Disorders of Pancreas Except Malignancy DRG 440 Payment Rates

Summary & Overview

Disorders of Pancreas Except Malignancy without CC/MCC: Inpatient Reimbursement Overview

DRG 440 covers disorders of the pancreas except malignancy without Complication or Comorbidity or Major Complication or Comorbidity, typically including acute pancreatitis and other benign pancreatic conditions managed without significant complications. It matters for inpatient reimbursement because this Diagnosis-Related Group defines a lower resource payment tier under Medicare for straightforward pancreatic admissions compared with complicated or malignant pancreatic disease.

Disorders of Pancreas Except Malignancy without CC/MCCDRG Disorders of Pancreas Except Malignancy without CC/MCCDRG 440Diagnosis-Related GroupInpatient ReimbursementMedicareGastroenterologyGeneral SurgeryAcute Pancreatitis

DRG 440 Overview

DRG 440 covers non-malignant disorders of the pancreas without a Complication or Comorbidity or Major Complication or Comorbidity, typically including acute pancreatitis and other benign pancreatic conditions managed medically or with limited intervention. This Diagnosis-Related Group groups cases with lower resource use compared with pancreatic disease with complications, affecting payment relative to more severe pancreatic DRGs. Hospitals use DRG 440 assignment to determine Medicare inpatient reimbursement under the inpatient prospective payment system, aligning payment with expected resource consumption for straightforward pancreatic admissions. Accurate coding of diagnoses and procedures is critical to ensure appropriate classification into this Diagnosis-Related Group.

National Payment Rates

Payer rates for DRG 440 range from about $370 (BCBS minimum) up to $24K (Anthem maximum) across the sample payers shown; the mean payer-level averages cluster between roughly $6.2K (BCBS) and $10K (Aetna/Cigna). The widest spread between minimum and maximum observed values is Anthem at $24K versus BCBS low values near $370, appearing in the table and chart below. Refer to the table and chart for payer-specific quartiles and distribution details.

Mean Rates by Payer — National — DRG 440

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer rates in Alaska for DRG 440 range from about $9.7K (Blue Cross Blue Shield and Anthem) up to $15K mean with a $25K maximum for Cigna. The most notable deviation versus national averages is Cigna’s elevated upper-end and mean relative to the national distribution. Reference the table and chart below for payer-level detail and visual comparison.

Key Insights for Alaska

Highest paying payer: Cigna (mean $15K, max $25K); Lowest paying payer: Blue Cross Blue Shield and Anthem (mean $9.7K).
Cigna’s mean and upper-end ($25K max) sit meaningfully above the national means presented, while BCBS/Anthem in Alaska align below the national mean range.

Clinical Trials

Acute interventional trials evaluating minimally invasive or endoscopic drainage techniques for acute pancreatitis or pancreatic fluid collections: These studies compare procedural approaches (endoscopic transluminal drainage, percutaneous drainage, or early minimally invasive necrosectomy) in hospitalized patients with necrotizing or complicated non-malignant pancreatic disorders. The patient population includes adults admitted with severe or complicated pancreatitis or symptomatic pseudocysts; outcomes focus on short-term clinical recovery, organ failure, procedure-related complications, and length of stay, which directly affect inpatient resource use and reimbursement. Such research is relevant to providers and payers because demonstrating safer, more efficient acute interventions can reduce ICU utilization, reoperation rates, and overall hospitalization costs for DRG 440 admissions.
Comparative effectiveness studies of inpatient medical management strategies for non-malignant pancreatic disorders: These trials examine different medical approaches (for example, early aggressive fluid resuscitation protocols, nutritional strategies such as enteral versus delayed feeding, or standardized pain and opioid-sparing pathways) in patients hospitalized with interstitial or mild-moderate pancreatitis. The studied population typically comprises adults with non-necrotizing pancreatitis who do not require immediate invasive procedures; primary outcomes include complication rates, opioid consumption, time to oral intake, and hospital length of stay. Findings guide clinicians and payers on best practices that can lower variability in care, improve patient throughput under DRG 440, and potentially reduce readmissions and costs through evidence-based inpatient protocols.
Post-discharge and outcomes research on readmission prevention and longitudinal quality of life after non-malignant pancreatic disease hospitalizations: These prospective cohort studies or randomized care-coordination trials target patients discharged after an index admission for pancreatitis or other non-malignant pancreatic disorders, testing interventions such as structured transition-of-care programs, early outpatient follow-up, or remote monitoring to prevent early readmission. The population includes patients at higher risk for recurrence or complications (older adults, those with alcohol- or gallstone-related etiologies, or with comorbid substance use), and outcomes include 30- to 90-day readmission rates, emergency department utilization, and patient-reported function and pain. This research is important to providers and payers because reducing preventable readmissions and improving functional recovery directly affects downstream costs and quality metrics tied to DRG performance.

Disorders of the Biliary Tract without CC/MCC: Inpatient Reimbursement Overview

425-OTHER-HEPATOBILIARY-OR-PANCREAS-O-R-PROCEDURES-WITHOUT-CC-MCC

Other Hepatobiliary or Pancreas O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

432-CIRRHOSIS-AND-ALCOHOLIC-HEPATITIS-WITH-MCC

Cirrhosis and Alcoholic Hepatitis with MCC: Inpatient Reimbursement Overview

436-MALIGNANCY-OF-HEPATOBILIARY-SYSTEM-OR-PANCREAS-WITH-CC

Malignancy of Hepatobiliary System or Pancreas with CC: Inpatient Reimbursement Overview

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

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

437-MALIGNANCY-OF-HEPATOBILIARY-SYSTEM-OR-PANCREAS-WITHOUT-CC-MCC

Malignancy of Hepatobiliary System or Pancreas without CC/MCC: Inpatient Reimbursement Overview

423-OTHER-HEPATOBILIARY-OR-PANCREAS-O-R-PROCEDURES-WITH-MCC

Other Hepatobiliary or Pancreas O.R. Procedures with MCC: Inpatient Reimbursement Overview

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

Pancreas, Liver and Shunt Procedures with CC: 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

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

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

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OpenPayer

Summary & Overview

Disorders of Pancreas Except Malignancy without CC/MCC: Inpatient Reimbursement Overview

DRG 440 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