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    v1.0.30
    OpenPayerBilling CodesEndocrine, Nutritional and Metabolic Diseases and DisordersDRG 620-o-r-procedures-for-obesity-with-cc
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    O.R. Procedures for Obesity with CC: Inpatient Reimbursement Overview

    DRG 620 encompasses operating room procedures for obesity when a Complication or Comorbidity is present; it includes bariatric surgical interventions with concurrent clinical complexities that increase resource use. This Diagnosis-Related Group is important for inpatient reimbursement because the Complication or Comorbidity status alters payment classification and reflects higher expected hospital costs under Medicare.

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    DRG 620 Overview

    DRG 620 covers inpatient hospitalizations for patients undergoing operating room procedures for obesity when a Complication or Comorbidity is present. This Diagnosis-Related Group captures surgical and perioperative resource use associated with bariatric procedures complicated by additional clinical conditions. It matters for Medicare payment because the presence of a Complication or Comorbidity increases relative resource intensity and influences reimbursement under the inpatient prospective payment system. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and the corresponding payment impact.

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    National Payment Rates

    Across national payers the rate range for DRG 620 spans roughly from $370 up to $65K, with the widest spread between the lowest BCBS/Beyond-payers values and Anthem’s maximum of $65K. Benchmark medians cluster from about $16K (BCBS) to $27K (Anthem), while Aetna and Cigna show higher lower-quartile floors. See the table and chart below for payer-specific distributions and percentile 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 ($16.3k), average submitted covered charges ($79.2k), average Medicare payment amount ($11.8k), and total discharges (2.4k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $16K$79K$12K2.4K

    Patient Population

    This DRG’s patient population is mixed but leans toward working-age adults rather than exclusively Medicare-age. Commercial payers (e.g., Blue Cross Blue Shield, Aetna, Cigna, Anthem) commonly cover a substantial share of cases alongside Medicare fee-for-service beneficiaries. Overall, the cohort spans adult ages with contributions from both Medicare-age and non-Medicare-age patients, reflecting a mixed payer distribution.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Payer rates in Alaska range from $25K to $33K in mean reimbursement, with Cigna at the high end (mean $33K, max $64K) and Anthem and Blue Cross Blue Shield at the low end (mean $25K each). This state profile highlights a pronounced high-end outlier versus national central tendencies, driven by Cigna’s elevated maximum. See the table and chart below for payer-specific distributions.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $33K) is the top-paying payer in Alaska; Lowest payers: Anthem and Blue Cross Blue Shield (mean $25K each).
    • Alaska shows a wider top-end rate (Cigna max $64K) compared with national medians, indicating a notable high-end deviation from national averages.

    Clinical Trials

    • Randomized comparative effectiveness trials of different bariatric surgical techniques (for example, laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy) in adults with class II–III obesity who have obesity-related complications; these studies assess perioperative morbidity, length of stay, operative time, and short-term complication rates to determine which approach offers better risk/benefit profiles for patients requiring operating-room procedures. Such research is directly relevant to surgeons and hospital finance teams because differences in complication rates, ICU transfers, and readmissions materially affect inpatient resource use and DRG-related reimbursement.
    • Perioperative optimization and risk-reduction intervention studies targeting medically complex obese inpatients (for example, randomized or cohort studies of preoperative pulmonary and nutritional optimization protocols, enhanced venous thromboembolism prophylaxis strategies, or glycemic control pathways) enrolling patients with significant comorbidities such as obstructive sleep apnea, diabetes, and cardiopulmonary disease. These trials focus on the immediate pre- and intraoperative period to lower CC-level complications documented during the index hospitalization, which matters to providers aiming to reduce surgical complications and to payers and hospitals managing costs under DRG payments.
    • Post-discharge outcomes and health-services research evaluating long-term functional outcomes, reoperation rates, readmissions, and cost-effectiveness of inpatient bariatric procedures among diverse populations (including older adults and patients with higher baseline CC burden) using prospective registries or pragmatic observational cohorts. This research examines longer-term resource utilization and quality-of-life trajectories that influence bundled-payment planning and payer decisions about coverage criteria, follow-up care pathways, and investments in post-acute services for patients assigned to this DRG.

    Related Codes

    614-ADRENAL-AND-PITUITARY-PROCEDURES-WITH-CC-MCC

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

    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

    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 620
    Mean Rates by Payer — Alaska — DRG 620