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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 100-seizures-with-mcc
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    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.

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    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.

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    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.

    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).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $18K$90K$15K23K

    Patient Population

    This DRG’s population includes both Medicare-age and working-age patients, yielding a mixed-age profile rather than being confined to Medicare-age only. Commercial payers (Blue Cross Blue Shield, Anthem, Cigna, Aetna) cover a meaningful portion of cases alongside Medicare fee-for-service enrollments. Overall, the distribution skews toward a mixed payer mix with substantial representation from Medicare given the sizable number of discharges reported in the CMS data.

    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.

    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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    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 100
    Mean Rates by Payer — Alaska — DRG 100