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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 089-concussion-with-cc
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    Concussion with Complication or Comorbidity: Inpatient Reimbursement Overview

    DRG 089 pertains to concussions when at least one Complication or Comorbidity is present, encompassing patients requiring additional monitoring, diagnostic testing, or treatment. Accurate classification into this Diagnosis-Related Group influences inpatient reimbursement under Centers for Medicare & Medicaid Services rules because the Complication or Comorbidity level alters relative payment weights.

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    DRG 089 Overview

    DRG 089 covers inpatient cases primarily for concussion with one or more Complication or Comorbidity present. This Diagnosis-Related Group captures hospital admissions where head trauma is significant enough to require observation or treatment beyond a straightforward concussion. It matters for Medicare payment because the presence of Complication or Comorbidity increases resource use and therefore affects the relative payment weight assigned by the Centers for Medicare & Medicaid Services. Payers and hospitals monitor assignment to DRG 089 for reimbursement and resource allocation purposes.

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    National Payment Rates

    Across payers the observed rate range spans roughly $9.4K to $31K, with the widest spread between the lowest median (Blue Cross Blue Shield at $9.4K) and the highest maximum (Anthem at $38K). Refer to the table and chart below for payer-specific quartiles and distribution. Payer comparators include Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem.

    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 ($10.8k), average submitted covered charges ($57.1k), average Medicare payment amount ($8.4k), and total discharges (1.3k) for DRG 089.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $11K$57K$8.4K1.3K

    Patient Population

    This DRG’s patient population skews toward a mixed-age cohort with meaningful representation from both Medicare-age and working-age adults. Medicare discharges are significant but private/commercial payers also cover a notable portion of cases, indicating a mixed payer mix rather than exclusively Medicare-age. Age distribution therefore spans typical working-age through Medicare beneficiaries.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 089 reimbursement range across payers is narrow for Anthem and Blue Cross Blue Shield at $17K, while Cigna spans from $14K to $44K with a mean around $26K, producing the widest dispersion. Cigna represents the most notable deviation from national averages by exhibiting a substantially higher upper bound and mean compared with the other AK payers. Reference the table and chart below for the payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (max $44K, mean $26K); Lowest payer: Anthem and BCBS (all metrics at $17K).
    • Cigna in AK shows a materially higher upper range and mean versus other state payers, and its mean ($26K) is above the national median range for Cigna/Aetna.

    Clinical Trials

    • Acute neuroprotective and monitoring intervention trials: studies in this area evaluate time-sensitive treatments and advanced neuromonitoring strategies for hospitalized patients with concussion and complicating conditions (CC) such as intracranial hemorrhage, acute neurologic deficits, or coagulopathy. Typical participants are adults admitted for concussion with a recorded CC, and trials test interventions like optimized head injury protocols, targeted intracranial pressure monitoring thresholds, or short-term pharmacologic neuroprotection during the first 24–72 hours. Results inform inpatient clinical pathways, resource utilization (ICU versus ward care), and immediate complication prevention, which directly affects length of stay and short-term costs for payers and discharge planning for providers.
    • Comparative effectiveness studies of diagnostic and management strategies: these trials compare different approaches to imaging, observation duration, and use of specialist consultations for patients with concussion plus CC (for example advanced CT imaging protocols versus routine CT, or brief inpatient observation versus extended monitoring). Populations include older adults, patients on anticoagulation, or those with comorbid neurologic conditions who have higher risk of deterioration; outcomes measured include missed complications, return visits, procedural interventions, and inpatient resource use. Findings help clinicians refine triage and care algorithms and help payers assess which pathways reduce unnecessary admission days or downstream emergency care while maintaining patient safety.
    • Post-discharge functional outcome and rehabilitation trials: longitudinal studies focus on recovery trajectories, cognitive and functional outcomes, and rehabilitation interventions for patients hospitalized with concussion and CC, including those with persistent post-concussive symptoms or secondary injuries. These studies enroll patients after discharge to evaluate timing and intensity of outpatient therapies, telehealth follow-up, and predictors of readmission or long-term disability over months to a year. Evidence from these trials guides discharge criteria, outpatient care coordination, and coverage decisions by payers aimed at reducing readmissions and long-term disability costs while optimizing recovery for high-risk concussion patients.

    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 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 089
    Mean Rates by Payer — Alaska — DRG 089