Kidney and Ureter Procedures for Non-Neoplasm DRG Reimbursement

Summary & Overview

Kidney and Ureter Procedures for Non-Neoplasm without CC/MCC: Inpatient Reimbursement Overview

DRG 661 includes kidney and ureter procedures for non-neoplasm cases without Complication or Comorbidity or Major Complication or Comorbidity, focusing on surgical treatment of benign urologic conditions. It matters for inpatient reimbursement because it defines the bundled payment level under the Centers for Medicare & Medicaid Services system and influences hospital revenue for these procedures.

Kidney and Ureter Procedures for Non-Neoplasm without CC/MCCDRG Kidney and Ureter Procedures for Non-Neoplasm without CC/MCCDRG 661Diagnosis-Related GroupInpatient ReimbursementMedicareUrologyNephrologySurgical ProceduresHospital Coding

DRG 661 Overview

DRG 661 covers inpatient cases involving kidney and ureter procedures for non-neoplastic conditions without a Complication or Comorbidity or Major Complication or Comorbidity. Typical encounters include surgical management of stones, obstructions, or repair of urinary tract injury when no significant secondary diagnoses are present. This Diagnosis-Related Group is important for Medicare payment because it groups similar resource use and sets a bundled payment rate for the hospital stay. Accurate assignment affects hospital reimbursement and case-mix reporting.

National Payment Rates

Across commercial payers the payment distribution for DRG 661 ranges from about $370 to $41K, with payers’ medians clustering between $10K and $19K (see the table and chart below). The widest spread is observed between Anthem (max $41K) and BCBS (min $370), yielding the largest payer-to-payer range. Benchmarks show Aetna, Cigna, BCBS and Anthem medians and quartiles that vary notably, indicating significant commercial market dispersion.

Mean Rates by Payer — National — DRG 661

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 ($9.7k), average submitted covered charges ($53.7k), average Medicare payment ($7.0k), and total discharges (9.9k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska payer means for DRG 661 range from $16K to $25K across payers, with Anthem and Blue Cross Blue Shield clustered at $16K and Cigna notably higher at $25K. The spread reflects a substantial deviation from many national averages, where means are generally lower or more compressed. See the table and chart below for payer-specific distributions.

Key Insights for Alaska

Highest payer: Cigna (mean $25K); Lowest payers: Anthem and BCBS (mean $16K).
Cigna’s mean payment (~$25K) meaningfully exceeds the other Alaska payers and is notably above typical national means for comparable payers.

Clinical Trials

Acute perioperative management trials: randomized or prospective cohort studies evaluating interventions to reduce intraoperative complications, blood loss, or postoperative renal dysfunction in adult patients undergoing kidney or ureter procedures for non-neoplastic indications (e.g., stone extraction, reconstructive ureteral surgery, obstruction relief). These studies typically enroll medically heterogeneous inpatients—including older adults and those with baseline chronic kidney disease—to test procedural techniques, anesthesia approaches, or perioperative fluid and hemodynamic protocols. Results are relevant to providers and payers because improved perioperative protocols can shorten length of stay, reduce ICU transfers and readmissions, and lower inpatient costs associated with complications and escalation of care.
Comparative effectiveness studies of surgical and endourologic techniques: pragmatic trials or registry-based comparative analyses that compare outcomes, resource use, and complication rates between approaches such as open vs. minimally invasive (laparoscopic/robotic) repair, percutaneous vs. ureteroscopic stone removal, or stent-first vs. definitive repair strategies. These studies focus on adult inpatients with symptomatic obstruction, complex stones, or ureteral injuries and assess metrics such as procedure success, need for repeat interventions, hospital length of stay, and short-term morbidity. Payers and hospital systems use this evidence to inform procedure selection, reimbursement policy, and bundled payment models by identifying approaches that offer equivalent or better clinical outcomes with lower total cost of care.
Post-discharge outcomes and readmission prevention research: prospective observational studies and intervention trials that evaluate discharge planning, outpatient follow-up, pain management, and complication surveillance to reduce 30-day readmissions and emergency visits after inpatient kidney or ureter procedures for non-neoplastic disease. These studies enroll patients at discharge—often those with comorbidities like diabetes, CKD, or obesity—and test care-coordination interventions, telehealth monitoring, or protocolized stent removal schedules to detect and address complications early. Findings help providers optimize transition of care and help payers estimate and mitigate post-acute costs tied to readmissions, unplanned imaging or procedures, and prolonged recovery.

Other Kidney and Urinary Tract Procedures without CC/MCC: Inpatient Reimbursement Overview

670-TRANSURETHRAL-PROCEDURES-WITHOUT-CC-MCC

Transurethral Procedures without CC/MCC: Inpatient Reimbursement Overview

674-OTHER-KIDNEY-AND-URINARY-TRACT-PROCEDURES-WITH-CC

Other Kidney and Urinary Tract Procedures with CC: Inpatient Reimbursement Overview

684-RENAL-FAILURE-WITHOUT-CC-MCC

Renal Failure without CC/MCC: Inpatient Reimbursement Overview

671-URETHRAL-PROCEDURES-WITH-CC-MCC

Urethral Procedures with CC/MCC: Inpatient Reimbursement Overview

698-OTHER-KIDNEY-AND-URINARY-TRACT-DIAGNOSES-WITH-MCC

Other Kidney and Urinary Tract Diagnoses with MCC: Inpatient Reimbursement Overview

694-URINARY-STONES-WITHOUT-MCC

Urinary Stones without MCC: Inpatient Reimbursement Overview

660-KIDNEY-AND-URETER-PROCEDURES-FOR-NON-NEOPLASM-WITH-CC

Kidney and Ureter Procedures for Non-Neoplasm with CC: Inpatient Reimbursement Overview

662-MINOR-BLADDER-PROCEDURES-WITH-MCC

Minor Bladder Procedures with MCC: Inpatient Reimbursement Overview

686-KIDNEY-AND-URINARY-TRACT-NEOPLASMS-WITH-MCC

Kidney and Urinary Tract Neoplasms with MCC: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$9.7K	$54K	$7K	9.9K