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    OpenPayerBilling CodesEndocrine, Nutritional and Metabolic Diseases and DisordersDRG 621-o-r-procedures-for-obesity-without-cc-mcc
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    O.R. Procedures for Obesity without CC/MCC: Inpatient Reimbursement Overview

    DRG 621 encompasses inpatient admissions for operating room procedures for obesity without Complication or Comorbidity or Major Complication or Comorbidity; it covers primary bariatric surgeries performed in patients without additional significant diagnoses. Accurate assignment of this Diagnosis-Related Group is important for inpatient reimbursement because it determines the base Medicare payment and resource-classification for these surgical admissions.

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    DRG 621 Overview

    DRG 621 covers inpatient admissions for patients undergoing operating room procedures specifically for obesity when there is no Complication or Comorbidity and no Major Complication or Comorbidity present. This group captures primary surgical interventions such as bariatric procedures performed without additional significant diagnoses that would increase resource use. It matters for Medicare payment because bundling into this Diagnosis-Related Group determines base reimbursement and influences hospital revenue for straightforward obesity operations. Payer classification under DRG 621 affects length of stay expectations and relative payment weights for these admissions.

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    National Payment Rates

    Across commercial payers the DRG rate benchmarks range from about $1.1K (BCBS p25) up to $57K (Anthem max), with typical median rates clustering around $23K–$25K depending on payer. The widest spread is observed between the Anthem maximum ($57K) and BCBS lower quartile values (around $1.1K), reflecting substantial variation across payers; see the table and chart below for payer-specific distributions. Reported payer medians are approximately $23K–$25K for Anthem, Aetna, Cigna and BCBS.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 621. These figures summarize Medicare paid amounts and billed charges at the national level for 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $14K$69K$10K6.3K

    Patient Population

    This DRG’s population skews toward working-age adults rather than predominantly Medicare-age beneficiaries, reflecting a mix but leaning younger than typical Medicare-only cohorts. Commercial payers (Aetna, Anthem, Cigna, BCBS) are prominent payers in the market for this DRG alongside Medicare, indicating a mixed-age population. Overall, the payer mix includes a substantial portion of privately insured, working-age patients with a meaningful but smaller Medicare component.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Across payers in Alaska for DRG 621, negotiated mean rates range from $22K (BCBS and Anthem) up to $34K (Cigna), with medians clustering near $23K for BCBS and Anthem and $24K for Cigna. Cigna represents the most notable deviation, paying substantially more than the other local payers and above several national comparators. Reference the table and chart below for payer-level distributions and percentile detail.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $34K) is the highest-paying payer in Alaska; lowest payers: BCBS and Anthem (both mean $22K).
    • Cigna’s mean ($34K) sits noticeably above the Alaska median range and is meaningfully higher than other local payers, exceeding national mean benchmarks for some payers; BCBS/Anthem cluster below national means for similar payers.

    Clinical Trials

    • Perioperative risk-reduction and enhanced recovery studies: randomized or prospective cohort studies that test preoperative optimization bundles (e.g., weight-loss programs, nutritional assessment, glycemic control, and pulmonary/cardiac risk stratification) versus standard preoperative care for adults undergoing bariatric or other obesity-related O.R. procedures without major complications. These trials enroll elective surgical patients with class II–III obesity or obesity-related comorbidities to evaluate intraoperative metrics (operative time, blood loss), short-term morbidity, and length of stay. Results inform hospitals and payers on which preoperative interventions most effectively reduce resource utilization and unplanned escalations of care in this DRG.
    • Comparative effectiveness trials of surgical techniques and approaches: pragmatic head-to-head studies comparing minimally invasive techniques, different anastomotic methods, or variations in procedure type (for example, comparing procedure A versus procedure B within obesity surgery) in patients who are otherwise uncomplicated (no CC/MCC). These trials focus on differences in operative efficiency, complication rates within 30 days, readmission, and functional outcomes such as weight loss and resolution of metabolic comorbidities, enrolling typical inpatient candidates for O.R. procedures for obesity. Payers and clinical leaders use this evidence to guide procedure selection, credentialing, and bundled payment design because small differences in complication or readmission rates markedly affect reimbursement and DRG resource use.
    • Post-discharge outcomes and long-term utilization cohort studies: longitudinal observational studies following patients discharged after O.R. procedures for obesity without CC/MCC to assess rehospitalization, outpatient utilization, quality-of-life, and cost trajectories over 6–24 months. These studies often stratify by discharge disposition, outpatient follow-up intensity, and adherence to lifestyle interventions to identify predictors of downstream utilization and late complications such as nutritional deficiencies or need for revision. Findings help payers and health systems design post-discharge care pathways, transitional care programs, and risk-sharing arrangements that optimize long-term outcomes and control total episode costs associated with 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

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

    O.R. Procedures for Obesity with CC: 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 621
    Mean Rates by Payer — Alaska — DRG 621