Normal Newborn: Inpatient Reimbursement Overview

DRG 795 represents routine, uncomplicated inpatient care for a normal newborn and defines the clinical scope for coding and payment. It matters for inpatient reimbursement because it establishes the payment classification for standard postnatal care, affecting hospital billing and resource accounting under Centers for Medicare & Medicaid Services rules.

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DRG 795 Overview

DRG 795 covers routine care for a healthy term newborn without significant complications, typically assigned when the infant requires only standard postnatal observation and uncomplicated care. This Diagnosis-Related Group matters for Medicare payment because it defines the inpatient reimbursement for normal newborn hospital stays, influencing hospital billing, resource allocation, and payment recognition for uncomplicated deliveries. Assignment hinges on coded diagnoses and procedures documenting the absence of Major Complication or Comorbidity or Complication or Comorbidity. Reimbursement under this group supports standard newborn care services provided during the admission.

National Payment Rates

Across payers the reported rates for this DRG range roughly from $230 to $7.1K, with payer medians clustering between about $1.8K and $2.9K. The widest spread is between Cigna’s low-end values and Anthem’s high-end maximum ($230 to $7.1K). See the table and chart below for payer-specific distributions and percentile details.

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows avg_tot_pymt_amt (average total payment), avg_submtd_cvrd_chrg (average submitted covered charges), avg_mdcr_pymt_amt (average Medicare payment amount), and tot_dschrgs (total discharges).

Patient Population

DRG 795 skews toward a non-Medicare or mixed-age population, with a substantial portion of episodes covered by private/commercial payers rather than exclusively Medicare. The age profile is therefore more concentrated in working-age adults and younger patients than in primarily Medicare-age beneficiaries. Expect a mixed payer mix with private insurers representing a large share of cases.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 795 payments cluster between about 4.5K and 5.6K across major payers, with Anthem and BCBS at the upper end and Cigna at the lower end. The state range is notably higher than common national medians for this DRG, reflecting elevated regional rates. See the table and chart below for payer-specific percentiles and distribution.

Key Insights for Alaska

Anthem is the highest paying payer in Alaska with a mean of 5.6K, while Cigna is the lowest with a mean of 4.5K.
Alaska’s payer means (range roughly 4.5K–5.6K) sit well above typical national medians for this DRG, indicating materially higher newborn reimbursement in the state.

Clinical Trials

Early-term and full-term newborn transitional physiology studies: observational and interventional studies examine respiratory adaptation, thermoregulation, feeding initiation, and jaundice surveillance in healthy term and near-term neonates in the immediate postpartum period. These studies enroll infants classified as normal newborns (no congenital anomalies, gestational age ≥37 weeks in many protocols) to define best practices for monitoring frequency, thresholds for intervention (e.g., phototherapy initiation criteria for hyperbilirubinemia), and short-stay discharge protocols. Findings are relevant to clinicians and payers because they inform standardized inpatient care pathways that can reduce unnecessary interventions, length of stay, and readmissions while ensuring safe early discharge decisions.
Comparative effectiveness and quality improvement trials on birthing center and hospital delivery care models: randomized or quasi-experimental research compares outcomes among different delivery and newborn care models (rooming-in versus nursery observation, breastfeeding support bundles, lactation consultant availability, and nurse staffing ratios) for otherwise healthy newborns. These studies focus on patient-centered outcomes such as breastfeeding exclusivity, maternal–infant bonding measures, rates of newborn observation transfers, and early neonatal complications that require escalation of care. Results guide hospitals and payers on which care model investments and protocols yield better clinical outcomes and resource use for the large population captured by the Normal Newborn DRG.
Post-discharge infant outcomes and health services research: cohort and registry studies follow infants initially classified as normal newborns after discharge to measure readmission rates, emergency visits for feeding or jaundice issues, developmental screening uptake, and parental satisfaction. These studies often evaluate predictors of early post-discharge problems (e.g., short hospital stay, inadequate feeding support, or social determinants) and assess the impact of postnatal home visits, telehealth follow-up, or early primary care engagement on utilization and outcomes. This evidence is important for payers and providers to design discharge criteria, outpatient follow-up schedules, and transitional care programs that minimize costly readmissions and support population health for newborns in this DRG.

Neonates, Died or Transferred to Another Acute Care Facility: Inpatient Reimbursement Overview

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

References

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.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.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.

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National Payment Rates

Mean Rates by Payer — National — DRG 795

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 795

Key Insights for Alaska

Anthem is the highest paying payer in Alaska with a mean of 5.6K, while Cigna is the lowest with a mean of 4.5K.
Alaska’s payer means (range roughly 4.5K–5.6K) sit well above typical national medians for this DRG, indicating materially higher newborn reimbursement in the state.

Clinical Trials

Early-term and full-term newborn transitional physiology studies: observational and interventional studies examine respiratory adaptation, thermoregulation, feeding initiation, and jaundice surveillance in healthy term and near-term neonates in the immediate postpartum period. These studies enroll infants classified as normal newborns (no congenital anomalies, gestational age ≥37 weeks in many protocols) to define best practices for monitoring frequency, thresholds for intervention (e.g., phototherapy initiation criteria for hyperbilirubinemia), and short-stay discharge protocols. Findings are relevant to clinicians and payers because they inform standardized inpatient care pathways that can reduce unnecessary interventions, length of stay, and readmissions while ensuring safe early discharge decisions.
Comparative effectiveness and quality improvement trials on birthing center and hospital delivery care models: randomized or quasi-experimental research compares outcomes among different delivery and newborn care models (rooming-in versus nursery observation, breastfeeding support bundles, lactation consultant availability, and nurse staffing ratios) for otherwise healthy newborns. These studies focus on patient-centered outcomes such as breastfeeding exclusivity, maternal–infant bonding measures, rates of newborn observation transfers, and early neonatal complications that require escalation of care. Results guide hospitals and payers on which care model investments and protocols yield better clinical outcomes and resource use for the large population captured by the Normal Newborn DRG.
Post-discharge infant outcomes and health services research: cohort and registry studies follow infants initially classified as normal newborns after discharge to measure readmission rates, emergency visits for feeding or jaundice issues, developmental screening uptake, and parental satisfaction. These studies often evaluate predictors of early post-discharge problems (e.g., short hospital stay, inadequate feeding support, or social determinants) and assess the impact of postnatal home visits, telehealth follow-up, or early primary care engagement on utilization and outcomes. This evidence is important for payers and providers to design discharge criteria, outpatient follow-up schedules, and transitional care programs that minimize costly readmissions and support population health for newborns in this DRG.

Neonates, Died or Transferred to Another Acute Care Facility: Inpatient Reimbursement Overview

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

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Normal Newborn: Inpatient Reimbursement Overview

Sign up for drg 795 policy alerts

DRG 795 Overview

Normal Newborn: Inpatient Reimbursement Overview

Sign up for drg 795 policy alerts

DRG 795 Overview

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References