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    OpenPayerBilling CodesDiseases and Disorders of the Ear, Nose, Mouth and ThroatDRG 140-major-head-and-neck-procedures-with-mcc
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    Major Head and Neck Procedures with MCC: Inpatient Reimbursement Overview

    DRG 140 applies to major head and neck surgeries accompanied by a Major Complication or Comorbidity and defines a higher resource-intensity category for inpatient cases. It matters for inpatient reimbursement because the assigned Diagnosis-Related Group determines Medicare payment levels tied to case complexity and resource consumption.

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    DRG 140 Overview

    DRG 140 covers major surgical procedures of the head and neck performed for significant pathology when a Major Complication or Comorbidity is present. Typical cases include extensive resections, complex reconstructions, or combined airway and oncologic procedures with significant physiologic impact. This Diagnosis-Related Group matters for Medicare payment because the presence of a Major Complication or Comorbidity increases relative resource use and influences inpatient reimbursement. Accurate coding and documentation of the Major Complication or Comorbidity are therefore central to correct payment assignment.

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    National Payment Rates

    Across payers the observed rate range spans from $370 (minimum) up to $130K, with payer-level reported maxima between $110K and $130K; the widest spread appears in Anthem where values range from very low reported minima up to $130K. Commercial payers show median/mean clustering around the $58K–$71K band for Aetna, Cigna, and Anthem, while BCBS reports lower central tendency. See the table and chart below for payer-specific quartiles and distribution detail.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments as reported in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($44.2k), average submitted covered charges ($221.4k), average Medicare payment amount ($37.4k), and total discharges (678).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $44K$220K$37K680

    Patient Population

    This DRG’s population skews toward Medicare-age patients rather than exclusively working-age; Medicare beneficiaries make up a substantial share of inpatient volume for high-acuity DRGs. Commercial/private payers also contribute but to a lesser extent, indicating a mixed but Medicare-leaning payer mix. Age distribution therefore trends older, with a significant Medicare component reflected in utilization.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska payer means for DRG 140 span from $66K to $100K, with Anthem and Blue Cross Blue Shield at $66K and Cigna at $100K. The most notable deviation from national averages is Cigna’s mean of $100K, which sits well above common national medians. See the table and chart below for payer-specific percentiles and distributions.

    Key Insights for Alaska

    • Cigna is the highest paying payer at a mean of $100K, notably above other state payers and above national means for some payers.
    • Anthem and BCBS both report a uniform mean of $66K, making them the lowest payers in AK and substantially lower than Cigna by $34K.
    • The state payer range ($66K–$100K) shows a meaningful upward deviation at the top end versus national median benchmarks, driven by Cigna.

    Clinical Trials

    • Perioperative complication reduction trials examining interventions to decrease airway-related and wound-healing complications after major head and neck resections: these studies enroll adult patients undergoing extensive ablative surgery (eg, composite resections for advanced oral cavity, oropharyngeal, laryngeal, or hypopharyngeal cancers) and test perioperative bundles such as enhanced preoperative optimization, standardized airway management protocols, and intensified flap monitoring. The objective is to reduce immediate postoperative morbidity (airway obstruction, flap failure, bleeding, and infection) and shorten ICU/hospital length of stay, which is directly relevant to surgical teams and payers because complications drive readmissions and large cost variance under this DRG. - Comparative effectiveness studies of reconstructive strategies and resource utilization after major head and neck procedures: randomized or prospective observational studies compare types of reconstruction (eg, free microvascular flap versus regional flap versus local closure) and timing of reconstruction for patients with large composite defects following oncologic resection. These trials assess functional outcomes (speech, swallowing), complication rates, reoperation rates, and total inpatient costs, informing surgeons and hospital administrators which approaches yield better patient-centered recovery and may optimize reimbursement and LOS for cases classified under DRG 140. - Post-discharge rehabilitation and long-term outcomes research focusing on swallowing, nutrition, and quality of life in survivors of major head and neck surgery: longitudinal cohorts or intervention trials evaluate structured outpatient programs (speech and swallow therapy, nutritional support pathways, and psychosocial interventions) in patients after discharge from index hospitalization for major head and neck procedures with complications. The research question addresses readmission risk, durable functional recovery, and ongoing healthcare utilization, providing evidence for payers and care managers on programs that reduce downstream costs and improve long-term outcomes for this high-risk DRG population.

    Related Codes

    135-SINUS-AND-MASTOID-PROCEDURES-WITH-CC-MCC

    Sinus and Mastoid Procedures with CC/MCC: Inpatient Reimbursement Overview

    136-SINUS-AND-MASTOID-PROCEDURES-WITHOUT-CC-MCC

    Sinus and Mastoid Procedures without CC/MCC: Inpatient Reimbursement Overview

    137-MOUTH-PROCEDURES-WITH-CC-MCC

    Mouth Procedures with CC/MCC: Inpatient Reimbursement Overview

    138-MOUTH-PROCEDURES-WITHOUT-CC-MCC

    Mouth Procedures without CC/MCC: Inpatient Reimbursement Overview

    139-SALIVARY-GLAND-PROCEDURES

    Salivary Gland Procedures: Inpatient Reimbursement Overview

    141-MAJOR-HEAD-AND-NECK-PROCEDURES-WITH-CC

    Major Head and Neck Procedures with CC: Inpatient Reimbursement Overview

    142-MAJOR-HEAD-AND-NECK-PROCEDURES-WITHOUT-CC-MCC

    Major Head and Neck Procedures without CC/MCC: Inpatient Reimbursement Overview

    143-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITH-MCC

    Other Ear, Nose, Mouth and Throat O.R. Procedures with MCC: Inpatient Reimbursement Overview

    144-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITH-CC

    Other Ear, Nose, Mouth and Throat O.R. Procedures with CC: Inpatient Reimbursement Overview

    145-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITHOUT-CC-MCC

    Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 24

    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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    Mean Rates by Payer — National — DRG 140
    Mean Rates by Payer — Alaska — DRG 140