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    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 413-cholecystectomy-with-c-d-e-without-cc-mcc
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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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    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 PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $14K$82K$11K110

    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.

    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

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

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

    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

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    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 413
    Mean Rates by Payer — Alaska — DRG 413