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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 057-degenerative-nervous-system-disorders-without-mcc
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    Degenerative Nervous System Disorders without MCC: Inpatient Reimbursement Overview

    DRG 057 addresses inpatient admissions for degenerative nervous system disorders that do not involve a Major Complication or Comorbidity and reflects cases with lower resource intensity. Precise classification into this Diagnosis-Related Group influences Medicare inpatient reimbursement and hospital payment for these chronic neurologic conditions.

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    DRG 057 Overview

    DRG 057 covers hospital admissions for degenerative nervous system disorders without a Major Complication or Comorbidity. This group includes conditions such as Parkinson disease, amyotrophic lateral sclerosis in non-acute stages, and other chronic neurodegenerative diagnoses managed without major complications. It matters for Medicare payment because classification into this Diagnosis-Related Group affects inpatient prospective payment rates and resource intensity for Medicare beneficiaries. Accurate coding and documentation determine assignment to this group and the associated reimbursement.

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    National Payment Rates

    Across commercial payers the observed rate range runs from about $370 up to $44K, with mean payer benchmarks spanning roughly $12K to $22K; the widest spread appears between Blue Cross Blue Shield (BCBS) and Anthem at the high end versus the low-end outliers shown in the table and chart below. Payers shown include Blue Cross Blue Shield, Cigna, Aetna, and Anthem. Reference the table and chart below for payer-specific percentiles and distributions.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($13.2k), average submitted covered charges ($53.6k), average Medicare payment ($10.7k), and total discharges (26.5k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $13K$54K$11K26K

    Patient Population

    This DRG’s population skews toward Medicare-age beneficiaries rather than exclusively working-age adults, reflecting a predominance of older patients covered by Medicare fee-for-service. Commercial/private payers capture a smaller share of cases, indicating a mixed but Medicare-leaning payer mix. The age distribution is therefore primarily Medicare-age with some representation from working-age commercial enrollees.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Across payers in Alaska for DRG 057, mean rates span from $20K to $31K, representing a moderate state range. Cigna sits at the top with a mean of $31K while Anthem and Blue Cross Blue Shield are clustered at $20K. The most notable deviation versus national averages is Cigna’s higher mean in Alaska relative to Cigna’s national mean (~$21K). See the table and chart below for detailed distributions by payer.

    Key Insights for Alaska

    • Highest payer: Cigna at a mean of $31K; lowest payers: Anthem and Blue Cross Blue Shield at a mean of $20K.
    • Alaska’s mean rates range from $20K to $31K, with Cigna notably above national means for Cigna (state $31K vs national mean $21K).

    Clinical Trials

    • Studies of neuroprotective and symptomatic pharmacologic strategies in hospitalized older adults with progressive degenerative neurologic diseases (for example, trials testing agents targeting neuroinflammation or neurotransmitter modulation). These studies typically enroll patients admitted for worsening motor or cognitive symptoms to evaluate short-term safety, tolerability, and functional effects during acute care episodes; investigators measure inpatient neurological status, length of stay, and early functional change. Results are relevant to clinicians and payers because evidence about inpatient response and safety can inform formulary decisions, medication-use protocols, and potential to reduce complications or readmissions in this DRG.
    • Comparative effectiveness trials of inpatient multidisciplinary care models versus standard neurology consult care for patients with advanced degenerative nervous system disorders (for example, testing integrated physical therapy, swallow evaluation, medication reconciliation, and discharge planning). These pragmatic studies enroll patients with falls, aspiration risk, or sudden functional decline to compare outcomes such as complication rates, inpatient resource use, discharge disposition, and 30‑day readmissions. Findings guide hospitals and payers on which care pathways produce better functional outcomes and lower overall costs for this high-risk inpatient population.
    • Post-discharge longitudinal outcome and health-services research assessing readmission drivers, long-term functional trajectories, and hospice or durable medical equipment utilization among survivors of acute admissions for degenerative neurologic disease progression. These cohort studies follow patients after discharge to identify predictors of recurrent hospitalization, caregiver burden, and downstream service needs, often stratified by baseline disease severity and discharge disposition. This research helps payers and providers design targeted transitional care, home-support, and case-management interventions to reduce avoidable readmissions and optimize resource allocation for patients in DRG 057.

    Related Codes

    020-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with MCC: Inpatient Reimbursement Overview

    021-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-CC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with CC: Inpatient Reimbursement Overview

    022-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITHOUT-CC-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage without CC/MCC: Inpatient Reimbursement Overview

    023-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITH-MCC-OR-ANTINEOPLASTIC-IMPLANT-OR-EPILEPSY-WITH-NEUROSTIMULATOR

    Craniotomy with Major Device Implant or Complex CNS DRG 023: Inpatient Reimbursement Overview

    024-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITHOUT-MCC

    Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis without MCC: Inpatient Reimbursement Overview

    025-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-MCC

    Craniotomy and Endovascular Intracranial Procedures with MCC: Inpatient Reimbursement Overview

    026-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-CC

    Craniotomy and Endovascular Intracranial Procedures with CC: Inpatient Reimbursement Overview

    027-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITHOUT-CC-MCC

    Craniotomy and Endovascular Intracranial Procedures without CC/MCC: Inpatient Reimbursement Overview

    028-SPINAL-PROCEDURES-WITH-MCC

    Spinal Procedures with MCC: Inpatient Reimbursement Overview

    029-SPINAL-PROCEDURES-WITH-CC-OR-SPINAL-NEUROSTIMULATORS

    Spinal Procedures with CC or Spinal Neurostimulators: Inpatient Reimbursement Overview

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    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.

    Mean Rates by Payer — National — DRG 057
    Mean Rates by Payer — Alaska — DRG 057