Epistaxis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

DRG 150 addresses inpatient care for epistaxis with a Major Complication or Comorbidity, encompassing cases with substantial clinical complexity and higher resource needs. Accurate assignment influences Medicare inpatient reimbursement by directing higher-weighted payment under the Diagnosis-Related Group framework.

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DRG 150 Overview

DRG 150 covers inpatient admissions for epistaxis, or nosebleed, when accompanied by a Major Complication or Comorbidity that significantly increases resource use and clinical complexity. This Diagnosis-Related Group typically applies when patients require intensive interventions, transfusions, or management of significant comorbid conditions. It matters for Medicare payment because the presence of a Major Complication or Comorbidity shifts reimbursement to a higher-weighted payment tier within the Medicare Severity Diagnosis-Related Group system. Proper assignment affects hospital payment for resource-intensive epistaxis cases.

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Epistaxis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

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DRG 150 Overview

National Payment Rates

Across the commercial payers shown, negotiated rates range from about $11K to $49K, with payer medians and quartiles varying by insurer; the widest spread is between Anthem (max $49K) and BCBS (median $11K). See the table and chart below for payer-specific distributions. Payer labels use full commercial names like Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem for clarity.

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 ($12.7k), average submitted covered charges ($58.1k), average Medicare payment amount ($10.8k), and total discharges (726).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$13K	$58K	$11K	730

Patient Population

This DRG’s population skews toward Medicare-age beneficiaries rather than primarily working-age patients, reflecting a predominance of older adults in the inpatient caseload. Commercial payers still cover a portion of cases, indicating a mixed but Medicare-leaning payer mix. Age distribution therefore trends toward the 65+ cohort rather than predominantly working-age adults.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska, DRG 150 rates span from $21K to $32K across reported payers, with Anthem and Blue Cross Blue Shield clustered at $21K and Cigna at $32K. The most notable deviation from national averages is Cigna’s rate sitting well above the state’s other payers and above several national medians. See the table and chart below for payer-level detail.

Key Insights for Alaska

Anthem is the highest-paying payer in Alaska at $21K, while BCBS (Blue Cross Blue Shield) also reports $21K and Cigna is higher at $32K; Cigna represents the highest payer in the state when compared across available payers and Anthem/BCBS the lowest.
Alaska’s payer rates range from $21K to $32K, with Cigna notably above the other state payers and exceeding typical national median levels for some payers, indicating a meaningful upward deviation versus many national benchmarks.

Clinical Trials

Acute hemostatic intervention trials: randomized or prospective studies comparing immediate bleeding-control strategies in hospitalized adults with severe epistaxis complicated by major comorbidities (for example, patients with coagulopathy, on anticoagulation, or with significant cardiovascular disease). These studies evaluate time to hemostasis, need for transfusion, procedure rates (nasal packing, cautery, arterial ligation/embolization), and short-term complications, addressing the acute management decisions that determine length of stay and resource intensity. Results inform in-hospital protocols that directly affect inpatient reimbursement and resource allocation for high-acuity DRG 150 cases.
Comparative effectiveness and care pathway research: observational cohorts and pragmatic trials comparing different care pathways (emergency department-only vs. admission with ENT consult, early interventional radiology vs. surgical approaches, protocols for reversal of anticoagulation) in heterogeneous adult populations who present with epistaxis and major complications. These studies focus on outcomes such as rates of rebleeding, procedural utilization, ICU admission, and total hospitalization cost, helping payers and hospitals identify which pathways reduce complications and avoidable use of high-cost services. Findings guide clinical pathways and case management strategies to optimize DRG payments and minimize costly readmissions or extended stays.
Post-discharge outcomes and readmission prevention studies: cohort studies and quality-improvement trials following patients discharged after hospitalization for epistaxis with significant comorbidity to assess rates and predictors of 30- and 90-day readmission, delayed bleeding, thromboembolic events after anticoagulation management changes, and health-related quality of life. These investigations often target transitional care interventions (structured follow-up, anticoagulation clinic referral, patient education) in older adults and those with bleeding diatheses, providing evidence on interventions that reduce readmissions and downstream costs. This research is relevant to providers and payers because reducing readmissions and post-discharge complications improves overall outcomes and impacts total cost of care associated with DRG 150 episodes.

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

140-MAJOR-HEAD-AND-NECK-PROCEDURES-WITH-MCC

Major Head and Neck Procedures with MCC: 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

Showing 1–10 of 24

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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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.

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National Payment Rates

Mean Rates by Payer — National — DRG 150

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$13K	$58K	$11K	730

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 150

Key Insights for Alaska

Anthem is the highest-paying payer in Alaska at $21K, while BCBS (Blue Cross Blue Shield) also reports $21K and Cigna is higher at $32K; Cigna represents the highest payer in the state when compared across available payers and Anthem/BCBS the lowest.
Alaska’s payer rates range from $21K to $32K, with Cigna notably above the other state payers and exceeding typical national median levels for some payers, indicating a meaningful upward deviation versus many national benchmarks.

Clinical Trials

Acute hemostatic intervention trials: randomized or prospective studies comparing immediate bleeding-control strategies in hospitalized adults with severe epistaxis complicated by major comorbidities (for example, patients with coagulopathy, on anticoagulation, or with significant cardiovascular disease). These studies evaluate time to hemostasis, need for transfusion, procedure rates (nasal packing, cautery, arterial ligation/embolization), and short-term complications, addressing the acute management decisions that determine length of stay and resource intensity. Results inform in-hospital protocols that directly affect inpatient reimbursement and resource allocation for high-acuity DRG 150 cases.
Comparative effectiveness and care pathway research: observational cohorts and pragmatic trials comparing different care pathways (emergency department-only vs. admission with ENT consult, early interventional radiology vs. surgical approaches, protocols for reversal of anticoagulation) in heterogeneous adult populations who present with epistaxis and major complications. These studies focus on outcomes such as rates of rebleeding, procedural utilization, ICU admission, and total hospitalization cost, helping payers and hospitals identify which pathways reduce complications and avoidable use of high-cost services. Findings guide clinical pathways and case management strategies to optimize DRG payments and minimize costly readmissions or extended stays.
Post-discharge outcomes and readmission prevention studies: cohort studies and quality-improvement trials following patients discharged after hospitalization for epistaxis with significant comorbidity to assess rates and predictors of 30- and 90-day readmission, delayed bleeding, thromboembolic events after anticoagulation management changes, and health-related quality of life. These investigations often target transitional care interventions (structured follow-up, anticoagulation clinic referral, patient education) in older adults and those with bleeding diatheses, providing evidence on interventions that reduce readmissions and downstream costs. This research is relevant to providers and payers because reducing readmissions and post-discharge complications improves overall outcomes and impacts total cost of care associated with DRG 150 episodes.

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

140-MAJOR-HEAD-AND-NECK-PROCEDURES-WITH-MCC

Major Head and Neck Procedures with MCC: 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

Showing 1–10 of 24

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.

OpenPayer

Epistaxis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

Sign up for drg 150 policy alerts

DRG 150 Overview

OpenPayer

Epistaxis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

Sign up for drg 150 policy alerts

DRG 150 Overview

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References