Hip and Femur Procedures Except Major Joint DRG Reimbursement

DRG 482 encompasses hip and femur procedures except major joint procedures for patients without Major Complication or Comorbidity or Complication or Comorbidity, focusing on operative treatments like fracture repairs. It matters for inpatient reimbursement because it defines a standardized payment category that reflects expected resource use and influences Medicare payment and hospital case-mix index reporting.

DRG 482 Overview

DRG 482 covers inpatient hospital admissions for hip and femur procedures except major joint replacement or reattachment for patients without a Major Complication or Comorbidity and without a Complication or Comorbidity. Typical cases include surgical interventions for femur fractures, hip fracture repairs not coded as major joint replacement, and related operative treatment when no significant comorbid conditions are documented. This Diagnosis-Related Group groups similar resource use to determine Medicare inpatient payment, making accurate coding of procedure and comorbidity status important for appropriate reimbursement. The classification affects payment tiers and hospital case-mix reporting under the Centers for Medicare & Medicaid Services payment methodology.

DRG 482 Overview

Across payers the observed rate range runs from about $15K to $60K, with the widest spread seen between Blue Cross Blue Shield and Anthem. The payer table and accompanying chart below summarize payer-specific distributions and quartiles. Note that commercial plans such as Blue Cross Blue Shield, Aetna, Cigna, and Anthem are shown alongside national aggregates for comparison.

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 ($14.2k), average submitted covered charges ($73.2k), average Medicare payment amount ($11.6k), and total discharges (15.3k).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$14K	$73K	$12K	15K

Patient Population

DRG 482 patients typically span both Medicare-age and working-age populations, reflecting a mixed-age cohort with a substantial Medicare representation. Payer mix often includes a large share of Medicare fee-for-service discharges alongside commercial coverage from major insurers. This distribution indicates neither exclusively Medicare-age nor exclusively working-age dominance but a blend across age groups.

Alaska Benchmarks

Alaska’s DRG 482 mean rates span from $25K (Anthem and Blue Cross Blue Shield) up to $39K (Cigna), showing a clear spread driven by Cigna’s higher mean. This represents a notable deviation from national medians where Anthem and BCBS national medians are higher than Alaska’s $25K, while Cigna in Alaska exceeds national median levels. See the table and chart below for payer-level detail.

Key Insights for Alaska

Highest payer: Cigna at a mean of $39K; Lowest payers: Anthem and Blue Cross Blue Shield (BCBS) both at $25K.
Alaska’s payer range is relatively tight for Anthem/BCBS at $25K but Cigna sits meaningfully above both and above national medians, indicating a higher rate outlier versus national benchmarks.

Acute perioperative optimization trials: randomized or pragmatic studies testing protocols for intraoperative anesthesia techniques, blood management strategies (eg, restrictive vs liberal transfusion thresholds), and short-term perioperative care bundles in patients undergoing hip fracture repairs or femur fracture fixation without major joint replacement. These trials focus on elderly, often frail patients with acute traumatic or fragility fractures who present for urgent surgical repair, aiming to reduce immediate complications such as bleeding, delirium, and cardiopulmonary events. Results are directly relevant to hospitals and payers by informing protocols that can shorten length of stay, lower complication-related costs, and standardize care pathways for this high-utilization DRG.
Comparative effectiveness studies of fixation techniques and implant choice: observational cohort studies or randomized trials comparing different surgical approaches and implants for hip and femur procedures (for example, intramedullary nailing versus plate fixation, or hemi‑arthroplasty versus internal fixation in specific fracture patterns). These studies enroll adults across a spectrum of bone quality and comorbidity profiles to evaluate outcomes such as reoperation rate, functional recovery, and short-term postoperative morbidity. Findings guide surgeons on technique selection that balances upfront OR time and implant costs with downstream outcomes, which matters to providers managing clinical risk and to payers estimating episode costs and readmission risk.
Post-discharge outcomes and rehabilitation interventions: trials and cohort studies assessing early mobilization programs, tailored inpatient-to-home transitional care, or structured rehab regimens versus usual care for patients after hip or femur procedures without major joint replacement. These studies typically include older patients with varying levels of baseline mobility and comorbidities, measuring 30–90 day functional status, return to independent living, and rates of readmission or post-acute facility use. Evidence from this research helps health systems and payers optimize post-acute resource allocation and reduce costly complications and readmissions associated with this DRG.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$14K	$73K	$12K	15K

Patient Population

Alaska Benchmarks

Key Insights for Alaska

Highest payer: Cigna at a mean of $39K; Lowest payers: Anthem and Blue Cross Blue Shield (BCBS) both at $25K.
Alaska’s payer range is relatively tight for Anthem/BCBS at $25K but Cigna sits meaningfully above both and above national medians, indicating a higher rate outlier versus national benchmarks.

Acute perioperative optimization trials: randomized or pragmatic studies testing protocols for intraoperative anesthesia techniques, blood management strategies (eg, restrictive vs liberal transfusion thresholds), and short-term perioperative care bundles in patients undergoing hip fracture repairs or femur fracture fixation without major joint replacement. These trials focus on elderly, often frail patients with acute traumatic or fragility fractures who present for urgent surgical repair, aiming to reduce immediate complications such as bleeding, delirium, and cardiopulmonary events. Results are directly relevant to hospitals and payers by informing protocols that can shorten length of stay, lower complication-related costs, and standardize care pathways for this high-utilization DRG.
Comparative effectiveness studies of fixation techniques and implant choice: observational cohort studies or randomized trials comparing different surgical approaches and implants for hip and femur procedures (for example, intramedullary nailing versus plate fixation, or hemi‑arthroplasty versus internal fixation in specific fracture patterns). These studies enroll adults across a spectrum of bone quality and comorbidity profiles to evaluate outcomes such as reoperation rate, functional recovery, and short-term postoperative morbidity. Findings guide surgeons on technique selection that balances upfront OR time and implant costs with downstream outcomes, which matters to providers managing clinical risk and to payers estimating episode costs and readmission risk.
Post-discharge outcomes and rehabilitation interventions: trials and cohort studies assessing early mobilization programs, tailored inpatient-to-home transitional care, or structured rehab regimens versus usual care for patients after hip or femur procedures without major joint replacement. These studies typically include older patients with varying levels of baseline mobility and comorbidities, measuring 30–90 day functional status, return to independent living, and rates of readmission or post-acute facility use. Evidence from this research helps health systems and payers optimize post-acute resource allocation and reduce costly complications and readmissions associated with this DRG.

OpenPayer

Hip and Femur Procedures Except Major Joint without CC/MCC: Inpatient Reimbursement Overview

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DRG 482 Overview

OpenPayer

Hip and Femur Procedures Except Major Joint without CC/MCC: Inpatient Reimbursement Overview

Sign up for drg 482 policy alerts

DRG 482 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