Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Female Reproductive SystemDRG 743-uterine-and-adnexa-procedures-for-non-malignancy-without-cc-mcc
    Ask Trek AI about this page

    Uterine and Adnexa Procedures for Non-Malignancy without CC/MCC: Inpatient Reimbursement Overview

    DRG 743 encompasses inpatient uterine and adnexa procedures performed for non-malignant conditions without a Complication or Comorbidity or Major Complication or Comorbidity and captures typical benign gynecologic surgeries. It matters for inpatient reimbursement because the Diagnosis-Related Group assignment drives Medicare payment rates and reflects the expected resource use for straightforward surgical admissions.

    Customize your policy alerts

    Sign up for drg 743 policy alerts

    Get alerted when payer policies referencing 743 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 743 Overview

    DRG 743 covers inpatient hospital admissions for surgical procedures on the uterus and adnexa for non-malignant conditions without a Complication or Comorbidity or Major Complication or Comorbidity. Typical cases include hysterectomy, oophorectomy, salpingectomy, and related procedures performed for benign indications. This Diagnosis-Related Group matters for Medicare payment because grouping determines the fixed inpatient reimbursement and influences hospital resource allocation and coding specificity. Accurate assignment affects reimbursement level and compliance with Centers for Medicare & Medicaid Services billing rules.

    Table of contents

    Progress1 / 5

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    National Payment Rates

    Across commercial payers the observed rate range runs from a low near $370 (BCBS minimum) up to $39K (Anthem maximum), with mean payer benchmarks clustering between about $11K and $20K. The widest spread is seen in Anthem and BCBS where minimums are very low and maximums reach the upper tens of thousands, producing the largest payer-to-payer variability. See the table and chart below for payer-specific distributions and quartiles.

    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 ($11.5k), average submitted covered charges ($66.3k), average Medicare payment ($8.3k), and total discharges (2.95k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $11K$66K$8.3K3K

    Patient Population

    This DRG’s population skews toward a mixed-age cohort but is primarily concentrated in working-age adults rather than predominantly Medicare-age patients. Medicare discharges account for a minority of total encounters versus combined commercial payers in typical practice, indicating significant private/commercial coverage presence. Overall, the payer mix is mixed but leans toward non-Medicare (working-age) members rather than being Medicare-dominant.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska rates for DRG 743 span from $19K to $30K across payers, with Blue Cross Blue Shield and Anthem at $19K and Cigna notably higher at $30K. The state’s Cigna mean sits well above the national Cigna median/mean range, representing the most notable deviation from national averages. Reference the table and chart below for payer-specific distributions and percentile detail.

    Key Insights for Alaska

    • Highest payer: Cigna at a mean of 30K; Lowest payers: BCBS and Anthem, both at a mean of 19K.
    • Alaska’s mean rates cluster higher than national BCBS and Anthem medians, with Cigna particularly elevated versus national Cigna benchmarks.

    Clinical Trials

    • Trials comparing minimally invasive surgical techniques versus open laparotomy for benign uterine and adnexal conditions, focused on intraoperative metrics and short-term recovery: these studies enroll adult women undergoing hysterectomy, myomectomy, or adnexal surgery for non-malignant indications (e.g., fibroids, endometriosis, ovarian cysts) and measure operative time, blood loss, complication rates, and length of stay. They address the immediate inpatient care pathway and are relevant to providers optimizing perioperative management and to payers because differences in resource use and complication rates directly affect DRG costs and reimbursement risk.
    • Comparative effectiveness studies of perioperative care bundles and enhanced recovery after surgery (ERAS) protocols tailored to benign gynecologic surgery: these investigations evaluate standardized protocols including anesthesia choices, analgesia regimens, thromboembolism prophylaxis, and early mobilization in patients undergoing uterine/adnexal procedures without CC/MCC, measuring outcomes such as postoperative pain control, readmission, and time to return to baseline function. Research in this area targets reducing variability in inpatient care and avoidable complications, making it highly relevant for clinicians seeking best practices and payers interested in lowering length of stay and post-discharge utilization associated with this DRG.
    • Post-discharge outcomes and health services research tracking readmission, long-term functional recovery, and patient-reported outcomes after non-malignant uterine and adnexal surgery: cohort studies and registry analyses follow patients from discharge through 30–90 days to assess rates and causes of readmission, persistent symptoms, and quality-of-life metrics, often stratified by comorbidity burden and social determinants. These studies inform risk stratification and transitional care interventions that providers can use to reduce preventable readmissions and help payers identify drivers of downstream costs beyond the index hospitalization covered under this DRG.

    Related Codes

    734-PELVIC-EVISCERATION-RADICAL-HYSTERECTOMY-AND-RADICAL-VULVECTOMY-WITH-CC-MCC

    Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy with CC/MCC: Inpatient Reimbursement Overview

    735-PELVIC-EVISCERATION-RADICAL-HYSTERECTOMY-AND-RADICAL-VULVECTOMY-WITHOUT-CC-MCC

    Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy: Inpatient Reimbursement Overview

    736-UTERINE-AND-ADNEXA-PROCEDURES-FOR-OVARIAN-OR-ADNEXAL-MALIGNANCY-WITH-MCC

    Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with MCC: Inpatient Reimbursement Overview

    737-UTERINE-AND-ADNEXA-PROCEDURES-FOR-OVARIAN-OR-ADNEXAL-MALIGNANCY-WITH-CC

    Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy with CC: Inpatient Reimbursement Overview

    738-UTERINE-AND-ADNEXA-PROCEDURES-FOR-OVARIAN-OR-ADNEXAL-MALIGNANCY-WITHOUT-CC-MCC

    Uterine and Adnexa Procedures for Ovarian or Adnexal Malignancy without CC/MCC: Inpatient Reimbursement Overview

    739-UTERINE-AND-ADNEXA-PROCEDURES-FOR-NON-OVARIAN-AND-NON-ADNEXAL-MALIGNANCY-WITH-MCC

    Uterine and Adnexa Procedures for Non-Ovarian and Non-Adnexal Malignancy with MCC: Inpatient Reimbursement Overview

    740-UTERINE-AND-ADNEXA-PROCEDURES-FOR-NON-OVARIAN-AND-NON-ADNEXAL-MALIGNANCY-WITH-CC

    Uterine and Adnexa Procedures for Non-Ovarian and Non-Adnexal Malignancy with CC: Inpatient Reimbursement Overview

    741-UTERINE-AND-ADNEXA-PROCEDURES-FOR-NON-OVARIAN-AND-NON-ADNEXAL-MALIGNANCY-WITHOUT-CC-MCC

    Uterine and Adnexa Procedures for Non-Ovarian and Non-Adnexal Malignancy without CC/MCC: Inpatient Reimbursement Overview

    742-UTERINE-AND-ADNEXA-PROCEDURES-FOR-NON-MALIGNANCY-WITH-CC-MCC

    Uterine and Adnexa Procedures for Non-Malignancy with CC/MCC: Inpatient Reimbursement Overview

    744-D-C-CONIZATION-LAPAROSCOPY-AND-TUBAL-INTERRUPTION-WITH-CC-MCC

    D&C, Conization, Laparoscopy and Tubal Interruption with CC/MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 24

    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.
    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.

    Mean Rates by Payer — National — DRG 743
    Mean Rates by Payer — Alaska — DRG 743