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    OpenPayerBilling CodesNewborns and Other Neonates with Conditions Originating in Perinatal PeriodDRG 789-neonates-died-or-transferred-to-another-acute-care-facility
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    Neonates, Died or Transferred to Another Acute Care Facility: Inpatient Reimbursement Overview

    DRG 789 encompasses neonates who died in-hospital or were transferred to another acute care facility; it captures very high-acuity neonatal discharges with distinct payment implications. Understanding this Diagnosis-Related Group is important for inpatient reimbursement because disposition-driven grouping influences relative weights, payment calculations, and hospital case mix indexing under Medicare policies.

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    DRG 789 Overview

    DRG 789 covers neonates who die during the hospital stay or are transferred to another acute care facility, representing the most resource-intense and high-acuity neonatal discharges. This Diagnosis-Related Group groups cases by disposition rather than specific diagnoses, which affects how hospitals are reimbursed under inpatient prospective payment systems. It matters for Medicare payment because disposition-driven grouping can alter relative weights and payment calculations for neonatal care episodes. Payers and hospitals monitor this DRG for implications on case mix index and resource allocation.

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    National Payment Rates

    Payer benchmarks for DRG 789 range from about $370 to $63K across the payers in the table below, with individual payer means spanning roughly $13K to $23K; the widest spread between minimum and maximum observed values is $63K (Anthem). See the table and chart below for payer-level percentiles and distributions across Aetna, Cigna, BCBS, and Anthem.

    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, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 789. These columns summarize Medicare’s payment and charge metrics at the national level for the DRG.

    Patient Population

    DRG 789 patient mix generally skews younger than a typical Medicare-heavy DRG and includes a substantial share of working-age and commercially insured patients alongside Medicare beneficiaries. As a result, the payer mix is mixed rather than predominantly Medicare-age. Expect enrollment to include both private/commercial plans and Medicare fee-for-service members.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 789 rates range from $28K to $73K across payers, with most payers clustered at $28K and Cigna showing the widest upper bound at $73K. This cluster at $28K contrasts with lower national medians for the DRG, while Cigna’s $73K maximum represents the most notable deviation. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Anthem is the highest-paying payer in Alaska at $28K, while Blue Cross Blue Shield and Cigna are lower with Cigna showing a wider spread up to $73K in the state benchmarks.
    • Alaska’s payer rates cluster tightly around $28K for Blue Cross Blue Shield and Anthem, which is markedly higher than many national medians but Cigna’s maximum at $73K represents a meaningful deviation above national benchmarks.

    Clinical Trials

    • Acute neonatal resuscitation and stabilization trials: randomized or observational studies evaluating different approaches to the immediate management of critically ill newborns in delivery room and early NICU settings, such as optimization of ventilation strategies, circulatory support, or targeted temperature management protocols. These studies focus on term and preterm neonates who require intensive resuscitation or who deteriorate within the first days of life and are at high risk of death or transfer to higher-level acute care centers. Findings inform best practices for initial stabilization that can reduce early mortality, decrease need for transfer, and influence resource use and reimbursement patterns for hospitals managing these high-acuity DRG cases.
    • Comparative effectiveness research on regionalized transfer and inter-facility care pathways: cohort studies and pragmatic trials comparing outcomes and costs between models of neonatal care that emphasize early transfer to tertiary NICUs versus prolonged stabilization at community hospitals with telemedicine support. Populations include neonates with severe respiratory failure, congenital anomalies, or complex surgical needs who are candidates for transfer; the research examines timing of transfer, transport modalities, and coordination protocols. Results are relevant to providers and payers because they impact decisions about when to transfer, admission destination coding, length of stay, mortality rates, and the allocation of acute-care resources tied to this DRG.
    • Retrospective and prospective outcomes research on predictors of in-hospital mortality and post-transfer survival: registry-based prognostic studies and quality-improvement-driven audits that identify clinical, demographic, and system-level predictors associated with death in the neonatal period or poor outcomes after transfer. These studies typically use data from NICU admissions, transport services, and hospital discharge records to model risk, assess disparities, and evaluate the impact of interventions such as early specialist involvement or standardized sepsis bundles. This research helps hospitals and payers stratify risk, refine case-mix adjustment for reimbursement, target quality improvement to reduce avoidable transfers and deaths, and inform resource planning for the high-cost patient population captured by DRG 789.

    Related Codes

    790-EXTREME-IMMATURITY-OR-RESPIRATORY-DISTRESS-SYNDROME-NEONATE

    Extreme Immaturity or Respiratory Distress Syndrome, Neonate: Inpatient Reimbursement Overview

    791-PREMATURITY-WITH-MAJOR-PROBLEMS

    Prematurity with Major Problems: Inpatient Reimbursement Overview

    792-PREMATURITY-WITHOUT-MAJOR-PROBLEMS

    Prematurity without Major Problems: Inpatient Reimbursement Overview

    793-FULL-TERM-NEONATE-WITH-MAJOR-PROBLEMS

    Full Term Neonate with Major Problems: Inpatient Reimbursement Overview

    794-NEONATE-WITH-OTHER-SIGNIFICANT-PROBLEMS

    Neonate with Other Significant Problems: Inpatient Reimbursement Overview

    795-NORMAL-NEWBORN

    Normal Newborn: Inpatient Reimbursement Overview

    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 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 789
    Mean Rates by Payer — Alaska — DRG 789