acute care needs. Findings are relevant to hospital quality improvement, discharge planning, and payer assessments of bundled payments or case-mix adjustments based on risk of post-discharge utilization.

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

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Showing 1–10 of 35

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

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

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DRG 413 Overview

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

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DRG 413 Overview

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References