Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 440-disorders-of-pancreas-except-malignancy-without-cc-mcc
    Ask Trek AI about this page

    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.

    Customize your policy alerts

    Sign up for drg 440 policy alerts

    Get alerted when payer policies referencing 440 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    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.

    Table of contents

    Progress1 / 5

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    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.

    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 ($6.2k), average submitted covered charges ($31.8k), average Medicare payment amount ($3.9k), and total discharges (5.9k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $6.2K$32K$3.9K6K

    Patient Population

    The DRG 440 population skews toward a mixed-age group with a meaningful Medicare component but also substantial representation from working-age, commercially insured patients. Medicare fee-for-service accounts for a sizeable share of inpatient discharges in the CMS dataset, indicating an important Medicare-age presence alongside private/commercial coverage. Overall, the payer mix should be considered mixed rather than exclusively Medicare-age or exclusively working-age.

    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.

    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

    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

    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.
    Published by

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

    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 440
    Mean Rates by Payer — Alaska — DRG 440