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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 065-intracranial-hemorrhage-or-cerebral-infarction-with-cc-or-tpa-in-24-hours
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    Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 Hours: Inpatient Reimbursement Overview

    DRG 065 addresses inpatient care for intracranial hemorrhage or cerebral infarction with a Complication or Comorbidity or receipt of tissue plasminogen activator within 24 hours, encompassing conditions that drive moderate to high resource use. Correct documentation and coding under this Diagnosis-Related Group affect Medicare inpatient reimbursement by determining the payment weight assigned to these cerebrovascular admissions.

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    DRG 065 Overview

    DRG 065 covers inpatient admissions for intracranial hemorrhage or cerebral infarction with a documented Complication or Comorbidity or administration of tissue plasminogen activator within 24 hours. It captures high-acuity cerebrovascular events that typically require intensive diagnostic and therapeutic resources such as neuroimaging, intensive monitoring, and possible thrombolytic therapy. This Diagnosis-Related Group influences Medicare payment by grouping cases with moderate complexity into a payment weight that reflects expected resource use. Accurate documentation of complications, comorbidities, and timely thrombolytic administration is essential for correct grouping and reimbursement.

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    National Payment Rates

    Payer rates for DRG 065 span roughly from $370 to $38K across the national sample, with mean payer-level averages ranging approximately from $10K to $17K; the widest spread between minimum and maximum observed values is about $38K. See the table and chart below for payer-specific percentiles and distributions. Payer variability is notable between Blue Cross Blue Shield, Cigna, Anthem, and Aetna.

    The CMS 2023 data shown are national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 065. Values reflect national aggregates for Medicare FFS in 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $9.5K$53K$7.2K75K

    Patient Population

    This DRG’s population includes both Medicare-age and working-age patients but skews toward Medicare-age beneficiaries given the high share of inpatient volume historically covered by Medicare FFS. Commercial payers (Blue Cross Blue Shield, Cigna, Aetna, Anthem) represent a meaningful portion of cases among working-age adults, producing a mixed-age distribution. Overall, Medicare is the dominant payer population for inpatient DRG volume.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    In Alaska, DRG 065 reimbursement ranges notably across payers, from lows near $7.5K (seen with Anthem and BCBS minima) up to a $43K maximum observed for Cigna, with mean rates roughly $16K–$25K by payer. Cigna stands out as a high outlier compared with other local payers and relative to national medians, while Anthem and BCBS sit near the lower end of national distributions. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • The highest paying payer in Alaska is Cigna (max $43K, mean $25K), while the lowest median payer is Anthem (median $16K; min $7.5K).
    • Alaska’s payer range is wide (mins around $7.5K to a max of $43K), with Cigna notably above typical national medians and Anthem/BCBS clustered at lower medians around $16K, representing a meaningful skew versus national benchmarks.

    Clinical Trials

    • Acute reperfusion and hemostatic intervention trials: Studies in this area evaluate time-sensitive acute treatments administered within the first hours after presentation, including use of thrombolytic therapy for ischemic stroke within specified time windows and management strategies for spontaneous intracerebral hemorrhage (e.g., reversal of anticoagulation, blood pressure control, and hemostatic agents). These trials enroll patients admitted with acute cerebral infarction or intracranial hemorrhage who meet strict onset-to-treatment criteria, and they measure short-term neurologic outcomes, in-hospital complications, and mortality. Results are directly relevant to clinicians and payers because they inform emergent care protocols, resource utilization in the first 24–72 hours, and criteria for high-cost interventions that drive DRG resource intensity.
    • Comparative effectiveness and care pathway studies during the inpatient stay: These trials compare different in-hospital management strategies such as intensive versus standard blood pressure targets, protocols for neurocritical monitoring, or models of multidisciplinary stroke-unit care versus general ward care. They typically enroll patients with moderate-to-severe intracranial hemorrhage or ischemic stroke with complicating comorbidities (the CC element of the DRG) and assess outcomes like length of stay, complication rates (e.g., infections, recurrent stroke), functional status at discharge, and readmission. Findings help hospitals and payers optimize inpatient pathways, allocate critical care resources, and establish evidence-based standards that affect DRG case-mix, cost drivers, and quality-based reimbursement.
    • Post-discharge outcomes, secondary prevention, and rehabilitation trials: These studies focus on the transition from inpatient to outpatient care, evaluating interventions such as early intensive rehabilitation programs, secondary stroke prevention strategies, and coordinated post-acute care models to reduce disability and readmissions. They enroll survivors of intracranial hemorrhage or ischemic stroke who received acute inpatient care (including those who received thrombolysis) and measure functional recovery over weeks to months, adherence to secondary prevention, and downstream healthcare utilization. This research is pertinent to providers and payers because improved post-discharge outcomes can lower long-term costs, reduce readmissions that impact bundled payment models, and inform discharge planning and post-acute care resource allocation for patients categorized under this DRG.

    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

    Showing 1–10 of 71

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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 065
    Mean Rates by Payer — Alaska — DRG 065