Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 101-seizures-without-mcc
    Ask Trek AI about this page

    Seizures without MCC: Inpatient Reimbursement Overview

    DRG 101 covers inpatient stays for seizures when no Major Complication or Comorbidity is present, encompassing acute or breakthrough seizure events that do not drive high resource use. Correct assignment to this Diagnosis-Related Group matters for inpatient reimbursement because it determines the prospective payment rate under Medicare and impacts hospital payment for the episode of care.

    Customize your policy alerts

    Sign up for drg 101 policy alerts

    Get alerted when payer policies referencing 101 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 101 Overview

    DRG 101 covers inpatient admissions where the principal diagnosis is seizures without a Major Complication or Comorbidity and where no secondary diagnoses qualify as a Major Complication or Comorbidity. This Diagnosis-Related Group typically includes patients with acute seizure events, breakthrough seizures in known epilepsy, or single provoked seizures that do not require advanced resource use. It matters for Medicare payment because classification into this Diagnosis-Related Group determines the prospective payment rate and influences hospital reimbursement for the inpatient stay. Accurate coding and documentation of seizure etiology and comorbid conditions affect whether an admission is assigned to this Diagnosis-Related Group or to a higher-paying group.

    Table of contents

    Progress1 / 5

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    National Payment Rates

    Across commercial payers, negotiated rates for DRG 101 range from about $8.2K (BCBS) up to $15K (Aetna and Cigna median ranges by payer), with individual payer medians reported between $8.1K and $16K — the widest spread between payer medians is roughly $8K. See the table and chart below for payer-level distributions and percentile detail. Payer distributions include Aetna, Cigna, Anthem, and BCBS as shown.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported in the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 101. Values reflect Medicare FFS payment activity nationally for the year 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $9.1K$45K$6.9K28K

    Patient Population

    This DRG population includes both Medicare-age and working-age patients, but billing volume and Medicare discharges indicate a meaningful Medicare representation given the CMS FFS dataset. The mix therefore skews toward a combined population with a substantial Medicare component rather than being exclusively working-age. Expect the payer mix to include a notable share of commercial payers alongside Medicare beneficiaries.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Payer rates in Alaska for DRG 101 range from $14K to $22K across the reported payers, with Anthem and Blue Cross Blue Shield clustered at $14K and Cigna at $22K. The notable deviation is Cigna’s mean, which sits well above the other local payers and above many national medians. Refer to the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $22K); Lowest payers: Anthem and Blue Cross Blue Shield (mean $14K each).
    • Cigna in Alaska pays substantially above the other local payers and is materially higher than national BCBS and Anthem medians, indicating a pronounced in-state premium for Cigna relative to the AK payer set.

    Clinical Trials

    • Acute emergency management trials: Studies focusing on rapid ED and inpatient treatments for patients presenting with new-onset seizures or breakthrough seizures without major complications evaluate time-to-seizure-control interventions, dosing strategies, and protocols for safe observation versus admission. These trials enroll adults and children who present with isolated seizure events or short seizure clusters but without life‑threatening comorbidities, aiming to define best practices that reduce inpatient length of stay and avoid unnecessary escalation of care. Results are directly relevant to hospital clinicians and payers because optimized acute pathways can lower resource utilization and readmission risk while ensuring safe disposition decisions.
    • Comparative effectiveness and medication strategy studies: Research comparing anticonvulsant selection, initiation versus deferment of chronic therapy, or route and timing of administration among patients admitted for seizures without major complications examines outcomes such as seizure recurrence, adverse events, and functional recovery. These studies typically include patients with provoked or unprovoked seizures who do not meet criteria for major complications or prolonged ICU stays, and they seek to identify which medication strategies best balance seizure control with side‑effect profiles. Findings inform inpatient prescribing practices, formulary decisions, and length‑of-stay considerations that impact reimbursement and overall cost of care.
    • Post-discharge outcomes and care coordination studies: Observational cohorts and interventional trials testing transitional-care models, outpatient neurology follow‑up timing, and patient education/self‑management programs target patients discharged after a seizure hospitalization without major complications to reduce recurrence, emergency visits, and readmissions. These studies measure metrics such as outpatient visit adherence, subsequent ED use, functional status, and medication adherence over weeks to months, enrolling patients considered stable enough for routine discharge. For providers and payers, evidence from these studies supports effective discharge planning and care pathways that can improve patient safety while lowering downstream acute-care costs.

    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

    • More pages

    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.
    Published by

    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 101
    Mean Rates by Payer — Alaska — DRG 101