Summary & Overview

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.

Concussion with CCDRG Concussion with CCDRG 089Diagnosis-Related GroupInpatient ReimbursementMedicareNeurologyTraumaHead InjuryHospital Billing

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.

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.

Mean Rates by Payer — National — DRG 089

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.

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.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$11K	$57K	$8.4K	1.3K

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.

OpenPayer

Summary & Overview

Concussion with Complication or Comorbidity: Inpatient Reimbursement Overview

DRG 089 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