Division of Insurance Division of Insurance en espanol State of Colorado DORA
2013 Hospital Average Reimbursement Rate Survey
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1. Did your carrier have any written or earned premium for health insurance in Colorado in 2013? Exclude premium for Limited medical-payment plans (including disability income, accident only, specified or dread disease, hospital indemnity, vision only, and dental only), Medicare, Medicaid, long term care, outpatient procedures, stop loss, credit disability and Medicare supplement insurance.
Yes
No

2. If your company has any 2013 written or earned premium for health insurance in Colorado, a response to each of the below categories is required. Please enter 0 if your company had no inpatient procedure data for a given code.
Average Reimbursement Rate per claim Number of claims included in the data, by Code
190 Chronic obstructive pulmonary disease w MCC
191 Chronic obstructive pulmonary disease w CC
192 Chronic obstructive pulmonary disease w/o CC/MCC
193 Simple pneumonia & pleurisy w MCC
194 Simple pneumonia & pleurisy w CC
195 Simple pneumonia & pleurisy w/o CC/MCC
202 Bronchitis & asthma w CC/MCC
203 Bronchitis & asthma w/o CC/MCC
246 Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents
247 Perc cardiovasc proc w drug-eluting stent w/o MCC
286 Circulatory disorders except AMI, w card cath w MCC
287 Circulatory disorders except AMI, w card cath w/o MCC
291 Heart failure & shock w MCC
292 Heart failure & shock w CC
293 Heart failure & shock w/o CC/MCC
312 Syncope & collapse
313 Chest pain
391 Esophagitis, gastroent & misc digest disorders w MCC
392 Esophagitis, gastroent & misc digest disorders w/o MCC
459 Spinal fusion except cervical w MCC
460 Spinal fusion except cervical w/o MCC
469 Major joint replacement or reattachment of lower extremity w MCC
470 Major joint replacement or reattachment of lower extremity w/o MCC
551 Medical back problems w MCC
552 Medical back problems w/o MCC
602 Cellulitis w MCC
603 Cellulitis w/o MCC
640 Nutritional & misc metabolic disorders w MCC
641 Nutritional & misc metabolic disorders w/o MCC
689 Kidney & urinary tract infections w MCC
690 Kidney & urinary tract infections w/o MCC
742 Uterine & adnexa proc for non-malignancy w CC/MCC
743 Uterine & adnexa proc for non-malignancy w/o CC/MCC
765 Cesarean section w CC/MCC
766 Cesarean section w/o CC/MCC
767 Vaginal delivery w sterilization &/or D&C
768 Vaginal delivery w O.R. proc except steril &/or D&C
774 Vaginal delivery w complicating diagnoses
775 Vaginal delivery w/o complicating diagnoses
781 Other antepartum diagnoses w medical complications
782 Other antepartum diagnoses w/o medical complications
789 Neonates, died or transferred to another acute care facility
790 Extreme immaturity or respiratory distress syndrome, neonate
791 Prematurity w major problems
792 Prematurity w/o major problems
793 Full term neonate w major problems
794 Neonate w other significant problems
795 Normal newborn
870 Septicemia or severe sepsis w MV 96+ hours
871 Septicemia or severe sepsis w/o MV 96+ hours w MCC
872 Septicemia or severe sepsis w/o MV 96+ hours w/o MCC
885 Psychoses
896 Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC
897 Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC
917 Poisoning & toxic effects of drugs w MCC
918 Poisoning & toxic effects of drugs w/o MCC
945 Rehabilitation w CC/MCC
946 Rehabilitation w/o CC/MCC

We very much appreciate your assistance. Thank you!
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