DRG 661 Overview

DRG 661 covers inpatient cases involving kidney and ureter procedures for non-neoplastic conditions without a Complication or Comorbidity or Major Complication or Comorbidity. Typical encounters include surgical management of stones, obstructions, or repair of urinary tract injury when no significant secondary diagnoses are present. This Diagnosis-Related Group is important for Medicare payment because it groups similar resource use and sets a bundled payment rate for the hospital stay. Accurate assignment affects hospital reimbursement and case-mix reporting.

Across commercial payers the payment distribution for DRG 661 ranges from about $370 to $41K, with payers’ medians clustering between $10K and $19K (see the table and chart below). The widest spread is observed between Anthem (max $41K) and BCBS (min $370), yielding the largest payer-to-payer range. Benchmarks show Aetna, Cigna, BCBS and Anthem medians and quartiles that vary notably, indicating significant commercial market dispersion.

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 ($9.7k), average submitted covered charges ($53.7k), average Medicare payment ($7.0k), and total discharges (9.9k).

• Acute perioperative management trials: randomized or prospective cohort studies evaluating interventions to reduce intraoperative complications, blood loss, or postoperative renal dysfunction in adult patients undergoing kidney or ureter procedures for non-neoplastic indications (e.g., stone extraction, reconstructive ureteral surgery, obstruction relief). These studies typically enroll medically heterogeneous inpatients—including older adults and those with baseline chronic kidney disease—to test procedural techniques, anesthesia approaches, or perioperative fluid and hemodynamic protocols. Results are relevant to providers and payers because improved perioperative protocols can shorten length of stay, reduce ICU transfers and readmissions, and lower inpatient costs associated with complications and escalation of care.
• Comparative effectiveness studies of surgical and endourologic techniques: pragmatic trials or registry-based comparative analyses that compare outcomes, resource use, and complication rates between approaches such as open vs. minimally invasive (laparoscopic/robotic) repair, percutaneous vs. ureteroscopic stone removal, or stent-first vs. definitive repair strategies. These studies focus on adult inpatients with symptomatic obstruction, complex stones, or ureteral injuries and assess metrics such as procedure success, need for repeat interventions, hospital length of stay, and short-term morbidity. Payers and hospital systems use this evidence to inform procedure selection, reimbursement policy, and bundled payment models by identifying approaches that offer equivalent or better clinical outcomes with lower total cost of care.
• Post-discharge outcomes and readmission prevention research: prospective observational studies and intervention trials that evaluate discharge planning, outpatient follow-up, pain management, and complication surveillance to reduce 30-day readmissions and emergency visits after inpatient kidney or ureter procedures for non-neoplastic disease. These studies enroll patients at discharge—often those with comorbidities like diabetes, CKD, or obesity—and test care-coordination interventions, telehealth monitoring, or protocolized stent removal schedules to detect and address complications early. Findings help providers optimize transition of care and help payers estimate and mitigate post-acute costs tied to readmissions, unplanned imaging or procedures, and prolonged recovery.