Other Disorders of the Eye with MCC or Thrombolytic Agent: Inpatient Reimbursement Overview

DRG 124 encompasses inpatient admissions for Other Disorders of the Eye with Major Complication or Comorbidity or administration of a thrombolytic agent; it includes severe ocular conditions that require elevated resource intensity. Correct coding and documentation are important because Diagnosis-Related Group assignment affects Medicare inpatient reimbursement by reflecting increased clinical complexity and treatment intensity.

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DRG 124 Overview

DRG 124 covers hospital inpatient cases for Other Disorders of the Eye with Major Complication or Comorbidity or administration of a thrombolytic agent. Typical clinical situations include severe ocular infections, traumatic eye injuries, ischemic ocular events, or other acute eye conditions that require inpatient-level care and may involve systemic thrombolytic therapy. This classification matters for Medicare payment because the presence of a Major Complication or Comorbidity or use of a thrombolytic agent increases resource use and therefore the Diagnosis-Related Group assignment and reimbursement. Accurate coding of the principal diagnosis, secondary diagnoses, and procedures determines placement in this higher-severity Diagnosis-Related Group.

National Payment Rates

Across payers the reported allowed rates for DRG 124 range from about $370 (BCBS min) up to $46K (Anthem max), with mean allowed amounts clustering near $20K–$22K for Cigna, Aetna, and Anthem. The widest spread is seen between BCBS’s minimums and Anthem’s maximums, indicating substantial variation in negotiated rates. See the payer benchmark table and the chart below for payer-level distributions and percentiles.

The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under 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 124. Values reflect national-level aggregates for the 2023 Medicare FFS population.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$14K	$66K	$11K	1K

Patient Population

The DRG 124 population generally includes both Medicare-age and working-age patients, producing a mixed payer distribution but with a significant share attributed to Medicare given the DRG’s inclusion in inpatient Medicare reporting. Medicare beneficiaries tend to represent older adults (65+), while private/commercial payers cover primarily working-age adults (under 65). Overall, the population skews toward a mixed cohort with a meaningful Medicare component rather than exclusively working-age.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer reimbursements for DRG 124 in Alaska range from roughly $7.5K up to $57K across payers, with Anthem and Blue Cross Blue Shield clustering near a $20K mean and Cigna notably higher at a $33K mean. The most notable deviation from national averages is Cigna’s elevated mean and top-end max ($57K), which sits above the typical national range reported. Reference the table and chart below for payer-specific percentiles and distributions.

Key Insights for Alaska

Highest payer: Cigna (max $57K, mean $33K) and Lowest payer: Anthem/BCBS (max $32K, mean $20K).
Cigna’s mean ($33K) is meaningfully above the state mean distribution and above national means, while Anthem and Blue Cross Blue Shield in AK cluster lower around a $20K mean, representing a notable deviation below national averages for some national payers.

Clinical Trials

Acute interventional trials assessing emergency intravitreal or intra-arterial therapies for severe vision-threatening intraocular hemorrhages and retinal vascular occlusions: these studies focus on patients admitted with acute, severe eye disorders under DRG 124, including those with major complications or who received systemic thrombolytic agents, and evaluate rapid procedural interventions to preserve vision and prevent further ocular morbidity. Results are relevant to inpatient providers for optimizing timing and selection of acute interventions, and to payers for understanding short-term resource use and cost-effectiveness of high-intensity emergency care.
Comparative effectiveness studies of surgical versus minimally invasive procedures for complex ocular conditions complicated by major comorbidities: these trials enroll heterogeneous inpatient populations with other eye disorders plus major complications (for example, combined vitreoretinal pathologies or secondary glaucoma) to compare outcomes, complication rates, and length of stay between different operative strategies and perioperative management protocols. Findings inform clinicians on best practices for procedural choice in medically complex patients and help payers predict differences in utilization, readmissions, and procedural cost across treatment pathways.
Post-discharge outcomes and care coordination studies examining visual recovery, rehospitalization, and rehabilitation needs after inpatient treatment for severe eye disorders: these observational cohorts or pragmatic trials follow patients post-discharge to measure functional vision outcomes, adherence to outpatient ophthalmology follow-up, rates of recurrent events, and needs for home or skilled services. This research is important for providers to design discharge planning and rehabilitation services and for payers to model long-term costs, preventable readmissions, and the value of investments in transitional care for this high-risk DRG.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

115-EXTRAOCULAR-PROCEDURES-EXCEPT-ORBIT

Extraocular Procedures Except Orbit: Inpatient Reimbursement Overview

116-INTRAOCULAR-PROCEDURES-WITH-CC-MCC

Intraocular Procedures with CC/MCC: Inpatient Reimbursement Overview

117-INTRAOCULAR-PROCEDURES-WITHOUT-CC-MCC

Intraocular Procedures without CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

References

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.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.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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National Payment Rates

Mean Rates by Payer — National — DRG 124

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$14K	$66K	$11K	1K

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 124

Key Insights for Alaska

Highest payer: Cigna (max $57K, mean $33K) and Lowest payer: Anthem/BCBS (max $32K, mean $20K).
Cigna’s mean ($33K) is meaningfully above the state mean distribution and above national means, while Anthem and Blue Cross Blue Shield in AK cluster lower around a $20K mean, representing a notable deviation below national averages for some national payers.

Clinical Trials

Acute interventional trials assessing emergency intravitreal or intra-arterial therapies for severe vision-threatening intraocular hemorrhages and retinal vascular occlusions: these studies focus on patients admitted with acute, severe eye disorders under DRG 124, including those with major complications or who received systemic thrombolytic agents, and evaluate rapid procedural interventions to preserve vision and prevent further ocular morbidity. Results are relevant to inpatient providers for optimizing timing and selection of acute interventions, and to payers for understanding short-term resource use and cost-effectiveness of high-intensity emergency care.
Comparative effectiveness studies of surgical versus minimally invasive procedures for complex ocular conditions complicated by major comorbidities: these trials enroll heterogeneous inpatient populations with other eye disorders plus major complications (for example, combined vitreoretinal pathologies or secondary glaucoma) to compare outcomes, complication rates, and length of stay between different operative strategies and perioperative management protocols. Findings inform clinicians on best practices for procedural choice in medically complex patients and help payers predict differences in utilization, readmissions, and procedural cost across treatment pathways.
Post-discharge outcomes and care coordination studies examining visual recovery, rehospitalization, and rehabilitation needs after inpatient treatment for severe eye disorders: these observational cohorts or pragmatic trials follow patients post-discharge to measure functional vision outcomes, adherence to outpatient ophthalmology follow-up, rates of recurrent events, and needs for home or skilled services. This research is important for providers to design discharge planning and rehabilitation services and for payers to model long-term costs, preventable readmissions, and the value of investments in transitional care for this high-risk DRG.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

115-EXTRAOCULAR-PROCEDURES-EXCEPT-ORBIT

Extraocular Procedures Except Orbit: Inpatient Reimbursement Overview

116-INTRAOCULAR-PROCEDURES-WITH-CC-MCC

Intraocular Procedures with CC/MCC: Inpatient Reimbursement Overview

117-INTRAOCULAR-PROCEDURES-WITHOUT-CC-MCC

Intraocular Procedures without CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

References

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.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.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.