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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Kidney and Urinary TractDRG 689-kidney-and-urinary-tract-infections-with-mcc
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    Kidney and Urinary Tract Infections with MCC: Inpatient Reimbursement Overview

    DRG 689 covers inpatient care for kidney and urinary tract infections with a Major Complication or Comorbidity, including severe or complicated presentations that increase resource needs. This Diagnosis-Related Group matters for inpatient reimbursement because designation with a Major Complication or Comorbidity generally yields higher Medicare payment to reflect increased clinical complexity and resource utilization.

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    DRG 689 Overview

    DRG 689 covers inpatient admissions for patients with kidney and urinary tract infections accompanied by a Major Complication or Comorbidity. The clinical scope includes severe urinary infections such as complicated pyelonephritis, emphysematous infections, or urinary sepsis in patients with significant comorbidity burden. This Diagnosis-Related Group matters for Medicare payment because presence of a Major Complication or Comorbidity typically increases the relative weight and reimbursement, reflecting higher expected resource use during the hospital stay. Accurate documentation of diagnoses and comorbid conditions is essential to ensure the claim is categorized to the appropriate Diagnosis-Related Group.

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    National Payment Rates

    Across the major commercial payers the negotiated rates for DRG 689 range from about $370 up to $40K, with individual payer means spanning roughly $10K to $19K; the widest spread between reported minimum and maximum values is between $390 and $40K. See the table and chart below for payer-specific quartiles and distribution details. Payer labels in the supplemental table use full names such as Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, 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, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 689. These values summarize national-level payment and volume metrics for Medicare FFS inpatient activity.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $10K$48K$8.5K81K

    Patient Population

    This DRG’s admissions typically include both Medicare-age and working-age patients, producing a mixed payer population with a significant share of Medicare beneficiaries given the condition’s prevalence in older adults. The population therefore skews toward Medicare but still includes a meaningful portion of commercially insured, working-age patients. Age distribution tends to span late-adult through elderly cohorts rather than exclusively one age group.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    The DRG 689 mean reimbursements in Alaska range from $18K to $28K across payers, with Cigna at the high end and Blue Cross Blue Shield and Anthem at the low end. Cigna’s mean of $28K is a notable upward deviation relative to the other state payers and compared with many national payers. Reference the table and chart below for payer-level distributions and percentiles.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $28K); Lowest payers: Blue Cross Blue Shield and Anthem (mean $18K).
    • Alaska’s payer means cluster at $18K–$28K shows Cigna notably above other state payers and above national mean benchmarks for some payers, while BCBS/Anthem are well below national means.

    Clinical Trials

    • Acute antimicrobial stewardship and rapid diagnostics trials: Studies evaluating the impact of accelerated pathogen identification (e.g., rapid urine or blood PCR/point-of-care tests) combined with antimicrobial stewardship algorithms on time-to-appropriate therapy, antibiotic exposure, and in-hospital complications for adults admitted with complicated urinary tract infections or pyelonephritis and an MCC (such as sepsis, acute kidney injury, or immunosuppression). The patient population typically includes medically complex inpatients who are at high risk for poor outcomes and antibiotic-related adverse events; these trials are relevant because faster, more targeted therapy can reduce ICU transfers, length of stay, and costs that drive DRG payments. Payers and hospital quality programs are interested in evidence that diagnostic-therapy bundles reduce costly downstream events while maintaining safety in this high-acuity DRG.
    • Comparative effectiveness studies of inpatient care pathways and supportive management: Pragmatic trials or cohort studies comparing different inpatient management strategies (for example, early aggressive fluid and renal support protocols versus standard care, or inpatient observation plus multidisciplinary care versus routine admission) for patients with kidney/urinary infections complicated by major comorbidities such as chronic kidney disease, diabetes, or heart failure. These studies enroll heterogeneous medically complex adults to determine which care pathways reduce progression to acute kidney injury, need for dialysis, ICU escalation, and readmissions. Results inform clinicians which resource-intensive interventions produce better clinical outcomes and inform payers about which pathways yield better value within the fixed DRG reimbursement.
    • Post-discharge and transitional care outcome studies: Research focused on post-hospitalization interventions (for example, structured outpatient follow-up, home-based antimicrobial therapy programs, medication reconciliation and renal dose optimization, or remote monitoring for recurrent infection and kidney function) measuring 30- to 90-day readmissions, recurrent infection rates, renal recovery, and total cost of care. These trials typically enroll survivors of an index admission for complicated urinary or kidney infection with major comorbidities who are at high risk for readmission or progression of kidney disease; the objective is to identify discharge strategies that improve recovery and reduce avoidable returns to hospital. Findings are directly relevant to providers and payers seeking to lower readmission penalties, reduce cumulative costs under bundled payments, and improve long-term outcomes for this DRG population.

    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.
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    Mean Rates by Payer — National — DRG 689
    Mean Rates by Payer — Alaska — DRG 689