Summary & Overview
Major Chest Procedures with CC: Inpatient Reimbursement Overview
164 encompasses major chest surgical procedures accompanied by Major Complication or Comorbidity, representing higher-acuity thoracic care that drives increased resource use. Proper assignment of this Diagnosis-Related Group affects Medicare inpatient reimbursement because it shifts cases into higher-weighted payment categories reflecting greater clinical complexity.
DRG 164 Overview
164 covers hospital admissions for major chest procedures performed for significant thoracic conditions where at least one Major Complication or Comorbidity (MCC) is present, including complex resections, extensive chest wall operations, and certain advanced thoracic interventions. This Diagnosis-Related Group groups cases with higher resource use and clinical complexity, which affects Medicare inpatient payment relative to less complicated chest procedure DRGs. Accurate coding of principal procedures and accompanying Complication or Comorbidity (CC) or MCC status influences DRG assignment and reimbursement. The classification is important for hospital billing, case-mix index calculations, and payment benchmarking.
National Payment Rates
Mean payer rates for Diagnosis-Related Group 164 range from $19,840.55 for Medicare up to approximately $42,611.68 for commercial plans, with a wide spread between the lowest and highest mean rates. Commercial payers such as Aetna and Cigna sit near the top of the range while Blue Cross Blue Shield and BUCA are lower. The table and chart below summarize payer-level means and percentile benchmarks for comparison.
State Payment Rates
State: Alaska1 / 49
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.