Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesPregnancy, Childbirth and the PuerperiumDRG 806-vaginal-delivery-without-sterilization-or-d-c-with-cc
    Ask Trek AI about this page

    Vaginal Delivery without Sterilization or D&C with CC: Inpatient Reimbursement Overview

    DRG 806 encompasses vaginal delivery cases without sterilization or dilation and curettage that include a Complication or Comorbidity and defines the clinical scope as childbirth with additional maternal conditions affecting resource use. It matters for inpatient reimbursement because hospitals are paid based on Diagnosis-Related Group classification that reflects case complexity and drives Medicare hospital payment for the admission.

    Customize your policy alerts

    Sign up for drg 806 policy alerts

    Get alerted when payer policies referencing 806 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 806 Overview

    DRG 806 covers inpatient admissions for vaginal delivery without concurrent sterilization or dilation and curettage when a complication or comorbidity is present. It applies to typical obstetric care where additional medical complexity increases resource use, such as mild maternal conditions or managed peripartum complications. This Diagnosis-Related Group influences Medicare payment by grouping clinical severity to determine relative reimbursement for the hospital stay. Understanding this grouping helps clarify billing classification for inpatient vaginal deliveries with added clinical complexity.

    Table of contents

    Progress1 / 5

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    National Payment Rates

    Across national commercial payers the observed rate range spans roughly from $370 to $25K, with median benchmarks between about $6.4K and $10K depending on payer. Anthem and Aetna show the highest maximums ($25K and $19K respectively), producing the widest spread between minimums and maximums. See the table and chart below for payer-specific quartiles and distribution details.

    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 reports average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 806. Values reflect national aggregates for Medicare FFS in 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $7.7K$25K$5.4K1.1K

    Patient Population

    This DRG’s population skews toward working-age adults rather than primarily Medicare-age beneficiaries, so the payer mix typically includes a larger share of private/commercial coverage with a meaningful but smaller Medicare component. Medicare discharges are present in the national CMS data but are fewer in number relative to the broader commercial population for this DRG. Overall, the population is mixed but leans toward non-Medicare (working-age) payers.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Payer rates for DRG 806 in Alaska span from about $7.5K up to $32K, with Anthem and Blue Cross Blue Shield both clustering around a $12K mean while Cigna averages $19K. The most notable deviation from national averages is Cigna’s higher mean in Alaska compared with its national mean, producing a wider state range driven by Cigna’s upper bound. Reference the table and chart below for the payer-specific distributions.

    Key Insights for Alaska

    • Anthem is the lowest payer in Alaska at $7.5K–$18K (mean $12K), while Cigna is the highest at $8.5K–$32K (mean $19K).
    • Blue Cross Blue Shield aligns with Anthem in range and mean ($7.5K–$18K, mean $12K), creating a tighter state cluster around $12K for two major payers.
    • Cigna’s mean of $19K meaningfully exceeds national means for these payers, indicating a higher-than-national reimbursement level in Alaska for this DRG.

    Clinical Trials

    • Studies of intrapartum management strategies to reduce complications (comparative effectiveness): trials comparing different labor management protocols, such as active management of labor durations, second-stage maneuvers, or use of standardized oxytocin augmentation protocols for term, singleton vaginal deliveries without concurrent sterilization or dilation and curettage. The patient population includes low- to moderate-risk obstetric patients admitted in active labor; outcomes measured typically include rates of operative vaginal delivery, postpartum hemorrhage, perineal lacerations, maternal length of stay, and neonatal APGAR or admission to higher-level care. This research is directly relevant to providers and payers because optimizing intrapartum care can lower complication rates, reduce resource use (operative interventions, transfusions, or NICU stays), and influence DRG-related costs and reimbursement through improved quality metrics.
    • Comparative trials of pain management and analgesia approaches during labor and immediate postpartum (peri-procedural effectiveness and safety): randomized or pragmatic studies evaluating neuraxial analgesia techniques, varying epidural protocols, adjunct systemic analgesics, or nonpharmacologic modalities in birthing people undergoing vaginal delivery without sterilization or D&C. The studies focus on maternal pain control, mobility during labor, labor progression, breastfeeding initiation, and short-term neonatal outcomes in term singleton deliveries; subgroup analyses often include primiparous versus multiparous patients. Results inform clinical pathways and resource allocation for anesthesia services, impact maternal satisfaction and potential downstream utilization (length of stay, readmissions for pain-related issues), and help payers assess value and appropriate coverage of labor analgesia strategies.
    • Post-discharge maternal and neonatal outcome and health services research (longitudinal outcomes and utilization): cohort studies and pragmatic trials following patients after uncomplicated vaginal delivery to assess postpartum recovery, postpartum hemorrhage late presentations, wound or perineal complications, mental health screening adherence, breastfeeding continuation, and infant readmissions or outpatient visits. The population includes mothers discharged after vaginal delivery without concurrent sterilization/D&C and their newborns, with attention to sociodemographic and comorbidity factors that predict higher post-discharge utilization. This research matters to providers and payers because identifying predictors of post-discharge complications and effective interventions (education, home visits, telehealth follow-up) can reduce readmissions and emergency care, improve patient-centered outcomes, and influence overall cost of care under the DRG.

    Related Codes

    768-VAGINAL-DELIVERY-WITH-O-R-PROCEDURES-EXCEPT-STERILIZATION-AND-OR-D-C

    Vaginal Delivery with O.R. Procedures Except Sterilization and/or D&C: Inpatient Reimbursement Overview

    769-POSTPARTUM-AND-POST-ABORTION-DIAGNOSES-WITH-O-R-PROCEDURES

    Postpartum and Post Abortion Diagnoses with O.R. Procedures: Inpatient Reimbursement Overview

    770-ABORTION-WITH-D-C-ASPIRATION-CURETTAGE-OR-HYSTEROTOMY

    Abortion with D&C, Aspiration Curettage or Hysterotomy: Inpatient Reimbursement Overview

    776-POSTPARTUM-AND-POST-ABORTION-DIAGNOSES-WITHOUT-O-R-PROCEDURES

    Postpartum and Post Abortion Diagnoses without O.R. Procedures: Inpatient Reimbursement Overview

    779-ABORTION-WITHOUT-D-C

    Abortion without D&C: Inpatient Reimbursement Overview

    783-CESAREAN-SECTION-WITH-STERILIZATION-WITH-MCC

    Cesarean Section with Sterilization with MCC: Inpatient Reimbursement Overview

    784-CESAREAN-SECTION-WITH-STERILIZATION-WITH-CC

    Cesarean Section with Sterilization with CC: Inpatient Reimbursement Overview

    785-CESAREAN-SECTION-WITH-STERILIZATION-WITHOUT-CC-MCC

    Cesarean Section with Sterilization without CC/MCC: Inpatient Reimbursement Overview

    786-CESAREAN-SECTION-WITHOUT-STERILIZATION-WITH-MCC

    Cesarean Section without Sterilization with MCC: Inpatient Reimbursement Overview

    787-CESAREAN-SECTION-WITHOUT-STERILIZATION-WITH-CC

    Cesarean Section without Sterilization with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 22

    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.
    Published by

    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 806
    Mean Rates by Payer — Alaska — DRG 806