Physician-Modified Endografts: Innovation without Appropriate Reimbursement

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

J Vasc Surg

Keywords

aortic disease, clinical practice, cohort analysis, comorbidity, complication, conference abstract, controlled study, Current Procedural Terminology, diagnosis related group, disease management, female, hospital cost, hospitalization, human, major clinical study, male, medicare, physician, reimbursement, stent graft

Abstract

Objectives: Physician-modified endografts (PMEGs) have expanded endovascular treatment options for complex aortic pathology and transitioned from early innovation to more routine clinical practice in the United States. Although a distinct Current Procedural Terminology code was introduced, no corresponding Diagnosis Related Group (DRG) modification was established for facility reimbursement. This omission raises concern that current models inadequately reimburse for the costs of PMEG. This study evaluated the finances of PMEG procedures across insurance types and DRG assignments. Methods: All patients undergoing PMEGs at our vascular center between 2022 and 2025 were reviewed and financial data were extracted for the index hospitalization. Total costs represented the combined professional and technical costs incurred during the hospitalization. Financial outcomes were summarized as medians with interquartile ranges and stratified by insurance status and DRG. Comparisons across groups were performed using Kruskal-Wallis tests. Results: A total of 103 PMEG procedures were identified during the study period. Medicare coverage accounted for 79% of cases. Median total hospital costs were comparable across insurance payors, among Medicare beneficiaries, the median total cost was $96,418 (interquartile range [IQR], $72,553-$132,688). Despite comparable costs, median total profit/loss varied significantly (P = .008) by insurance status (Table I), with Medicare cases associated with the greatest loss −$34,667 (IQR, −$45,940 to −$18,244). The most frequently assigned DRGs were 268 (15.5%) and 269 (48.5%). Median total profit/loss was −$38,248 (IQR, −$51,898 to −$12,991) for DRG 268 and −$26,610 (IQR, −$42,027 to −$11,750) for DRG 269. Across all DRGs examined, median profit/loss remained negative and did not differ significantly by DRG assignment (P = .291) (Table II). Conclusions: In a Medicare-dominant population, PMEG procedures were associated with consistent negative financial margins. Losses persisted across all DRG assignments, including those with major complication or comorbidity adjustment, indicating that coding did not account for the increased clinical complexity of these procedures. These findings suggest that a distinct DRG is needed for PMEGs to better align reimbursement with actual costs of this increasingly mainstream procedure. [Formula presented] [Formula presented]

Volume

84

Issue

1

First Page

e63

Last Page

e64

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