Summary & Overview

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.

Degenerative Nervous System DisordersDRG Degenerative Nervous System Disorders without MCCDRG 057Diagnosis-Related GroupInpatient ReimbursementMedicareNeurologyParkinson DiseaseAmyotrophic Lateral SclerosisHospital Coding

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.

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.

Mean Rates by Payer — National — DRG 057

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.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$13K	$54K	$11K	26K

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.

OpenPayer

Summary & Overview

Degenerative Nervous System Disorders without MCC: Inpatient Reimbursement Overview

DRG 057 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes