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 CodesDiseases and Disorders of the Kidney and Urinary TractDRG 682-renal-failure-with-mcc
    Ask Trek AI about this page

    Renal Failure with MCC: Inpatient Reimbursement Overview

    DRG 682 encompasses inpatient renal failure cases with a Major Complication or Comorbidity, covering admissions where kidney dysfunction is accompanied by significant additional diagnoses that raise clinical complexity. This Diagnosis-Related Group matters for inpatient reimbursement because the presence of a Major Complication or Comorbidity increases expected resource use and therefore influences Centers for Medicare & Medicaid Services payment classification.

    Customize your policy alerts

    Sign up for drg 682 policy alerts

    Get alerted when payer policies referencing 682 are released or updated.

    Monitor payer policy activity

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

    DRG 682 Overview

    DRG 682 covers inpatient admissions for renal failure with Major Complication or Comorbidity and includes acute or chronic kidney failure when accompanied by significant additional diagnoses that increase resource use. This Diagnosis-Related Group is clinically focused on patients requiring intensified medical management, potential dialysis, and close monitoring for metabolic and fluid-electrolyte disturbances. It matters for Centers for Medicare & Medicaid Services payment because the presence of a Major Complication or Comorbidity increases expected resource consumption and affects reimbursement relative to lower severity categories. Accurate coding of renal failure and coexisting major conditions determines the appropriate Medicare inpatient payment classification.

    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

    Payer rates in the table range from about $7.4K to $55K across payers, with the widest spread observed between Anthem (max $55K) and BCBS (min $370 in the dataset), reflecting substantial variability by payer. See the table and chart below for payer-specific quartiles and medians. Payors shown include Cigna, Aetna, Blue Cross Blue Shield, and Anthem.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($13.3k), average submitted covered charges ($62.7k), average Medicare payment amount ($11.1k), and total discharges (80.2k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $13K$63K$11K80K

    Patient Population

    This DRG’s population skews toward Medicare-age patients, reflecting a larger share of admissions among older adults compared with commercial lines. While commercial payers (Aetna, Cigna, BCBS, Anthem) cover a portion of cases, the distribution is primarily Medicare-driven by volume. The mix is therefore weighted toward traditional Medicare beneficiaries rather than predominantly working-age patients.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 682 benchmarks show a tight low-end cluster with Blue Cross Blue Shield and Anthem both at $23K, while Cigna’s mean sits notably higher at $36K, giving a state payer range from $23K to $36K. This represents a substantial deviation from the national context where medians and means for comparable payers are generally lower; see the table and chart below for payer-level detail and distribution.

    Key Insights for Alaska

    • Blue Cross Blue Shield pays the lowest benchmark at $23K while Cigna pays the highest at $36K, representing the state range.
    • Anthem aligns with Blue Cross Blue Shield at $23K, creating a pronounced grouping at the low end compared with Cigna’s higher mean.
    • The state’s highest mean ($36K for Cigna) exceeds national BCBS/Aetna/Cigna averages shown in the national context, indicating a meaningful upward deviation for that payer in Alaska.

    Clinical Trials

    • Acute renal replacement therapy trials: Interventional studies evaluating timing, modality (continuous vs intermittent), and dosing of renal replacement therapy for patients hospitalized with acute renal failure and major complications (e.g., hemodynamic instability, severe metabolic derangements, or multiorgan failure). These trials enroll critically ill inpatients with renal failure and major complications to determine whether earlier initiation, specific dialysis modalities, or intensity of clearance improves short-term survival, organ support needs, and length of ICU/hospital stay. Results directly inform inpatient protocols, resource allocation, and reimbursement considerations because choices around modality and timing drive intensive care utilization and costs for this high-acuity DRG.
    • Comparative effectiveness and comorbidity management studies: Observational cohorts or pragmatic randomized studies comparing strategies to manage common MCCs that accompany renal failure—such as heart failure, sepsis, or uncontrolled diabetes—during the index hospitalization. These studies focus on adult inpatients with renal failure plus one or more major comorbid conditions, testing integrated care pathways, medication adjustment algorithms, or monitoring strategies to reduce complications like fluid overload, electrolyte disturbances, or medication toxicity. Findings are relevant to clinicians and payers because better comorbidity management can shorten hospital stays, reduce readmissions, and influence bundled-payment models for complex renal failure cases.
    • Post-discharge outcome and transitional care studies: Prospective cohort studies and interventional trials assessing post-discharge modalities like early nephrology follow-up, home-based dialysis initiation programs, and care-coordination interventions for patients discharged after an admission for renal failure with MCC. These studies enroll survivors of high-acuity hospitalizations who are at high risk for readmission, progression to chronic dialysis, or mortality, measuring outcomes such as 30- and 90-day readmission rates, time to chronic kidney replacement therapy, functional status, and health-care utilization. This research informs discharge planning, outpatient resource prioritization, and payer strategies to reduce avoidable downstream costs associated with this resource-intensive DRG.

    Related Codes

    650-KIDNEY-TRANSPLANT-WITH-HEMODIALYSIS-WITH-MCC

    Kidney Transplant with Hemodialysis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

    651-KIDNEY-TRANSPLANT-WITH-HEMODIALYSIS-WITHOUT-MCC

    Kidney Transplant with Hemodialysis without MCC: Inpatient Reimbursement Overview

    652-KIDNEY-TRANSPLANT

    Kidney Transplant: Inpatient Reimbursement Overview

    653-MAJOR-BLADDER-PROCEDURES-WITH-MCC

    Major Bladder Procedures with MCC: Inpatient Reimbursement Overview

    654-MAJOR-BLADDER-PROCEDURES-WITH-CC

    Major Bladder Procedures with CC: Inpatient Reimbursement Overview

    655-MAJOR-BLADDER-PROCEDURES-WITHOUT-CC-MCC

    Major Bladder Procedures without CC/MCC: Inpatient Reimbursement Overview

    656-KIDNEY-AND-URETER-PROCEDURES-FOR-NEOPLASM-WITH-MCC

    Kidney and Ureter Procedures for Neoplasm with MCC: Inpatient Reimbursement Overview

    657-KIDNEY-AND-URETER-PROCEDURES-FOR-NEOPLASM-WITH-CC

    Kidney and Ureter Procedures for Neoplasm with CC: Inpatient Reimbursement Overview

    658-KIDNEY-AND-URETER-PROCEDURES-FOR-NEOPLASM-WITHOUT-CC-MCC

    Kidney and Ureter Procedures for Neoplasm without CC/MCC: Inpatient Reimbursement Overview

    659-KIDNEY-AND-URETER-PROCEDURES-FOR-NON-NEOPLASM-WITH-MCC

    Kidney and Ureter Procedures for Non-Neoplasm with MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 41

    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 682
    Mean Rates by Payer — Alaska — DRG 682