Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesEndocrine, Nutritional and Metabolic Diseases and DisordersDRG 640-miscellaneous-disorders-of-nutrition-metabolism-fluids-and-electrolytes-with-mcc
    Ask Trek AI about this page

    Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC: Inpatient Reimbursement Overview

    DRG 640 encompasses miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with a Major Complication or Comorbidity; it includes severe electrolyte disturbances and complex metabolic or nutrition-related conditions requiring inpatient care. This Diagnosis-Related Group matters for inpatient reimbursement because the Major Complication or Comorbidity designation increases case severity and typically results in higher Medicare payment compared with lower-severity groupings.

    Customize your policy alerts

    Sign up for drg 640 policy alerts

    Get alerted when payer policies referencing 640 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 640 Overview

    DRG 640 covers inpatient cases grouped to miscellaneous disorders of nutrition, metabolism, fluids and electrolytes that include a Major Complication or Comorbidity. Typical clinical conditions include severe electrolyte disturbances, complex metabolic derangements, and significant nutrition-related complications that require hospital-level medical management and monitoring. This Diagnosis-Related Group is important for Medicare payment because presence of a Major Complication or Comorbidity generally increases resource use and results in higher reimbursement relative to non-major complication or comorbidity groupings. Accurate clinical documentation and coding determine whether a case is assigned to this Diagnosis-Related Group and thus affect payment.

    Table of contents

    Progress1 / 5

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    National Payment Rates

    Payor benchmarks for DRG 640 span from about $370 up to $44K across the national sample, with payer medians clustering between roughly $11K and $23K depending on carrier. The widest spread is observed between the lowest observed value ($370) and the highest ($44K). See the table and chart below for payer-specific distributions and percentile bands.

    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 average total payment ($12.1k), average submitted covered charges ($55.7k), average Medicare payment amount ($10.1k), and total discharges (73.7k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $12K$56K$10K74K

    Patient Population

    The patient mix for DRG 640 generally skews toward Medicare-age beneficiaries rather than exclusively working-age commercial populations, reflecting a larger share of care under Medicare fee-for-service. Commercial payers still represent a portion of cases, so the population is mixed but biased toward older adults. This implies greater prevalence of Medicare discharges compared with purely private-payer cohorts.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s reported DRG 640 means range from $21K (Anthem and Blue Cross Blue Shield) up to $32K (Cigna), reflecting a relatively narrow payer spread with one clear outlier on the high end. The presence of Cigna at $32K represents the most notable deviation from national averages, which are generally clustered lower for several large payers. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Cigna is the highest-paying payer in Alaska with a mean of $32K, while Anthem and Blue Cross Blue Shield are tied at the lowest reported mean of $21K.
    • Alaska’s mean range ($21K–$32K) skews above some national payers but Cigna’s $32K mean notably exceeds national medians for several payers, indicating a meaningful upside vs. many national rates.

    Clinical Trials

    • Acute inpatient management trials studying rapid correction strategies for severe electrolyte imbalances (such as profound hyponatremia, hyperkalemia, or severe acid–base disorders) in medically complex hospitalized adults. These studies enroll patients admitted with acute decompensations captured under DRG 640 to compare protocols for monitoring frequency, dosing algorithms for IV electrolyte replacement or removal, and safety endpoints like arrhythmia or osmotic demyelination. Results inform hospital protocols, length-of-stay, and resource use metrics that directly affect inpatient costs and reimbursement for cases with major complications.
    • Comparative effectiveness research evaluating nutrition support modalities and metabolic management in malnourished or catabolic inpatients with multisystem illness. Trials or observational cohorts compare approaches such as early enteral nutrition versus parenteral supplementation, protein-energy targets, or micronutrient repletion strategies in patients with comorbidities (e.g., renal dysfunction, liver disease, or sepsis) to assess impacts on infection rates, wound healing, metabolic derangements, and discharge disposition. Findings help clinicians tailor nutrition plans for high-risk patients and help payers understand downstream effects on readmissions, post-acute care needs, and overall episode costs.
    • Post-discharge outcomes and care-coordination studies targeting readmission prevention and long-term metabolic control after hospitalization for complex fluid, electrolyte, or nutritional disorders. These research projects follow patients discharged after an MCC-coded admission to evaluate transitional interventions such as structured follow-up, home-based monitoring of electrolytes and fluids, or patient education for medication and diet adherence, measuring 30- and 90-day readmission rates and functional outcomes. Evidence from these studies is relevant to hospitals and payers focused on reducing avoidable readmissions, optimizing post-acute resource allocation, and improving value-based payment performance.

    Related Codes

    614-ADRENAL-AND-PITUITARY-PROCEDURES-WITH-CC-MCC

    Adrenal and Pituitary Procedures with CC/MCC: Inpatient Reimbursement Overview

    615-ADRENAL-AND-PITUITARY-PROCEDURES-WITHOUT-CC-MCC

    Adrenal and Pituitary Procedures without CC/MCC: Inpatient Reimbursement Overview

    616-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-MCC

    Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

    617-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-CC

    Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

    618-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITHOUT-CC-MCC

    Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: Inpatient Reimbursement Overview

    619-O-R-PROCEDURES-FOR-OBESITY-WITH-MCC

    O.R. Procedures for Obesity with MCC: Inpatient Reimbursement Overview

    620-O-R-PROCEDURES-FOR-OBESITY-WITH-CC

    O.R. Procedures for Obesity with CC: Inpatient Reimbursement Overview

    621-O-R-PROCEDURES-FOR-OBESITY-WITHOUT-CC-MCC

    O.R. Procedures for Obesity without CC/MCC: Inpatient Reimbursement Overview

    622-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-MCC

    Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

    623-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-CC

    Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 25

    References

    1. 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. 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. 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.

    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.

    Mean Rates by Payer — National — DRG 640
    Mean Rates by Payer — Alaska — DRG 640