Minor Skin Disorders with MCC DRG Reimbursement Guide

Summary & Overview

Minor Skin Disorders with Major Complication or Comorbidity: Inpatient Reimbursement Overview

DRG 606 addresses hospital stays for minor skin disorders complicated by a Major Complication or Comorbidity, reflecting increased clinical complexity. It matters for inpatient reimbursement because the presence of a Major Complication or Comorbidity elevates resource use and thereby affects Medicare Severity Diagnosis-Related Group payment assignment.

Minor Skin DisordersDRG Minor Skin Disorders with MCCDRG 606Diagnosis-Related GroupInpatient ReimbursementMedicareDermatologyInfectious DiseaseWound CareHospital Coding

DRG 606 Overview

DRG 606 covers hospital admissions for minor skin disorders when a Major Complication or Comorbidity is present, including conditions such as infected skin lesions, severe dermatitis with systemic effects, and other localized skin conditions requiring inpatient management. This Diagnosis-Related Group groups cases by clinical similarity and resource use when the presence of a Major Complication or Comorbidity increases complexity and cost. Payment under Medicare Severity Diagnosis-Related Group logic adjusts reimbursement to account for the higher expected resource consumption associated with Major Complications or Comorbidities. Understanding this DRG is important for accurate inpatient coding and appropriate Medicare payment classification.

National Payment Rates

Across commercial payers the observed rate range runs from about $13K (Blue Cross Blue Shield) up to $52K (Anthem), with payer medians clustering in the low-to-mid $20Ks. The widest spread is between Anthem’s max of $52K and BCBS’s min of $370, a difference visible in the table and chart below. Benchmarks show Aetna, Cigna, and Anthem medians near $23K–$27K while BCBS reports lower median and wider lower-tail values.

Mean Rates by Payer — National — DRG 606

The CMS 2023 data represent national Medicare fee-for-service inpatient payments from the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($16.0k), average submitted covered charges ($67.6k), average Medicare payment ($12.9k), and total discharges (1.7k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 606 rates range from $24K to $36K across reported payers, with Cigna representing the high end and BCBS and Anthem clustered at the low end. The state exhibits a compressed spread compared with national variability but with Cigna notably above the other payers. See the table and chart below for payer-level distributions.

Key Insights for Alaska

Highest payer: Cigna at $36K (mean); Lowest payers: BCBS and Anthem, both at $24K (mean).
Cigna’s mean of $36K sits well above other state payers and is notably higher than national means for BCBS and Anthem, indicating a meaningful upward deviation from national-level rates for this DRG.

Clinical Trials

Acute procedural and wound-care intervention trials: studies testing different in-hospital interventions such as advanced wound dressings, topical antimicrobial regimens, or bedside debridement techniques for patients admitted with minor but complicated skin disorders (for example infected cellulitis requiring incision and drainage, pressure-related skin breakdown with secondary infection, or acute ulcerations). These trials enroll medically complex inpatients who often have comorbidities (eg, diabetes, peripheral vascular disease, or immunosuppression) to determine short-term outcomes like time to wound closure, need for repeat procedures, and length of stay. Results inform providers on which acute interventions reduce complications and resource use, and help payers evaluate cost-effectiveness of higher-cost wound technologies during the index hospitalization.
Comparative effectiveness studies of systemic and adjunctive therapies in complex minor skin disease: randomized or pragmatic trials comparing antibiotic strategies, duration of systemic therapy, or the addition of adjunctive measures (eg, negative-pressure wound therapy vs standard dressing, or anti-inflammatory versus standard care) in patients with minor skin disorders complicated by major comorbid conditions. These studies typically focus on medically complex subgroups (older adults, patients with MCC such as renal failure or poorly controlled diabetes) to determine which regimens reduce readmissions, adverse drug events, and treatment failure. Findings are directly relevant to clinicians deciding inpatient treatment intensity and to payers assessing appropriate care pathways that balance clinical benefit with risks and downstream costs.
Post-discharge outcomes and care transition research: prospective cohort studies or interventional trials evaluating discharge planning, outpatient wound clinic follow-up, home nursing support, and telemedicine monitoring for patients discharged after admission for minor skin disorders with major comorbidities. These studies examine rates of readmission, emergency visits for wound-related complications, adherence to outpatient care, and patient-centered outcomes such as functional status and quality of life in the vulnerable MCC population. Evidence from this research helps providers design effective transition-of-care protocols and allows payers to identify which post-discharge services reduce preventable readmissions and overall episode costs.

Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC: 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

603-CELLULITIS-WITHOUT-MCC

Cellulitis without MCC: Inpatient Reimbursement Overview

595-MAJOR-SKIN-DISORDERS-WITH-MCC

Major Skin Disorders with MCC: Inpatient Reimbursement Overview

597-MALIGNANT-BREAST-DISORDERS-WITH-MCC

Malignant Breast Disorders with MCC: Inpatient Reimbursement Overview

584-BREAST-BIOPSY-LOCAL-EXCISION-AND-OTHER-BREAST-PROCEDURES-WITH-CC-MCC

Breast Biopsy, Local Excision and Other Breast Procedures with CC/MCC: Inpatient Reimbursement Overview

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

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

593-SKIN-ULCERS-WITH-CC

Skin Ulcers with CC: Inpatient Reimbursement Overview

571-SKIN-DEBRIDEMENT-WITH-CC

Skin Debridement with CC: Inpatient Reimbursement Overview

604-TRAUMA-TO-THE-SKIN-SUBCUTANEOUS-TISSUE-AND-BREAST-WITH-MCC

Trauma to the Skin, Subcutaneous Tissue and Breast with MCC: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$16K	$68K	$13K	1.7K