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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Kidney and Urinary TractDRG 690-kidney-and-urinary-tract-infections-without-mcc
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    Kidney and Urinary Tract Infections without MCC: Inpatient Reimbursement Overview

    DRG 690 encompasses inpatient admissions for kidney and urinary tract infections without a Major Complication or Comorbidity, focusing on cases like pyelonephritis and uncomplicated complicated urinary tract infections. It matters for inpatient reimbursement because assignment to this Diagnosis-Related Group determines Medicare payment weight based on clinical severity and expected resource use.

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    DRG 690 Overview

    DRG 690 covers hospital admissions for kidney and urinary tract infections without a Major Complication or Comorbidity. It includes primary diagnoses such as pyelonephritis and complicated urinary tract infections when no higher-severity comorbid conditions are present. This Diagnosis-Related Group is used to assign inpatient payments under the Medicare prospective payment system and influences resource intensity and reimbursement. Understanding its clinical scope helps clarify case-mix and payment expectations for affected hospitalizations.

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    National Payment Rates

    Across commercial payers the observed rate range runs from about $7.3K (BCBS median) up to $14K (Aetna mean), with payer medians and means clustering between roughly $7K and $15K. The widest spread between payer percentiles appears in Anthem (min $390 to max $29K) as shown in the table and chart below. Refer to the table and chart below for payer-specific percentiles and distribution detail.

    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 690. Values reflect Medicare program payments and utilization at the national level for 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $7.5K$35K$5.7K91K

    Patient Population

    This DRG’s inpatient population includes a mix of Medicare-age and working-age adults, but claims volumes and Medicare reporting indicate a meaningful Medicare representation. The case mix therefore skews toward Medicare-age patients relative to pure commercial populations, while still including a substantial share of commercially insured working-age adults. Payer mix in practice will be influenced by local demographics and hospital referral patterns.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska commercial rates for DRG 690 span roughly $13K to $20K across major payers, with Cigna at the top end (mean $20K) and Blue Cross Blue Shield and Anthem clustering at the lower end (mean $13K). This state distribution sits noticeably above the national BCBS mean and median, representing a meaningful upward deviation from those national averages. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $20K); Lowest payer: BCBS / Anthem (mean $13K).
    • Alaska’s rates range from $13K to $20K across major commercial payers, notably higher than national BCBS mean (~$7.3K) and closer to national Anthem/Cigna averages, indicating a meaningful upward deviation from some national benchmarks.

    Clinical Trials

    • Acute antimicrobial strategy trials: randomized studies comparing short-course versus standard-duration antibiotic regimens or route-of-administration strategies (intravenous-to-oral switch protocols) for hospitalized patients with complicated urinary tract infections and pyelonephritis. These trials enroll adults admitted with confirmed kidney or upper urinary tract infections without major comorbid complications, focusing on time to clinical resolution, readmission rates, length of stay, and antibiotic-related adverse events. Results inform clinicians about safe de-escalation and stewardship practices and help payers evaluate cost-effective inpatient antibiotic use and opportunities to shorten hospital stays.
    • Diagnostic and risk-stratification studies: prospective cohort or diagnostic accuracy studies evaluating biomarkers, clinical prediction rules, and imaging criteria to distinguish patients who require inpatient care from those safe for outpatient management. These studies target diverse inpatients and emergency-department–presenting adults with suspected kidney or urinary tract infections, assessing predictors of progression to sepsis, need for invasive procedures, or treatment failure. Better risk stratification reduces unnecessary admissions and resource use, guiding authorization policies and care pathways used by providers and payers to allocate inpatient resources appropriately.
    • Post-discharge outcomes and care-transition research: observational or interventional studies assessing readmission prevention bundles, outpatient follow-up timing, and patient education or telehealth interventions after discharge for kidney and urinary tract infections. These trials enroll patients recently discharged under this DRG to measure 30-day readmissions, recurrent infection rates, outpatient antibiotic adherence, and downstream costs. Findings are relevant for hospitals and payers aiming to lower readmissions, optimize transitional care protocols, and align reimbursement incentives with improved long-term outcomes.

    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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    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 690
    Mean Rates by Payer — Alaska — DRG 690