Seizures with MCC DRG Reimbursement & Medicare Rates

Summary & Overview

Seizures with Major Complication or Comorbidity: Inpatient Reimbursement Overview

DRG 100 encompasses inpatient admissions for seizures with an accompanying Major Complication or Comorbidity, reflecting higher clinical complexity. This grouping matters for inpatient reimbursement because the identified Major Complication or Comorbidity increases the payment weight under Medicare inpatient prospective payment rules.

Seizures with Major Complication or ComorbidityDRG Seizures with MCCDRG 100Diagnosis-Related GroupInpatient ReimbursementMedicareNeurologyEpilepsyHospital CodingInpatient Prospective Payment

DRG 100 Overview

DRG 100 covers hospital inpatient admissions for patients treated primarily for seizures with at least one Major Complication or Comorbidity present. This Diagnosis-Related Group applies when seizure-related care is complicated by additional severe conditions that increase resource use, such as prolonged monitoring, intensive care, or management of life-threatening comorbidities. It matters for Medicare payment because the presence of Major Complication or Comorbidity elevates the relative weight and reimbursement compared with seizure cases without such complications, affecting hospital revenue and billing classification. Accurate coding and documentation of the seizure diagnosis and associated Major Complication or Comorbidity are therefore essential for correct assignment to this Diagnosis-Related Group.

National Payment Rates

Across commercial payers the negotiated rates for this DRG span from around $370 to $62K, with payer medians ranging roughly from $16K to $34K depending on carrier. The widest spread observed in the benchmark set is between the minimum and maximum values (about $370 to $62K). See the table and chart below for payer-level detail across Blue Cross Blue Shield, Anthem, Cigna, and Aetna.

Mean Rates by Payer — National — DRG 100

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 ($18.3k), average submitted covered charges ($89.7k), average Medicare payment amount ($15.4k), and total discharges (22.6k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska presents a payer rate range from about $29K to $48K across major commercial plans, with Cigna at the top end and Blue Cross Blue Shield and Anthem clustered at the lower end. The state-level spread is narrower than some national distributions but Cigna’s mean at $48K stands out as a notable deviation above national medians. See the table and chart below for payer-specific percentiles and distributions.

Key Insights for Alaska

Cigna is the highest paying payer in Alaska with a mean of $48K, while Blue Cross Blue Shield/Anthem are the lowest payers with means of $29K.
Alaska’s payer range ($29K–$48K) skews materially higher than national medians for several payers, most notably Cigna’s mean which exceeds typical national medians for this DRG.

Clinical Trials

Acute seizure management and status epilepticus intervention trials: randomized or prospective studies testing emergency protocols (e.g., timing, dosing, and routes of administration of anticonvulsant regimens and supportive measures) in hospitalized patients presenting with convulsive seizures or status epilepticus and significant comorbidities. These studies enroll patients during the index inpatient episode to evaluate short-term seizure cessation, ICU-level needs, neurologic complications, and safety in medically complex cohorts. Results are relevant to providers for optimizing acute care pathways and to payers for understanding resource utilization (ICU stays, ventilator use, length of stay) associated with different emergency strategies.
Comparative effectiveness studies of inpatient diagnostic and monitoring strategies: observational or pragmatic trials comparing approaches such as rapid EEG deployment, continuous EEG monitoring versus intermittent EEG, and different imaging or laboratory workups in patients with seizures complicated by major comorbid conditions. Patient populations include those admitted with new-onset seizures, breakthrough seizures on treatment, or seizures with altered mental status and significant medical complexity; outcomes include diagnostic yield, changes in management, complication rates, and inpatient costs. Findings inform clinicians about the value of intensive monitoring for improving diagnostic accuracy and outcomes, and help payers determine which diagnostic pathways provide cost-effective care for high-acuity seizure admissions.
Post-discharge outcomes and care-transition studies: prospective cohort studies or quality-improvement trials that follow patients with seizure admissions and major complications after hospital discharge to evaluate readmission risk, medication adherence, outpatient neurology follow-up, seizure recurrence, and functional status. These studies target medically complex patients discharged from acute care to home or post-acute settings and test interventions such as structured discharge planning, remote monitoring, or coordinated case management to reduce recurrent hospital use. Evidence from this research is vital for providers to design safe transition plans and for payers to identify interventions that reduce readmissions and long-term costs while improving patient safety and outcomes.

Other Cerebrovascular Disorders with CC: Inpatient Reimbursement Overview

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Carotid Artery Stent Procedures with CC: Inpatient Reimbursement Overview

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Precerebral Occlusion without Infarction with MCC: Inpatient Reimbursement Overview

065-INTRACRANIAL-HEMORRHAGE-OR-CEREBRAL-INFARCTION-WITH-CC-OR-TPA-IN-24-HOURS

Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 Hours: Inpatient Reimbursement Overview

064-INTRACRANIAL-HEMORRHAGE-OR-CEREBRAL-INFARCTION-WITH-MCC

Intracranial Hemorrhage or Cerebral Infarction with MCC: Inpatient Reimbursement Overview

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Non-Bacterial Infection of Nervous System Except Viral Meningitis with MCC: Inpatient Reimbursement Overview

083-TRAUMATIC-STUPOR-AND-COMA-1-HOUR-WITH-CC

Traumatic Stupor and Coma >1 Hour with CC: Inpatient Reimbursement Overview

094-BACTERIAL-AND-TUBERCULOUS-INFECTIONS-OF-NERVOUS-SYSTEM-WITH-MCC

Bacterial and Tuberculous Infections of Nervous System with MCC: Inpatient Reimbursement Overview

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Craniotomy and Endovascular Intracranial Procedures without CC/MCC: 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

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OpenPayer

Summary & Overview

Seizures with Major Complication or Comorbidity: Inpatient Reimbursement Overview

DRG 100 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