ECMO or Tracheostomy with MV >96 Hours: Inpatient Reimbursement Overview - OpenPayer

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Summary & Overview

ECMO or Tracheostomy with MV >96 Hours: Inpatient Reimbursement Overview

DRG 003 covers ECMO or tracheostomy with mechanical ventilation over 96 hours, or principal diagnoses outside the face/mouth/neck requiring major operating room procedures, reflecting very high-intensity critical care and surgery. Proper assignment matters for inpatient reimbursement because this Diagnosis-Related Group carries substantial payment weight to account for prolonged ICU resource use, specialized equipment, and complex operative care.

ECMODRG ECMO or Tracheostomy with MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck with Major O.R. ProceduresDRG 003Diagnosis-Related GroupInpatient ReimbursementMedicareMechanical VentilationTracheostomyCritical CareMajor O.R. Procedures

DRG 003 Overview

DRG 003 encompasses encounters involving extracorporeal membrane oxygenation (ECMO) or tracheostomy with mechanical ventilation (MV) beyond 96 hours, or cases with a principal diagnosis outside the face, mouth, and neck combined with major operating room procedures. This Diagnosis-Related Group (DRG) captures very resource-intensive critical care with high utilization of advanced respiratory support and major surgical interventions. It matters for Medicare payment because cases assigned here typically receive among the highest inpatient reimbursement weights to reflect prolonged ICU stays, specialized equipment, and complex perioperative care. Accurate clinical documentation and coding drive appropriate assignment and payment under the Medicare Severity Diagnosis-Related Group (MS-DRG) system.

National Payment Rates

Mean Rates by Payer — National — DRG 003

State Payment Rates

State: Alaska1 / 49

Mean Rates by Payer — Alaska — DRG 003

Alaska Benchmarks

For DRG 003 in Alaska, payer rates range from $330K to $510K across the sample. Anthem and Blue Cross Blue Shield report the lowest mean rates at $330K, while Cigna reports the highest mean at $510K. The commercial average is $390K, reflecting a moderate midpoint between the extremes.

Key Insights for Alaska

Cigna is the highest payer with a mean of $510K while Anthem and Blue Cross Blue Shield are tied as the lowest payers at $330K.
The commercial average of $390K sits between payer rates, producing a payer spread of $180K between the highest (Cigna) and lowest (Anthem/Blue Cross Blue Shield).

Related Codes

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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.

Medicare Distribution

Average Submitted Charges	Average Medicare Contribution	Average Total Final Payment	Total Discharges
$1.1M	$190K	$220K	10K

Average Submitted Charges is the amount hospitals initially bill — the starting request that is almost never paid in full. Average Medicare Contribution is the portion Medicare directly reimburses the provider. Average Total Final Payment is the total amount ultimately paid, combining Medicare's contribution with the beneficiary's cost-sharing and any other third-party payments.

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