Bronchitis and Asthma with CC/MCC DRG Reimbursement

Summary & Overview

Bronchitis and Asthma with CC/MCC: Inpatient Reimbursement Overview

DRG 202 encompasses inpatient admissions for bronchitis and asthma with a Complication or Comorbidity or Major Complication or Comorbidity, covering exacerbations and related respiratory complications that increase resource use. Precise documentation and coding of the respiratory diagnosis and any Complications or Comorbidities are critical because they affect Medicare payment classification and hospital reimbursement.

BronchitisAsthmaDRG Bronchitis and Asthma with CC/MCCDRG 202Diagnosis-Related GroupInpatient ReimbursementMedicarePulmonologyRespiratory Care

DRG 202 Overview

DRG 202 covers inpatient stays for bronchitis and asthma when the patient has a Complication or Comorbidity or a Major Complication or Comorbidity that increases resource use. This Diagnosis-Related Group includes acute exacerbations and complications of chronic obstructive airway disease and asthma requiring hospital-level care. It matters for Medicare payment because the presence of Complications or Comorbidities or Major Complications or Comorbidities alters relative payment weight and impacts reimbursement for hospitals. Accurate clinical documentation and coding of the primary respiratory condition and any associated Complications or Comorbidities determine assignment to this Diagnosis-Related Group.

National Payment Rates

Across commercial payers the observed rate range runs from about $9K to $16K in mean payments, with individual payer medians spanning roughly $8.7K to $17K across the sample; the widest spread between reported payer maxima and minima is roughly $33K (Anthem max vs. BCBS min). See the payer table and accompanying chart below for payer-specific distributions. Payer-level labels in the table use full names such as Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem.

Mean Rates by Payer — National — DRG 202

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska, DRG 202 reimbursement means range from $15K to $23K across the payers shown, with Cigna at the high end and BCBS and Anthem at the low end. This state range is tighter than national variability, and Cigna’s $23K mean represents the most notable upward deviation versus many national medians. See the table and chart below for payer-level detail.

Key Insights for Alaska

Highest payer: Cigna (mean $23K); Lowest payers: BCBS and Anthem (mean $15K each).
Rate range across payers is narrow in AK (~$15K–$23K), with Cigna notably higher than BCBS/Anthem and above typical national medians for some payers.

Clinical Trials

Acute inpatient management trials evaluating short-term interventions to reduce respiratory failure and length of stay: these studies test interventions such as optimized bronchodilator delivery methods, corticosteroid dosing strategies, or noninvasive ventilation protocols in hospitalized adults and children admitted primarily for bronchitis or asthma exacerbations with comorbid conditions (CC/MCC). The patient population is those requiring inpatient care for moderate-to-severe exacerbations where rapid stabilization and avoidance of ICU transfer are the objectives. Results are directly relevant to providers for clinical pathways and to payers because reductions in ICU use, mechanical ventilation, and LOS drive cost and resource utilization for this DRG.
Comparative effectiveness and precision-medicine studies comparing maintenance and rescue strategies around hospitalization: these trials compare different chronic controller regimens, adherence interventions, or biomarkers-guided therapy among patients with a history of asthma or chronic bronchitis who are hospitalized with exacerbations. Participants often include patients with comorbidities (e.g., heart failure, COPD overlap, or obesity) to determine which long-term management strategies most effectively prevent readmission and recurrent severe exacerbations. Findings inform discharge planning, case management, and formulary/payer coverage decisions by identifying therapies and patient subgroups that most reduce 30-day readmissions and downstream costs.
Post-discharge outcomes and transitional-care intervention studies focused on readmission reduction and equity: these pragmatic trials assess interventions such as pharmacist-led medication reconciliation, home-based inhaler education, telemonitoring of symptoms, or social determinant supports in the immediate post-discharge period for diverse adult and pediatric patients with bronchitis or asthma complicated by CC/MCC. The research question is whether structured transitional care reduces emergency visits, readmissions, and adverse events in high-risk populations (including those with limited access to outpatient care or multiple comorbidities). Payers and health systems rely on this evidence to design care management programs that lower readmission penalties and improve cost-effective allocation of post-acute resources.

Other Respiratory System O.R. Procedures with CC: Inpatient Reimbursement Overview

193-SIMPLE-PNEUMONIA-AND-PLEURISY-WITH-MCC

Simple Pneumonia and Pleurisy with MCC: Inpatient Reimbursement Overview

182-RESPIRATORY-NEOPLASMS-WITHOUT-CC-MCC

Respiratory Neoplasms without CC/MCC: Inpatient Reimbursement Overview

190-CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-WITH-MCC

Chronic Obstructive Pulmonary Disease with MCC: Inpatient Reimbursement Overview

191-CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-WITH-CC

Chronic Obstructive Pulmonary Disease with CC: Inpatient Reimbursement Overview

164-MAJOR-CHEST-PROCEDURES-WITH-CC

Major Chest Procedures with CC: Inpatient Reimbursement Overview

197-INTERSTITIAL-LUNG-DISEASE-WITH-CC

Interstitial Lung Disease with CC: Inpatient Reimbursement Overview

201-PNEUMOTHORAX-WITHOUT-CC-MCC

Pneumothorax without CC/MCC: Inpatient Reimbursement Overview

168-OTHER-RESPIRATORY-SYSTEM-O-R-PROCEDURES-WITHOUT-CC-MCC

Other Respiratory System O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

199-PNEUMOTHORAX-WITH-MCC

Pneumothorax with Major Complication or Comorbidity: Inpatient Reimbursement Overview

Showing 1–10 of 40

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.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$9K	$43K	$6.8K	19K