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    v1.0.30
    OpenPayerBilling CodesEndocrine, Nutritional and Metabolic Diseases and DisordersDRG 614-adrenal-and-pituitary-procedures-with-cc-mcc
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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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    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 PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $26K$130K$20K2.1K

    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.

    Related Codes

    615-ADRENAL-AND-PITUITARY-PROCEDURES-WITHOUT-CC-MCC

    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. 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.
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    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 614
    Mean Rates by Payer — Alaska — DRG 614