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    OpenPayerBilling CodesDiseases and Disorders of Blood, Blood Forming Organs and Immunologic DisordersDRG 801-splenic-procedures-without-cc-mcc
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    Splenic Procedures without CC/MCC: Inpatient Reimbursement Overview

    DRG 801 encompasses inpatient admissions involving splenic procedures without a Major Complication or Comorbidity and without a Complication or Comorbidity, defining a lower-severity surgical cohort for Medicare payment. Correct assignment matters because it influences Medicare payment classification, hospital case-mix index contribution, and reimbursement for splenic surgical services.

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    DRG 801 Overview

    DRG 801 covers inpatient hospital cases involving splenic procedures without a Major Complication or Comorbidity and without a Complication or Comorbidity, typically including partial or total splenectomy for conditions that do not generate additional coded complexity. This Diagnosis-Related Group groups clinically similar resource use for Medicare payment, affecting payment assignment, hospital billing, and case-mix indexing. The DRG is relevant for surgical, general surgery, trauma, and hematology services where splenic operations are performed. Accurate coding of accompanying diagnoses and procedures determines whether a case is assigned to this DRG or to a higher-severity category.

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    National Payment Rates

    Across commercial payers the observed rate range spans roughly from $15K to $54K, with Anthem and Aetna showing lower and higher extremes respectively; the widest spread between payer medians appears between Anthem and Aetna. Refer to the table and chart below for payer-specific quartiles and distributions. Payer labels in the visuals use Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem for clarity.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments as reported in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($16.4k), average submitted covered charges ($75.7k), average Medicare payment ($11.5k), and total discharges (68).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $16K$76K$11K68

    Patient Population

    This DRG’s population is mixed but tends to include a substantial Medicare-age cohort alongside working-age commercially insured patients. The presence of Medicare fee-for-service discharges indicates meaningful utilization by Medicare beneficiaries, while commercial payer benchmarks show active participation from private insurers. Overall, the population skews toward a combined Medicare and working-age mix rather than exclusively one age group.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska exhibits a compact rate range across payers from $30K to $46K, with most payers clustered at $30K and Cigna standing out at a $46K mean/median. The notable deviation is Cigna’s materially higher payments versus the local $30K cluster and versus several national median references. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (median $46K) is the top payer; Lowest payers: Anthem and Blue Cross Blue Shield (both median $30K) are the lowest.
    • Alaska’s payer range spans from $30K to $46K, with Cigna paying notably above the other local payers and exceeding typical national medians for some payers.

    Clinical Trials

    • Acute surgical technique and perioperative management trials: randomized or prospective cohort studies comparing different splenic-preserving versus splenectomy approaches (for example partial splenectomy, splenic salvage after trauma, or laparoscopic versus open splenectomy) and perioperative blood management strategies in hemodynamically stable patients undergoing splenic procedures. These studies enroll patients admitted for splenic injury, symptomatic splenic lesions, or elective splenic surgery and focus on intraoperative outcomes, transfusion requirements, complication rates, and early length of stay. Results inform surgeons and hospital administrators about techniques and protocols that minimize complications and resource utilization for cases grouped under this DRG.
    • Comparative effectiveness and care pathway research for non-complex splenic procedures: observational comparative studies or pragmatic trials evaluating standardized care pathways (enhanced recovery protocols, antibiotic stewardship, thromboprophylaxis timing) across community and tertiary hospitals for patients without major comorbidities or complications. The population includes adults assigned to this DRG because they underwent splenic procedures without CC/MCC, and the research compares outcomes such as readmission, post-op infections, cost of care, and discharge disposition. Findings are directly relevant to payers and case managers by identifying best practices that reduce variability, shorten inpatient stays, and lower overall episode costs while maintaining quality.
    • Post-discharge outcomes and long-term immunologic/function studies: prospective cohort or registry-based research tracking patients after splenic procedures to assess long-term outcomes such as infection risk, vaccine response, quality of life, and late complications in patients who did not have major in-hospital complications. These studies focus on follow-up care, adherence to recommended vaccinations or prophylaxis, and rates of late sepsis or thrombosis in the relatively lower-risk population captured by this DRG. Evidence from these studies guides outpatient care coordination, preventive service utilization, and payer decisions about coverage for follow-up interventions that may reduce costly readmissions or long-term adverse events.

    Related Codes

    799-SPLENIC-PROCEDURES-WITH-MCC

    Splenic Procedures with MCC: Inpatient Reimbursement Overview

    800-SPLENIC-PROCEDURES-WITH-CC

    Splenic Procedures with CC: Inpatient Reimbursement Overview

    802-OTHER-O-R-PROCEDURES-OF-THE-BLOOD-AND-BLOOD-FORMING-ORGANS-WITH-MCC

    Other O.R. Procedures of the Blood and Blood Forming Organs with MCC: Inpatient Reimbursement Overview

    803-OTHER-O-R-PROCEDURES-OF-THE-BLOOD-AND-BLOOD-FORMING-ORGANS-WITH-CC

    Other O.R. Procedures of the Blood and Blood Forming Organs with CC: Inpatient Reimbursement Overview

    804-OTHER-O-R-PROCEDURES-OF-THE-BLOOD-AND-BLOOD-FORMING-ORGANS-WITHOUT-CC-MCC

    Other O.R. Procedures of the Blood and Blood Forming Organs without CC/MCC: Inpatient Reimbursement Overview

    808-MAJOR-HEMATOLOGICAL-AND-IMMUNOLOGICAL-DIAGNOSES-EXCEPT-SICKLE-CELL-CRISIS-AND-COAGULATION-DISORDERS-WITH-MCC

    Major Hematological and Immunological Diagnoses: Inpatient Reimbursement Overview

    809-MAJOR-HEMATOLOGICAL-AND-IMMUNOLOGICAL-DIAGNOSES-EXCEPT-SICKLE-CELL-CRISIS-AND-COAGULATION-DISORDERS-WITH-CC

    Major Hematological and Immunological Diagnoses: Inpatient Reimbursement Overview

    810-MAJOR-HEMATOLOGICAL-AND-IMMUNOLOGICAL-DIAGNOSES-EXCEPT-SICKLE-CELL-CRISIS-AND-COAGULATION-DISORDERS-WITHOUT-CC-MCC

    Major Hematological and Immunological Diagnoses: Inpatient Reimbursement Overview

    811-RED-BLOOD-CELL-DISORDERS-WITH-MCC

    Red Blood Cell Disorders with MCC: Inpatient Reimbursement Overview

    812-RED-BLOOD-CELL-DISORDERS-WITHOUT-MCC

    Red Blood Cell Disorders without 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 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 801
    Mean Rates by Payer — Alaska — DRG 801