Hip and Femur Procedures Except Major Joint DRG Reimbursement

Summary & Overview

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

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.

Hip and Femur Procedures Except Major Joint without CC/MCCDRG Hip and Femur Procedures Except Major Joint without CC/MCCDRG 482Diagnosis-Related GroupInpatient ReimbursementMedicareOrthopedicsHip fracture repairFemur surgery

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.

National Payment Rates

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.

Mean Rates by Payer — National — DRG 482

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).

State Payment Rates

State: Alaska1 / 49

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.

Clinical Trials

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.

Hip Replacement with Principal Diagnosis of Hip Fracture with MCC: Inpatient Reimbursement Overview

561-AFTERCARE-MUSCULOSKELETAL-SYSTEM-AND-CONNECTIVE-TISSUE-WITHOUT-CC-MCC

Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC: Inpatient Reimbursement Overview

468-REVISION-OF-HIP-OR-KNEE-REPLACEMENT-WITHOUT-CC-MCC

Revision of Hip or Knee Replacement without CC/MCC: Inpatient Reimbursement Overview

498-LOCAL-EXCISION-AND-REMOVAL-OF-INTERNAL-FIXATION-DEVICES-OF-HIP-AND-FEMUR-WITH-CC-MCC

Local Excision and Removal of Internal Fixation Devices of Hip and Femur with CC/MCC: Inpatient Reimbursement Overview

551-MEDICAL-BACK-PROBLEMS-WITH-MCC

Medical Back Problems with Major Complication or Comorbidity: Inpatient Reimbursement Overview

504-FOOT-PROCEDURES-WITH-CC

Foot Procedures with CC: Inpatient Reimbursement Overview

510-SHOULDER-ELBOW-OR-FOREARM-PROCEDURES-EXCEPT-MAJOR-JOINT-PROCEDURES-WITH-MCC

Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures with MCC: Inpatient Reimbursement Overview

428-MULTIPLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL-WITHOUT-CC-MCC

Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC: Inpatient Reimbursement Overview

553-BONE-DISEASES-AND-ARTHROPATHIES-WITH-MCC

Bone Diseases and Arthropathies with MCC: Inpatient Reimbursement Overview

552-MEDICAL-BACK-PROBLEMS-WITHOUT-MCC

Medical Back Problems without MCC: Inpatient Reimbursement Overview

Showing 1–10 of 104

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.

OpenPayer

Summary & Overview

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

DRG 482 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