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Adrenal and Pituitary Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 614 covers inpatient adrenal and pituitary surgical procedures with Complication or Comorbidity or Major Complication or Comorbidity, focusing on cases with increased clinical complexity. It matters for inpatient reimbursement because the Complication or Comorbidity or Major Complication or Comorbidity status influences relative weights and payment under the Centers for Medicare & Medicaid Services system.

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DRG 614 Overview

DRG 614 encompasses inpatient admissions for adrenal and pituitary surgical procedures when a Complication or Comorbidity or a Major Complication or Comorbidity is present, reflecting more complex clinical care than routine endocrine procedures. This Diagnosis-Related Group groups cases by procedural focus on the adrenal glands and pituitary gland and captures the higher resource use associated with complications or comorbid conditions. It matters for Medicare payment because the presence of Complication or Comorbidity or Major Complication or Comorbidity elevates relative weights and reimbursement compared with non-CC/MCC surgical DRGs, affecting hospital revenue and case-mix considerations. Hospitals and coders must accurately document procedures and secondary diagnoses to ensure correct assignment to this Diagnosis-Related Group.

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Adrenal and Pituitary Procedures with CC/MCC: Inpatient Reimbursement Overview

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DRG 614 Overview

National Payment Rates

Payer rates in the benchmarks table range from a low of $370 up to $87K across payers, with the widest spread seen between Anthem (min $390 / max $87K) and BCBS (min $370 / max $64K). The payer-level distributions shown in the table and chart below illustrate substantial variability by payer. Refer to the table and chart for payer-specific quartiles and medians for Anthem, Aetna, Cigna, and BCBS.

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($26.1k), average submitted covered charges ($125.9k), average Medicare payment amount ($20.1k), and total discharges (2.1k).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$26K	$130K	$20K	2.1K

Patient Population

This DRG’s population includes a mix of Medicare-age and working-age patients, reflecting inpatient episodes billed to both Medicare and commercial payers. Medicare still represents a substantial portion of discharges given the presence of older adults in the case mix, while private/commercial payers cover a meaningful share of younger, working-age patients. Overall, the payer mix is mixed rather than exclusively Medicare-age or exclusively working-age.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Across payers in Alaska for DRG 614, mean rates range from $34K (Blue Cross Blue Shield and Anthem) up to $53K (Cigna), representing a narrow-to-moderate spread. The standout deviation is Cigna, whose $53K mean sits well above the state’s other payers and above many national averages. Reference the table and chart below for payer-specific percentiles and distribution details.

Key Insights for Alaska

Highest payer: Cigna at a mean of $53K; Lowest payers: BCBS and Anthem both at a mean of $34K.
Alaska’s mean range ($34K–$53K) shows Cigna paying materially above the other local payers and above many national means, while BCBS/Anthem sit below several national payer medians.

Clinical Trials

Perioperative complication reduction trials: randomized or pragmatic studies testing protocols (e.g., optimized hemodynamic management, steroid replacement strategies, or enhanced monitoring pathways) in patients undergoing adrenalectomy or transsphenoidal pituitary surgery for hormone-secreting or space-occupying lesions. These trials enroll the typical inpatient population captured by DRG 614 — adults with Cushing’s, pheochromocytoma, aldosteronism, nonfunctioning pituitary adenomas, or macroadenomas — and measure intraoperative hemodynamic events, postoperative electrolyte or adrenal insufficiency, length of stay, and complication rates. Results directly inform surgeons, endocrinologists, and inpatient care teams on best perioperative practices that can reduce costly complications and resource utilization relevant to hospital reimbursement and DRG payments.
Comparative effectiveness studies of surgical approaches and extent of resection: observational cohort studies or randomized trials comparing open adrenalectomy versus laparoscopic/robotic techniques, and microscopic versus endoscopic transsphenoidal approaches for pituitary tumors, including subgroup analyses by tumor size, hormonal activity, and comorbidity burden. These studies focus on clinical endpoints important to DRG management — operative time, blood loss, ICU use, postoperative endocrine deficits requiring readmission, and long-term control of hormone excess — in the heterogeneous surgical population classified under this DRG. Payers and providers use these data to evaluate procedure-related costs, readmission risk, and appropriateness of care pathways that affect inpatient reimbursement under DRG-based systems.
Post-discharge outcomes and readmission prevention research: prospective registry-based or intervention studies assessing medium-term outcomes such as adrenal insufficiency, steroid tapering complications, recurrence of hormone excess, quality of life, and 30- to 90-day readmissions among patients after adrenal or pituitary surgery. These studies enroll discharged inpatients from DRG 614 and evaluate discharge education, early endocrine follow-up, telehealth monitoring, and steroid replacement protocols to reduce avoidable readmissions and emergency endocrine crises. Findings are critical for hospital performance metrics, readmission penalties, and designing care transitions that lower downstream costs covered by payers while improving patient safety.

Adrenal and Pituitary Procedures without CC/MCC: Inpatient Reimbursement Overview

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Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

617-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-CC

Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

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Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: Inpatient Reimbursement Overview

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O.R. Procedures for Obesity without CC/MCC: Inpatient Reimbursement Overview

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Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

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Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

624-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITHOUT-CC-MCC

Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: Inpatient Reimbursement Overview

Showing 1–10 of 25

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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.

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National Payment Rates

Mean Rates by Payer — National — DRG 614

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$26K	$130K	$20K	2.1K

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 614

Key Insights for Alaska

Highest payer: Cigna at a mean of $53K; Lowest payers: BCBS and Anthem both at a mean of $34K.
Alaska’s mean range ($34K–$53K) shows Cigna paying materially above the other local payers and above many national means, while BCBS/Anthem sit below several national payer medians.

Clinical Trials

Perioperative complication reduction trials: randomized or pragmatic studies testing protocols (e.g., optimized hemodynamic management, steroid replacement strategies, or enhanced monitoring pathways) in patients undergoing adrenalectomy or transsphenoidal pituitary surgery for hormone-secreting or space-occupying lesions. These trials enroll the typical inpatient population captured by DRG 614 — adults with Cushing’s, pheochromocytoma, aldosteronism, nonfunctioning pituitary adenomas, or macroadenomas — and measure intraoperative hemodynamic events, postoperative electrolyte or adrenal insufficiency, length of stay, and complication rates. Results directly inform surgeons, endocrinologists, and inpatient care teams on best perioperative practices that can reduce costly complications and resource utilization relevant to hospital reimbursement and DRG payments.
Comparative effectiveness studies of surgical approaches and extent of resection: observational cohort studies or randomized trials comparing open adrenalectomy versus laparoscopic/robotic techniques, and microscopic versus endoscopic transsphenoidal approaches for pituitary tumors, including subgroup analyses by tumor size, hormonal activity, and comorbidity burden. These studies focus on clinical endpoints important to DRG management — operative time, blood loss, ICU use, postoperative endocrine deficits requiring readmission, and long-term control of hormone excess — in the heterogeneous surgical population classified under this DRG. Payers and providers use these data to evaluate procedure-related costs, readmission risk, and appropriateness of care pathways that affect inpatient reimbursement under DRG-based systems.
Post-discharge outcomes and readmission prevention research: prospective registry-based or intervention studies assessing medium-term outcomes such as adrenal insufficiency, steroid tapering complications, recurrence of hormone excess, quality of life, and 30- to 90-day readmissions among patients after adrenal or pituitary surgery. These studies enroll discharged inpatients from DRG 614 and evaluate discharge education, early endocrine follow-up, telehealth monitoring, and steroid replacement protocols to reduce avoidable readmissions and emergency endocrine crises. Findings are critical for hospital performance metrics, readmission penalties, and designing care transitions that lower downstream costs covered by payers while improving patient safety.

Adrenal and Pituitary Procedures without CC/MCC: Inpatient Reimbursement Overview

616-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-MCC

Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

617-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-CC

Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

618-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITHOUT-CC-MCC

Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: Inpatient Reimbursement Overview

619-O-R-PROCEDURES-FOR-OBESITY-WITH-MCC

O.R. Procedures for Obesity with MCC: Inpatient Reimbursement Overview

620-O-R-PROCEDURES-FOR-OBESITY-WITH-CC

O.R. Procedures for Obesity with CC: Inpatient Reimbursement Overview

621-O-R-PROCEDURES-FOR-OBESITY-WITHOUT-CC-MCC

O.R. Procedures for Obesity without CC/MCC: Inpatient Reimbursement Overview

622-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-MCC

Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

623-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-CC

Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

624-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITHOUT-CC-MCC

Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: Inpatient Reimbursement Overview

Showing 1–10 of 25

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

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

OpenPayer

Adrenal and Pituitary Procedures with CC/MCC: Inpatient Reimbursement Overview

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DRG 614 Overview

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OpenPayer

Adrenal and Pituitary Procedures with CC/MCC: Inpatient Reimbursement Overview

Sign up for Adrenal and Pituitary Procedures with CC/MCC: Inpatient Reimbursement Overview policy alerts

DRG 614 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