Uterine and Adnexa Procedures DRG 743 Reimbursement

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.

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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.

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

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DRG 743 Overview

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 Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$11K	$66K	$8.3K	3K

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.

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.

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DRG 743 Overview

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DRG 743 Overview

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References