Skin Graft for Skin Ulcer or Cellulitis with MCC DRG Reimbursement

Summary & Overview

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.

Skin Graft for Skin Ulcer or Cellulitis with MCCDRG Skin Graft for Skin Ulcer or Cellulitis with MCCDRG 573Diagnosis-Related GroupInpatient ReimbursementMedicareWound CareSurgical GraftingInfectious DiseaseHospital Coding

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.

Mean Rates by Payer — National — DRG 573

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.

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

593-SKIN-ULCERS-WITH-CC

Skin Ulcers with CC: Inpatient Reimbursement Overview

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Mastectomy for Malignancy with CC/MCC: Inpatient Reimbursement Overview

594-SKIN-ULCERS-WITHOUT-CC-MCC

Skin Ulcers without CC/MCC: Inpatient Reimbursement Overview

598-MALIGNANT-BREAST-DISORDERS-WITH-CC

Malignant Breast Disorders with CC: Inpatient Reimbursement Overview

601-NON-MALIGNANT-BREAST-DISORDERS-WITHOUT-CC-MCC

Non-Malignant Breast Disorders without CC/MCC: Inpatient Reimbursement Overview

607-MINOR-SKIN-DISORDERS-WITHOUT-MCC

Minor Skin Disorders without MCC: Inpatient Reimbursement Overview

603-CELLULITIS-WITHOUT-MCC

Cellulitis without MCC: Inpatient Reimbursement Overview

583-MASTECTOMY-FOR-MALIGNANCY-WITHOUT-CC-MCC

Mastectomy for Malignancy without CC/MCC: Inpatient Reimbursement Overview

572-SKIN-DEBRIDEMENT-WITHOUT-CC-MCC

Skin Debridement without CC/MCC: Inpatient Reimbursement Overview

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