Dental and Oral Diseases without CC/MCC DRG | Reimbursement

Summary & Overview

Dental and Oral Diseases without CC/MCC: Inpatient Reimbursement Overview

DRG 159 covers inpatient stays for dental and oral diseases without Complication or Comorbidity or Major Complication or Comorbidity, focusing on straightforward procedures and infections limited to the oral cavity. Classification in this Diagnosis-Related Group matters because it determines the Medicare prospective payment level and reflects lower expected resource use compared with more complex oral and maxillofacial cases.

Dental and Oral Diseases without CC/MCCDRG Dental and Oral Diseases without CC/MCCDRG 159Diagnosis-Related GroupInpatient ReimbursementMedicareOral SurgeryOral InfectionTooth ExtractionHospital Coding

DRG 159 Overview

DRG 159 covers hospital admissions for dental and oral diseases without a Complication or Comorbidity or Major Complication or Comorbidity, typically including tooth extractions, abscess drainage, and treatment of non-complex oral infections when no significant systemic complications are present. This Diagnosis-Related Group groups cases with relatively low resource use compared with more complex oral and maxillofacial conditions. For Medicare payment, classification in DRG 159 influences the base prospective payment and affects hospital revenue and resource allocation for routine dental and oral inpatient care. Accurate coding of diagnosis and comorbid conditions determines whether a case remains in DRG 159 or is assigned to a higher-paying Diagnosis-Related Group.

National Payment Rates

Across commercial payers the reported rate range spans from $370 (BCBS min) up to $24K (Anthem max), with payer means clustering between $6.6K and $12K; the widest observed spread is between BCBS (min $370) and Anthem (max $24K). See the table and chart below for payer-specific distributions and percentile details. Commercial benchmarks show notable variability by payer and percentile.

Mean Rates by Payer — National — DRG 159

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 159 rates span from roughly 11K to 29K across payers, with a cluster at 11K and a notable high outlier at 29K. The most notable deviation from national averages is the elevated Cigna mean (~17K) and its 29K max, which push the state mean above several national payer means. Reference the table and chart below for payer-level distributions and percentile details.

Key Insights for Alaska

Cigna is the highest-paying payer in Alaska with a mean of 17K, while Blue Cross Blue Shield and Anthem are the lowest, both at a mean of 11K.
Alaska’s payer range (min ~11K to max ~29K) shows a wider top-end than national medians, with Cigna’s mean (~17K) sitting above several national payer means, indicating meaningful upward deviation at the high end.

Clinical Trials

Studies evaluating novel acute management and surgical techniques for severe odontogenic infections and maxillofacial abscesses that require inpatient care. These trials often enroll adults and pediatric patients admitted for airway-compromising infections or deep space head and neck abscesses, comparing approaches such as timing of incision and drainage, adjunctive local care, or perioperative airway management strategies. Results inform protocol development for inpatient teams and influence resource use, length of stay, and complication rates important to hospital reimbursement and DRG assignment.
Comparative effectiveness research comparing different restorative and extraction strategies for patients hospitalized with advanced dental caries, pulpitis, or failed dental work leading to systemic symptoms. These studies enroll medically complex patients (for example, those with diabetes, anticoagulation, or immunosuppression) to compare outcomes of conservative endodontic-based care versus extraction and prosthetic planning, measuring short-term morbidity, need for readmission, and downstream dental service utilization. Findings guide clinicians and payers on which inpatient care pathways reduce complications and subsequent costs, affecting care coordination and post-discharge reimbursement planning.
Post-discharge outcomes and care-transition studies focusing on access to outpatient dental follow-up, oral rehabilitation, and prevention among patients discharged after inpatient dental procedures or infection management. These prospective cohort or health-services trials follow patients for readmissions, ongoing infection, oral function, pain control, and enrollment in dental care programs, often targeting underserved populations with limited dental access. Understanding these outcomes helps hospitals and payers design discharge planning, community partnerships, and value-based programs to reduce readmissions and improve long-term oral health outcomes tied to DRG performance.

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

148-EAR-NOSE-MOUTH-AND-THROAT-MALIGNANCY-WITHOUT-CC-MCC

Ear, Nose, Mouth and Throat Malignancy without CC/MCC: Inpatient Reimbursement Overview

156-OTHER-EAR-NOSE-MOUTH-AND-THROAT-DIAGNOSES-WITHOUT-CC-MCC

Other Ear, Nose, Mouth and Throat Diagnoses without CC/MCC: Inpatient Reimbursement Overview

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

Sinus and Mastoid Procedures with CC/MCC: 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

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

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

146-EAR-NOSE-MOUTH-AND-THROAT-MALIGNANCY-WITH-MCC

Ear, Nose, Mouth and Throat Malignancy with MCC: Inpatient Reimbursement Overview

151-EPISTAXIS-WITHOUT-MCC

Epistaxis without MCC: Inpatient Reimbursement Overview

149-DYSEQUILIBRIUM

Dysequilibrium: 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

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.

OpenPayer

Summary & Overview

Dental and Oral Diseases without CC/MCC: Inpatient Reimbursement Overview

DRG 159 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes