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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Male Reproductive SystemDRG 722-malignancy-male-reproductive-system-with-mcc
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    Malignancy, Male Reproductive System with MCC: Inpatient Reimbursement Overview

    DRG 722 addresses inpatient stays for malignancy of the male reproductive system with a Major Complication or Comorbidity, covering higher-severity cases that drive increased resource use. It matters for inpatient reimbursement because Medicare Severity Diagnosis-Related Group assignment, influenced by documented comorbidities and complications, affects hospital payment levels under Centers for Medicare & Medicaid Services rules.

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    DRG 722 Overview

    DRG 722 covers hospital admissions for malignant neoplasms of the male reproductive system when a Major Complication or Comorbidity is present, typically including complex cases such as advanced prostate or testicular cancers with significant secondary conditions. This Diagnosis-Related Group groups patients by clinical similarity and resource use, informing Medicare inpatient payment adjustments based on severity. The presence of a Major Complication or Comorbidity increases expected resource consumption and payment relative to less severe groupings. Hospitals and coders use this DRG to align clinical documentation with appropriate Medicare Severity Diagnosis-Related Group reimbursement.

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    National Payment Rates

    Across commercial payers the observed rate range runs roughly from $16K to $62K, with the widest spread between the lowest median-level payer and the highest observed maximum among payers. Cigna, Anthem, Blue Cross Blue Shield, and Aetna show distinct payer-level dispersion; see the table and chart below for payer-specific percentiles and distributions. The largest single-payer maximum in the dataset is $62K (Anthem) while several payers have medians clustered near $28K–$32K.

    The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($17.8k), average submitted covered charges ($77.0k), average Medicare payment amount ($14.9k), and total discharges (789). These figures summarize Medicare payment activity at the national level for the DRG.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $18K$77K$15K790

    Patient Population

    This DRG’s population includes both Medicare-age beneficiaries and working-age patients, reflecting a mixed-age distribution with a clear skew toward Medicare-aged individuals due to typical inpatient utilization patterns among older adults. Commercial payers (Cigna, Anthem, BCBS, Aetna) cover a meaningful portion of cases but overall counts are often lower than Medicare discharges. Expect the payer mix to include a substantial Medicare share alongside a smaller but significant commercial cohort.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Payer rates in Alaska range from $28K (Anthem and Blue Cross Blue Shield) up to $73K max for Cigna with a mean of $44K and median $43K. The most notable deviation from national averages is Cigna’s higher central tendency in Alaska compared with national medians for major payers. See the table and chart below for payer-specific distributions.

    Key Insights for Alaska

    • Highest payer: Cigna (median $43K, mean $44K); Lowest payers: Anthem and Blue Cross Blue Shield (all metrics $28K).
    • Cigna in Alaska pays materially above national medians for major payers (Alaska median $43K vs national Cigna median $28K), while Anthem/BCBS are flat at $28K, below several national payer medians.

    Clinical Trials

    • Trials of perioperative management strategies for advanced male reproductive malignancies with major complications: randomized or pragmatic studies comparing different approaches to intraoperative blood conservation, timing and intensity of critical care support, or protocols for managing sepsis and hemorrhage in patients undergoing genitourinary cancer surgery. The population includes men admitted with prostate, testicular, or penile cancers who develop major complications (eg, postoperative bleeding, sepsis, organ failure) requiring prolonged inpatient care and potential ICU-level interventions. These studies are relevant because optimized acute management can reduce length of stay, readmissions, and high-cost resource use, directly affecting hospital reimbursement and DRG-based payment validity.
    • Comparative effectiveness studies of multimodal systemic and local therapies in hospitalized patients with advanced or metastatic male reproductive malignancies: observational cohorts or pragmatic trials evaluating sequences or combinations of systemic therapies, palliative radiotherapy, and urinary or wound management procedures for patients admitted with symptomatic tumor-related complications (eg, obstructive uropathy, bleeding, pathologic fractures). The focus population is patients with malignancy-related complications leading to inpatient stays, including those with significant comorbidities or organ dysfunction that often exclude them from outpatient trials. Results inform clinicians and payers about real-world effectiveness, resource utilization, and complication rates of different treatment pathways for high-cost admissions under this DRG.
    • Post-discharge outcomes and care-transition research for men hospitalized with malignant genitourinary disease and major complications: prospective cohort studies or quality-improvement trials testing enhanced discharge planning, nurse-led follow-up, home-based symptom management, and palliative care integration to reduce readmissions, emergency visits, and total episode costs. These studies enroll patients discharged after an index hospitalization for male reproductive system malignancy with major complications and measure functional status, symptom burden, readmission rates, and downstream resource use. Evidence from this area helps providers and payers design bundled-payment pathways and post-acute care strategies to improve outcomes and control costs associated with DRG 722 admissions.

    Related Codes

    707-MAJOR-MALE-PELVIC-PROCEDURES-WITH-CC-MCC

    Major Male Pelvic Procedures with CC/MCC: Inpatient Reimbursement Overview

    708-MAJOR-MALE-PELVIC-PROCEDURES-WITHOUT-CC-MCC

    Major Male Pelvic Procedures without CC/MCC: Inpatient Reimbursement Overview

    709-PENIS-PROCEDURES-WITH-CC-MCC

    Penis Procedures with CC/MCC: Inpatient Reimbursement Overview

    710-PENIS-PROCEDURES-WITHOUT-CC-MCC

    Penis Procedures without CC/MCC: Inpatient Reimbursement Overview

    711-TESTES-PROCEDURES-WITH-CC-MCC

    Testes Procedures with CC/MCC: Inpatient Reimbursement Overview

    712-TESTES-PROCEDURES-WITHOUT-CC-MCC

    Testes Procedures without CC/MCC: Inpatient Reimbursement Overview

    713-TRANSURETHRAL-PROSTATECTOMY-WITH-CC-MCC

    Transurethral Prostatectomy with CC/MCC: Inpatient Reimbursement Overview

    714-TRANSURETHRAL-PROSTATECTOMY-WITHOUT-CC-MCC

    Transurethral Prostatectomy without CC/MCC: Inpatient Reimbursement Overview

    715-OTHER-MALE-REPRODUCTIVE-SYSTEM-O-R-PROCEDURES-FOR-MALIGNANCY-WITH-CC-MCC

    Other Male Reproductive System O.R. Procedures for Malignancy with CC/MCC: Inpatient Reimbursement Overview

    716-OTHER-MALE-REPRODUCTIVE-SYSTEM-O-R-PROCEDURES-FOR-MALIGNANCY-WITHOUT-CC-MCC

    Other Male Reproductive System O.R. Procedures for Malignancy without CC/MCC: Inpatient Reimbursement Overview

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    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 722
    Mean Rates by Payer — Alaska — DRG 722