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    OpenPayerBilling CodesMyeloproliferative Diseases and Disorders, Poorly Differentiated NeoplasmsDRG 820-lymphoma-and-leukemia-with-major-o-r-procedures-with-mcc
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    Lymphoma and Leukemia with Major O.R. Procedures with MCC: Inpatient Reimbursement Overview

    DRG 820 addresses inpatient stays for lymphoma and leukemia with major operating room procedures and at least one Major Complication or Comorbidity, reflecting high-acuity surgical care. Proper assignment affects Medicare reimbursement by grouping cases that require extensive perioperative and inpatient resources.

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    DRG 820 Overview

    DRG 820 covers hospital admissions for patients with lymphoma and leukemia who undergo major operating room procedures and have at least one Major Complication or Comorbidity. This Diagnosis-Related Group groups high-resource surgical and perioperative care for hematologic malignancies, often involving complex resections, transplant-related procedures, or extensive vascular access and management. It matters for Medicare payment because cases in this group typically generate higher inpatient costs and therefore receive higher reimbursement relative to less complex lymphoma and leukemia admissions. Facilities and coders must ensure accurate documentation of procedures and Major Complication or Comorbidity to support assignment to this Diagnosis-Related Group.

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    National Payment Rates

    Payer rates range from a low median of $48K (BCBS) to highs reported up to $210K (Anthem), with mean benchmarks spanning roughly $49K to $96K across payers. The widest spread in reported maximums is between BCBS ($140K) and Anthem ($210K), a $70K gap. See the table and chart below for payer-specific percentiles and distribution details.

    The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The accompanying table shows average total payment ($64.4k), average submitted covered charges ($300.0k), average Medicare payment amount ($52.3k), and total discharges (1.1k). These values summarize national FFS payment and charge levels for the DRG.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $64K$300K$52K1.1K

    Patient Population

    This DRG’s population skews toward Medicare-age patients, reflecting a higher concentration of discharges in the Medicare fee-for-service population versus working-age commercial enrollees. Commercial payers still cover a portion of cases, so the overall mix is primarily Medicare with a meaningful working-age component. Age distribution therefore trends older rather than predominantly working-age.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 820 payer rates span from $91K to $140K across reported payers, with Cigna at the top end and BCBS and Anthem at the bottom. The state distribution shows a concentrated low-tier at $91K and a single notably higher mean of $140K for Cigna, which stands out relative to national averages. See the table and chart below for payer-specific values.

    Key Insights for Alaska

    • Cigna is the highest-paying payer in Alaska with a mean of $140K, while Blue Cross Blue Shield (BCBS) and Anthem are the lowest-paying payers at $91K.
    • The state range is wide ($91K to $140K), and Cigna’s mean at $140K notably exceeds national averages for most payers, indicating a material upward deviation from typical national rates.

    Clinical Trials

    • Studies of perioperative management and complication reduction for patients with lymphoma or leukemia undergoing major operative procedures: These trials evaluate strategies to prevent and treat acute surgical complications (eg, infection, hemorrhage, thromboembolism) and optimize perioperative hematologic support (transfusion protocols, growth factor timing, antimicrobial prophylaxis) in patients with high disease burden or treatment-related cytopenias. The patient population includes hospitalized adults with lymphoid or myeloid malignancies who require major OR procedures and are at high risk for morbidity; outcomes studied include perioperative mortality, ICU admission, length of stay, and resource use. This research is highly relevant to providers and payers because it aims to reduce costly complications and readmissions, improve risk-adjusted surgical outcomes, and inform evidence-based perioperative pathways for a high-acuity DRG population.
    • Comparative effectiveness studies of conditioning regimens and timing of major procedures in relation to systemic therapy for lymphoma and leukemia: These trials compare different approaches to sequencing or intensity of cytoreductive therapy, immunosuppression, or conditioning prior to major operations (including procedures related to disease control or complications) and often stratify by disease subtype, remission status, and comorbidity burden. The enrolled patients are those with active or recently treated hematologic malignancies who require major operative intervention, and the studies measure outcomes such as postoperative infection rates, hematologic recovery, long-term disease control, and cost-effectiveness. Findings guide clinical decision-making about optimal timing and regimen selection to balance oncologic benefit against surgical risk, thereby informing utilization and reimbursement policies for complex inpatient care under this DRG.
    • Post-discharge outcomes and care coordination trials focused on reducing readmissions and long-term resource utilization: These pragmatic studies test interventions such as structured discharge planning, enhanced outpatient hematology-oncology follow-up, home-based nursing or transfusion services, and remote monitoring for patients discharged after major OR procedures for lymphoma or leukemia. The target population is survivors discharged from inpatient stays categorized in this DRG who have ongoing needs like transfusion dependence, wound care, or immunosuppression; endpoints include 30- and 90-day readmission rates, outpatient utilization, patient-reported functional status, and total episode-of-care costs. Results are important for providers and payers because effective post-discharge models can lower expensive readmissions, improve patient outcomes, and support bundled payment or care-management strategies for high-cost oncology surgical episodes.

    Related Codes

    821-LYMPHOMA-AND-LEUKEMIA-WITH-MAJOR-O-R-PROCEDURES-WITH-CC

    Lymphoma and Leukemia with Major O.R. Procedures with CC: Inpatient Reimbursement Overview

    822-LYMPHOMA-AND-LEUKEMIA-WITH-MAJOR-O-R-PROCEDURES-WITHOUT-CC-MCC

    Lymphoma and Leukemia with Major O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    823-LYMPHOMA-AND-NON-ACUTE-LEUKEMIA-WITH-OTHER-PROCEDURES-WITH-MCC

    Lymphoma and Non-Acute Leukemia with Other Procedures with MCC: Inpatient Reimbursement Overview

    824-LYMPHOMA-AND-NON-ACUTE-LEUKEMIA-WITH-OTHER-PROCEDURES-WITH-CC

    Lymphoma and Non-Acute Leukemia with Other Procedures with CC: Inpatient Reimbursement Overview

    825-LYMPHOMA-AND-NON-ACUTE-LEUKEMIA-WITH-OTHER-PROCEDURES-WITHOUT-CC-MCC

    Lymphoma and Non-Acute Leukemia with Other Procedures without CC/MCC: Inpatient Reimbursement Overview

    826-MYELOPROLIFERATIVE-DISORDERS-OR-POORLY-DIFFERENTIATED-NEOPLASMS-WITH-MAJOR-O-R-PROCEDURES-WITH-MCC

    Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Major O.R. Procedures with MCC: Inpatient Reimbursement Overview

    827-MYELOPROLIFERATIVE-DISORDERS-OR-POORLY-DIFFERENTIATED-NEOPLASMS-WITH-MAJOR-O-R-PROCEDURES-WITH-CC

    Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Major O.R. Procedures with CC: Inpatient Reimbursement Overview

    828-MYELOPROLIFERATIVE-DISORDERS-OR-POORLY-DIFFERENTIATED-NEOPLASMS-WITH-MAJOR-O-R-PROCEDURES-WITHOUT-CC-MCC

    Myeloproliferative Disorders or Poorly Differentiated Neoplasms: Inpatient Reimbursement Overview

    829-MYELOPROLIFERATIVE-DISORDERS-OR-POORLY-DIFFERENTIATED-NEOPLASMS-WITH-OTHER-PROCEDURES-WITH-CC-MCC

    Myeloproliferative Disorders or Poorly Differentiated Neoplasms: Inpatient Reimbursement Overview

    830-MYELOPROLIFERATIVE-DISORDERS-OR-POORLY-DIFFERENTIATED-NEOPLASMS-WITH-OTHER-PROCEDURES-WITHOUT-CC-MCC

    Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Other Procedures 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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    Mean Rates by Payer — National — DRG 820
    Mean Rates by Payer — Alaska — DRG 820