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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 074-cranial-and-peripheral-nerve-disorders-without-mcc
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    Cranial and Peripheral Nerve Disorders without MCC: Inpatient Reimbursement Overview

    DRG 074 groups inpatient stays for cranial and peripheral nerve disorders without Major Complication or Comorbidity, encompassing conditions like compressive neuropathies and select cranial nerve dysfunctions. This grouping matters for inpatient reimbursement because it determines case classification, relative resource use, and the Medicare payment weight applied to qualifying admissions.

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    DRG 074 Overview

    DRG 074 covers inpatient admissions for cranial and peripheral nerve disorders without a Major Complication or Comorbidity. It includes diagnoses such as nerve compressions, neuropathies, and certain cranial nerve disorders when the clinical course is uncomplicated. This Diagnosis-Related Group is used to classify cases for Medicare inpatient payment and influences base payment rates and resource expectations. Understanding this DRG helps clarify reimbursement implications for hospital stays that do not involve major complications.

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    National Payment Rates

    Across featured payers the observed rate range runs roughly from $370 up to $35K, with the widest spread between Anthem (min $390, max $35K) and other payers reflecting a high dispersion. Commercial benchmarks show median payments clustered between about $9.3K and $18K depending on payer, while maximums extend into the high $20Ks to mid $30Ks. See the table and chart below for payer-specific quartiles and distributions.

    The CMS 2023 data represents national Medicare fee-for-service inpatient payments as published in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($10.1k), average submitted covered charges ($51.3k), average Medicare payment amount ($7.8k), and total discharges (11.6k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $10K$51K$7.8K12K

    Patient Population

    The DRG 074 population includes a mix of Medicare beneficiaries and commercially insured patients, reflecting both Medicare-age and working-age adults. Claims volumes indicate a meaningful Medicare share given the program’s large inpatient footprint, but private/commercial payers also represent a sizeable portion of cases. Overall the population skews toward a mixed-age group with a substantial Medicare component rather than being exclusively Medicare-age.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska payer rates for DRG 074 span from 16K to 25K across the reported payers, with Blue Cross Blue Shield and Anthem at the low end (16K) and Cigna at the high end (25K). The Cigna mean notably exceeds the other in-state payers and sits above many national averages, creating the most pronounced deviation. Reference the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna with a mean of 25K; Lowest payer(s): BCBS and Anthem, both with a mean of 16K.
    • Cigna’s mean (25K) in Alaska is meaningfully above the state’s other payers and above national means for several payers, indicating a notable upward deviation from national averages.

    Clinical Trials

    • Acute neuromodulation and surgical intervention trials: studies in this area evaluate the safety and short-term efficacy of acute surgical or neuromodulatory procedures (for example, decompression, nerve repair, or intraoperative monitoring-guided interventions) for patients admitted with cranial nerve palsies, traumatic peripheral nerve injury, or compressive neuropathies causing hospital-level symptoms. These trials typically enroll patients during the index hospitalization or immediately post-injury to measure time-to-recovery, complication rates, and need for reoperation, addressing questions about optimal timing and technique. Results inform surgeons, hospitalists, and payers about procedure-related resource use, length of stay implications, and early outcomes that drive inpatient reimbursement and bundle payment considerations.
    • Comparative effectiveness and perioperative management studies: these trials compare different non-surgical or adjunctive inpatient therapies (such as corticosteroid regimens, anticoagulation strategies when vascular causes are suspected, or different anesthesia/monitoring approaches) for acute cranial and peripheral nerve disorders. They enroll heterogeneous inpatient populations—patients with Bell’s palsy variants, ischemic cranial neuropathies, or acute compressive neuropathies—to determine which management pathways shorten neurologic deficit duration, reduce complications, or lower readmission. Findings are relevant to clinicians and payers because they identify care pathways that optimize outcomes while potentially reducing length of stay, avoidable imaging or consultations, and overall inpatient costs.
    • Post-discharge functional outcomes and rehabilitation trials: these studies focus on subacute and longer-term recovery, testing timing and intensity of rehabilitation interventions (physical therapy, occupational therapy, specialized nerve rehabilitation programs) or care-coordination models for patients discharged after an acute cranial or peripheral nerve event. They target patients with residual motor or sensory deficits after hospital discharge and measure functional recovery, quality of life, and downstream health-care utilization such as outpatient therapy needs, readmissions, or durable medical equipment. Evidence from these trials helps payers and providers plan post-acute services, allocate rehabilitation resources, and predict long-term costs associated with incomplete recovery in 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

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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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    Mean Rates by Payer — National — DRG 074
    Mean Rates by Payer — Alaska — DRG 074