Bronchitis and Asthma without CC/MCC DRG Reimbursement

Summary & Overview

Bronchitis and Asthma without CC/MCC: Inpatient Reimbursement Overview

DRG 203 covers bronchitis and asthma admissions without Complication or Comorbidity or Major Complication or Comorbidity; it includes lower-severity respiratory exacerbations managed with standard inpatient therapies. Correct assignment affects Medicare inpatient reimbursement because payment is determined by Diagnosis-Related Group grouping and relative severity.

BronchitisAsthmaDRG Bronchitis and Asthma without CC/MCCDRG 203Diagnosis-Related GroupInpatient ReimbursementMedicarePulmonologyHospital Medicine

DRG 203 Overview

DRG 203 covers admissions for bronchitis and asthma without Complication or Comorbidity or Major Complication or Comorbidity, typically involving acute exacerbations managed with medications, nebulized therapies, oxygen, and observation. This Diagnosis-Related Group captures generally lower-severity respiratory hospitalizations that require inpatient care but not intensive supportive interventions. It matters for Medicare payment because reimbursement is grouped at a lower relative weight than higher-severity respiratory DRGs, affecting hospital revenue for common respiratory admissions. Accurate coding of diagnoses and comorbidities determines whether cases fall into this lower-paying group or a higher-severity category.

National Payment Rates

National payer rates in the benchmark table range from about $370 to $25K across payers, with mean payer-level averages spanning roughly $6.4K to $11K; the widest spread is seen between the minimum ($370) and maximum ($25K). Refer to the payer benchmark table and accompanying chart below for payer-specific distributions and quartiles. Payer comparisons include Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem.

Mean Rates by Payer — National — DRG 203

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows avg total payment ($6.8k), avg submitted covered charges ($32.3k), avg Medicare payment ($4.6k), and total discharges (2.5k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s payer means for DRG 203 range from 10K (Anthem and Blue Cross Blue Shield) up to 16K (Cigna), showing a fairly wide rate spread across payers. The most notable deviation from national averages is Cigna’s mean of 16K, which sits above several national medians and the state’s other payers. See the table and chart below for the payer-level detail.

Key Insights for Alaska

Cigna is the highest paying payer in Alaska with a mean of 16K, while Anthem and BCBS both report a flat 10K mean, making them the lowest paying payers in the state.
Alaska’s payer means range from 10K to 16K, with Cigna notably above the Anthem/BCBS cluster and slightly above national averages for several payers, indicating a meaningful upward deviation for Cigna versus national medians.

Clinical Trials

Acute inpatient management trials: randomized or pragmatic studies comparing short-term interventions for hospitalized patients presenting with severe asthma exacerbation or acute bronchitis-related respiratory distress. These studies enroll patients during the index admission and evaluate outcomes such as need for intubation, time to clinical stability, length of stay, and in-hospital complication rates. Results inform protocols that can reduce resource use and avoid escalation of care, which is directly relevant to providers optimizing clinical pathways and to payers seeking to manage inpatient costs under this DRG.
Comparative effectiveness studies of corticosteroid and bronchodilator strategies across severity strata: observational cohort studies or pragmatic randomized trials that compare dosing regimens, routes of administration (inhaled versus systemic), and frequency of bronchodilator therapy in adults and pediatrics without major comorbidities (no CC/MCC). These studies focus on metrics such as symptom resolution, relapse or readmission within 30 days, and adverse events, helping clinicians select therapies that balance efficacy and safety. For payers, evidence from these studies supports formulary and guideline decisions that can reduce variability in care and downstream expenditures associated with recurrent admissions.
Post-discharge outcomes and care-coordination research: prospective cohort or implementation studies that evaluate discharge planning, early outpatient follow-up, home-based inhaler education, and remote monitoring for patients discharged after an asthma or bronchitis hospitalization. Patient populations include those at risk for readmission due to poor inhaler technique, social determinants of health, or inadequate follow-up; outcomes measured include 30-day readmission, emergency visits, adherence to controller therapy, and patient-reported symptom control. Findings are pertinent to providers designing transitional care interventions and to payers interested in reducing avoidable readmissions and improving value across the episode of care.

Related Codes

197-INTERSTITIAL-LUNG-DISEASE-WITH-CC

Interstitial Lung Disease with CC: Inpatient Reimbursement Overview

207-RESPIRATORY-SYSTEM-DIAGNOSIS-WITH-VENTILATOR-SUPPORT-96-HOURS

Respiratory System Diagnosis with Ventilator Support >96 Hours: Inpatient Reimbursement Overview

181-RESPIRATORY-NEOPLASMS-WITH-CC

Respiratory Neoplasms with CC: Inpatient Reimbursement Overview

189-PULMONARY-EDEMA-AND-RESPIRATORY-FAILURE

Pulmonary Edema and Respiratory Failure: Inpatient Reimbursement Overview

182-RESPIRATORY-NEOPLASMS-WITHOUT-CC-MCC

Respiratory Neoplasms without CC/MCC: Inpatient Reimbursement Overview

177-RESPIRATORY-INFECTIONS-AND-INFLAMMATIONS-WITH-MCC

Respiratory Infections and Inflammations 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

206-OTHER-RESPIRATORY-SYSTEM-DIAGNOSES-WITHOUT-MCC

Other Respiratory System Diagnoses without MCC: Inpatient Reimbursement Overview

186-PLEURAL-EFFUSION-WITH-MCC

Pleural Effusion with MCC: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$6.8K	$32K	$4.6K	2.5K

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 203

Key Insights for Alaska

Cigna is the highest paying payer in Alaska with a mean of 16K, while Anthem and BCBS both report a flat 10K mean, making them the lowest paying payers in the state.
Alaska’s payer means range from 10K to 16K, with Cigna notably above the Anthem/BCBS cluster and slightly above national averages for several payers, indicating a meaningful upward deviation for Cigna versus national medians.

Clinical Trials

Acute inpatient management trials: randomized or pragmatic studies comparing short-term interventions for hospitalized patients presenting with severe asthma exacerbation or acute bronchitis-related respiratory distress. These studies enroll patients during the index admission and evaluate outcomes such as need for intubation, time to clinical stability, length of stay, and in-hospital complication rates. Results inform protocols that can reduce resource use and avoid escalation of care, which is directly relevant to providers optimizing clinical pathways and to payers seeking to manage inpatient costs under this DRG.
Comparative effectiveness studies of corticosteroid and bronchodilator strategies across severity strata: observational cohort studies or pragmatic randomized trials that compare dosing regimens, routes of administration (inhaled versus systemic), and frequency of bronchodilator therapy in adults and pediatrics without major comorbidities (no CC/MCC). These studies focus on metrics such as symptom resolution, relapse or readmission within 30 days, and adverse events, helping clinicians select therapies that balance efficacy and safety. For payers, evidence from these studies supports formulary and guideline decisions that can reduce variability in care and downstream expenditures associated with recurrent admissions.
Post-discharge outcomes and care-coordination research: prospective cohort or implementation studies that evaluate discharge planning, early outpatient follow-up, home-based inhaler education, and remote monitoring for patients discharged after an asthma or bronchitis hospitalization. Patient populations include those at risk for readmission due to poor inhaler technique, social determinants of health, or inadequate follow-up; outcomes measured include 30-day readmission, emergency visits, adherence to controller therapy, and patient-reported symptom control. Findings are pertinent to providers designing transitional care interventions and to payers interested in reducing avoidable readmissions and improving value across the episode of care.