Kidney and Urinary Tract Infections with MCC DRG Reimbursement

Summary & Overview

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.

DRG Kidney and Urinary Tract Infections with MCCDRG 689Diagnosis-Related GroupInpatient ReimbursementMedicareInfectious DiseaseUrologySepsisHospital Medicine

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.

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.

Mean Rates by Payer — National — DRG 689

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.

Kidney and Urinary Tract Signs and Symptoms 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

652-KIDNEY-TRANSPLANT

Kidney Transplant: Inpatient Reimbursement Overview

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

Kidney Transplant with Hemodialysis with Major Complication or Comorbidity: 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

688-KIDNEY-AND-URINARY-TRACT-NEOPLASMS-WITHOUT-CC-MCC

Kidney and Urinary Tract Neoplasms without CC/MCC: Inpatient Reimbursement Overview

674-OTHER-KIDNEY-AND-URINARY-TRACT-PROCEDURES-WITH-CC

Other Kidney and Urinary Tract Procedures with CC: Inpatient Reimbursement Overview

667-PROSTATECTOMY-WITHOUT-CC-MCC

Prostatectomy without CC/MCC: Inpatient Reimbursement Overview

700-OTHER-KIDNEY-AND-URINARY-TRACT-DIAGNOSES-WITHOUT-CC-MCC

Other Kidney and Urinary Tract Diagnoses without CC/MCC: Inpatient Reimbursement Overview

686-KIDNEY-AND-URINARY-TRACT-NEOPLASMS-WITH-MCC

Kidney and Urinary Tract Neoplasms with MCC: Inpatient Reimbursement Overview

Showing 1–10 of 41

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.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$10K	$48K	$8.5K	81K

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 689

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.

Kidney and Urinary Tract Signs and Symptoms 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

652-KIDNEY-TRANSPLANT

Kidney Transplant: Inpatient Reimbursement Overview

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

Kidney Transplant with Hemodialysis with Major Complication or Comorbidity: 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

688-KIDNEY-AND-URINARY-TRACT-NEOPLASMS-WITHOUT-CC-MCC

Kidney and Urinary Tract Neoplasms without CC/MCC: Inpatient Reimbursement Overview

674-OTHER-KIDNEY-AND-URINARY-TRACT-PROCEDURES-WITH-CC

Other Kidney and Urinary Tract Procedures with CC: Inpatient Reimbursement Overview

667-PROSTATECTOMY-WITHOUT-CC-MCC

Prostatectomy without CC/MCC: Inpatient Reimbursement Overview

700-OTHER-KIDNEY-AND-URINARY-TRACT-DIAGNOSES-WITHOUT-CC-MCC

Other Kidney and Urinary Tract Diagnoses without CC/MCC: Inpatient Reimbursement Overview

686-KIDNEY-AND-URINARY-TRACT-NEOPLASMS-WITH-MCC

Kidney and Urinary Tract Neoplasms with MCC: Inpatient Reimbursement Overview

Showing 1–10 of 41

OpenPayer

Summary & Overview

Kidney and Urinary Tract Infections with MCC: Inpatient Reimbursement Overview

DRG 689 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes