Skin Graft for Skin Ulcer or Cellulitis with MCC: Inpatient Reimbursement Overview

DRG 573 addresses inpatient skin graft procedures for skin ulcers or cellulitis when a Major Complication or Comorbidity is present, encompassing higher-acuity surgical and medical care needs. This Diagnosis-Related Group matters for inpatient reimbursement because the Major Complication or Comorbidity designation increases payment to reflect greater resource consumption and complexity of care.

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DRG 573 Overview

DRG 573 covers inpatient admissions for patients receiving skin grafting procedures for skin ulcers or cellulitis when a Major Complication or Comorbidity is present. This Diagnosis-Related Group captures higher resource use due to more severe infection, comorbid conditions, or perioperative complications that increase length of stay and intensity of care. It matters for Medicare payment because the presence of a Major Complication or Comorbidity adjusts reimbursement to reflect greater expected costs during the hospitalization. Accurate coding of the underlying ulcer or cellulitis, the graft procedure, and the Major Complication or Comorbidity is essential for correct payment assignment.

National Payment Rates

Across commercial payers the reported rate range spans from about $1.1K (BCBS p25) up to $200K (Anthem max), with payer medians and means varying widely; the widest spread appears between BCBS and Anthem. See the payer table and accompanying chart below for payer-specific percentiles and distribution. Individual payers such as Aetna, Anthem, Cigna, and BCBS show notably different median and 75th-percentile levels.

The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment (avg_tot_pymt_amt), average submitted covered charges (avg_submtd_cvrd_chrg), average Medicare payment amount (avg_mdcr_pymt_amt), and total discharges (tot_dschrgs) for DRG 573. Values reflect national aggregates for Medicare FFS claims in 2023.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$51K	$220K	$42K	580

Patient Population

The DRG 573 population typically skews toward older adults covered by Medicare but includes a mix of working-age patients covered by commercial payers; therefore payer mix is mixed with a Medicare tilt. Expect a substantial proportion of discharges to be Medicare FFS beneficiaries, while commercial payers (Aetna, Anthem, Cigna, BCBS) account for a meaningful minority of cases. Age distribution trends are driven by payer enrollment patterns rather than clinical detail.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Across Alaska payers the mean rates range from $100K to $160K, with Cigna at the high end and both Blue Cross Blue Shield and Anthem at the low end. This represents a notable elevation for Cigna versus the other in-state payers and a tighter overall spread compared with national variability. See the table and chart below for payer-specific distributions.

Key Insights for Alaska

Highest payer: Cigna with a mean of $160K; lowest payers: BCBS and Anthem each with a mean of $100K.
Alaska rates show a compressed range relative to national benchmarks, but Cigna in AK is meaningfully above the state peers and above national mean context for some payers.

Clinical Trials

Acute surgical technique and perioperative management studies: randomized or pragmatic trials comparing different skin graft techniques (for example, split-thickness versus full-thickness grafting approaches, or varying donor site preparation and fixation methods) and perioperative adjuncts such as negative-pressure wound therapy used immediately before, during, or after grafting. These studies enroll hospitalized patients with skin ulcers or cellulitis requiring operative debridement and grafting, often complicated by critical comorbidities (eg, diabetes, peripheral arterial disease, immunosuppression) that drive the MCC designation. Results inform surgeons and hospital administrators about procedure success rates, short-term complication profiles, and resource utilization during the index admission — key inputs for clinical pathways, coding accuracy, and inpatient reimbursement decisions.
Comparative effectiveness and infective-control trials in complex infected wounds: multicenter cohort studies or randomized comparisons of antimicrobial strategies (systemic antibiotic regimens, local antibiotic delivery, antiseptic dressings) and timing of grafting after infection control. These trials target patients whose cellulitis or infected ulcers are the proximate reason for grafting but who present with varying pathogen profiles, antimicrobial resistance risk, and soft-tissue viability; they address optimal criteria for infection resolution prior to definitive closure. Findings are relevant to clinicians and payers because they affect length of stay, readmission risk for recurrent infection, intensive resource use (eg, prolonged IV antibiotics, isolation), and overall cost-effectiveness of inpatient management pathways.
Post-discharge functional, wound-healing, and utilization/outcomes studies: prospective observational or pragmatic trials evaluating long-term graft survival, wound recurrence, functional status, quality of life, and healthcare utilization (home health needs, readmissions, outpatient wound clinic visits) among patients discharged after skin grafting for ulcers or cellulitis. These studies include high-risk subgroups common under this DRG (elderly patients, those with diabetes or vascular disease, or with limited social support) and examine how discharge planning, outpatient follow-up intensity, and community services influence outcomes. Payers and care coordinators use this evidence to design post-acute care bundles, predict readmission drivers, and allocate resources to reduce preventable downstream costs while supporting durable wound closure and patient function.

Related Codes

570-SKIN-DEBRIDEMENT-WITH-MCC

Skin Debridement with Major Complication or Comorbidity: Inpatient Reimbursement Overview

571-SKIN-DEBRIDEMENT-WITH-CC

Skin Debridement with CC: Inpatient Reimbursement Overview

572-SKIN-DEBRIDEMENT-WITHOUT-CC-MCC

Skin Debridement without CC/MCC: Inpatient Reimbursement Overview

574-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

Skin Graft for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

575-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

Skin Graft for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

576-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-MCC

Skin Graft Except for Skin Ulcer or Cellulitis with MCC: Inpatient Reimbursement Overview

577-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

Skin Graft Except for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

578-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

579-OTHER-SKIN-SUBCUTANEOUS-TISSUE-AND-BREAST-PROCEDURES-WITH-MCC

Other Skin, Subcutaneous Tissue and Breast Procedures with MCC: Inpatient Reimbursement Overview

580-OTHER-SKIN-SUBCUTANEOUS-TISSUE-AND-BREAST-PROCEDURES-WITH-CC

Other Skin, Subcutaneous Tissue and Breast Procedures with CC: Inpatient Reimbursement Overview

Showing 1–10 of 31

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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National Payment Rates

Mean Rates by Payer — National — DRG 573

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$51K	$220K	$42K	580

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 573

Key Insights for Alaska

Highest payer: Cigna with a mean of $160K; lowest payers: BCBS and Anthem each with a mean of $100K.
Alaska rates show a compressed range relative to national benchmarks, but Cigna in AK is meaningfully above the state peers and above national mean context for some payers.

Clinical Trials

Acute surgical technique and perioperative management studies: randomized or pragmatic trials comparing different skin graft techniques (for example, split-thickness versus full-thickness grafting approaches, or varying donor site preparation and fixation methods) and perioperative adjuncts such as negative-pressure wound therapy used immediately before, during, or after grafting. These studies enroll hospitalized patients with skin ulcers or cellulitis requiring operative debridement and grafting, often complicated by critical comorbidities (eg, diabetes, peripheral arterial disease, immunosuppression) that drive the MCC designation. Results inform surgeons and hospital administrators about procedure success rates, short-term complication profiles, and resource utilization during the index admission — key inputs for clinical pathways, coding accuracy, and inpatient reimbursement decisions.
Comparative effectiveness and infective-control trials in complex infected wounds: multicenter cohort studies or randomized comparisons of antimicrobial strategies (systemic antibiotic regimens, local antibiotic delivery, antiseptic dressings) and timing of grafting after infection control. These trials target patients whose cellulitis or infected ulcers are the proximate reason for grafting but who present with varying pathogen profiles, antimicrobial resistance risk, and soft-tissue viability; they address optimal criteria for infection resolution prior to definitive closure. Findings are relevant to clinicians and payers because they affect length of stay, readmission risk for recurrent infection, intensive resource use (eg, prolonged IV antibiotics, isolation), and overall cost-effectiveness of inpatient management pathways.
Post-discharge functional, wound-healing, and utilization/outcomes studies: prospective observational or pragmatic trials evaluating long-term graft survival, wound recurrence, functional status, quality of life, and healthcare utilization (home health needs, readmissions, outpatient wound clinic visits) among patients discharged after skin grafting for ulcers or cellulitis. These studies include high-risk subgroups common under this DRG (elderly patients, those with diabetes or vascular disease, or with limited social support) and examine how discharge planning, outpatient follow-up intensity, and community services influence outcomes. Payers and care coordinators use this evidence to design post-acute care bundles, predict readmission drivers, and allocate resources to reduce preventable downstream costs while supporting durable wound closure and patient function.

Related Codes

570-SKIN-DEBRIDEMENT-WITH-MCC

Skin Debridement with Major Complication or Comorbidity: Inpatient Reimbursement Overview

571-SKIN-DEBRIDEMENT-WITH-CC

Skin Debridement with CC: Inpatient Reimbursement Overview

572-SKIN-DEBRIDEMENT-WITHOUT-CC-MCC

Skin Debridement without CC/MCC: Inpatient Reimbursement Overview

574-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

Skin Graft for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

575-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

Skin Graft for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

576-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-MCC

Skin Graft Except for Skin Ulcer or Cellulitis with MCC: Inpatient Reimbursement Overview

577-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

Skin Graft Except for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

578-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

579-OTHER-SKIN-SUBCUTANEOUS-TISSUE-AND-BREAST-PROCEDURES-WITH-MCC

Other Skin, Subcutaneous Tissue and Breast Procedures with MCC: Inpatient Reimbursement Overview

580-OTHER-SKIN-SUBCUTANEOUS-TISSUE-AND-BREAST-PROCEDURES-WITH-CC

Other Skin, Subcutaneous Tissue and Breast Procedures with CC: Inpatient Reimbursement Overview

Showing 1–10 of 31

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.