Summary & Overview
Pulmonary Edema and Respiratory Failure: Inpatient Reimbursement Overview
DRG 189 covers hospital admissions for pulmonary edema and acute respiratory failure requiring significant respiratory support and monitoring. Assigning cases to this DRG affects inpatient reimbursement because it reflects higher resource use and typically greater intensity of care under the Medicare Severity Diagnosis-Related Group payment system.
DRG 189 Overview
DRG 189—Pulmonary Edema and Respiratory Failure—captures inpatient admissions for patients treated primarily for acute respiratory failure, pulmonary edema, and related respiratory compromise requiring supportive management such as oxygen, noninvasive ventilation, or mechanical ventilation. This DRG groups resource use for severe respiratory conditions that often involve intensive monitoring, advanced respiratory therapies, and longer lengths of stay. It matters for Medicare payment because the Diagnosis-Related Group assignment drives the bundled inpatient reimbursement that hospitals receive, reflecting the higher costs associated with respiratory support and critical care intensity.
National Payment Rates
Across payers the mean payment rates range from $9,451.25 for Medicare up to $20,722.37 for Cigna, with a wide spread driven primarily by variation among commercial plans. Anthem and Cigna show large upper quartiles, indicating broader high-end reimbursement, while Medicare sits substantially lower than commercial averages. See the table and chart below for payer-specific percentiles and means.
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, average submitted covered charges, average Medicare payment amount, and total discharges for Diagnosis-Related Group .
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