Lymphoma and Leukemia with Major O.R. Procedures DRG Reimbursement

Summary & Overview

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.

Lymphoma and Leukemia with Major O.R. Procedures with MCCDRG Lymphoma and Leukemia with Major O.R. Procedures with MCCDRG 820Diagnosis-Related GroupInpatient ReimbursementMedicareHematologyOncology SurgeryTransplantHospital Coding

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.

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.

Mean Rates by Payer — National — DRG 820

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.

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

836-ACUTE-LEUKEMIA-WITHOUT-CC-MCC

Acute Leukemia without CC/MCC: Inpatient Reimbursement Overview

849-RADIOTHERAPY

Radiotherapy: 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

847-CHEMOTHERAPY-WITHOUT-ACUTE-LEUKEMIA-AS-SECONDARY-DIAGNOSIS-WITH-CC

Chemotherapy without Acute Leukemia as Secondary Diagnosis with CC: Inpatient Reimbursement Overview

848-CHEMOTHERAPY-WITHOUT-ACUTE-LEUKEMIA-AS-SECONDARY-DIAGNOSIS-WITHOUT-CC-MCC

Chemotherapy without Acute Leukemia as Secondary Diagnosis without CC/MCC: Inpatient Reimbursement Overview

835-ACUTE-LEUKEMIA-WITH-CC

Acute Leukemia with Complication or Comorbidity: Inpatient Reimbursement Overview

843-OTHER-MYELOPROLIFERATIVE-DISORDERS-OR-POORLY-DIFFERENTIATED-NEOPLASTIC-DIAGNOSES-WITH-MCC

Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses with MCC: Inpatient Reimbursement Overview

834-ACUTE-LEUKEMIA-WITH-MCC

Acute Leukemia with MCC: 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

846-CHEMOTHERAPY-WITHOUT-ACUTE-LEUKEMIA-AS-SECONDARY-DIAGNOSIS-WITH-MCC

Chemotherapy without Acute Leukemia as Secondary Diagnosis with MCC: Inpatient Reimbursement Overview

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Summary & Overview

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

DRG 820 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes