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    v1.0.30
    OpenPayerBilling CodesMyeloproliferative Diseases and Disorders, Poorly Differentiated NeoplasmsDRG 822-lymphoma-and-leukemia-with-major-o-r-procedures-without-cc-mcc
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    Lymphoma and Leukemia with Major O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    DRG 822 applies to hospital stays for lymphoma and leukemia cases with major operating room procedures when no Major Complication or Comorbidity or Complication or Comorbidity is present. It captures a high-resource surgical cohort and therefore has important implications for inpatient prospective payment under Medicare.

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    DRG 822 Overview

    DRG 822 covers inpatient admissions for patients with lymphoma and leukemia who undergo major operating room procedures without Major Complication or Comorbidity or Complication or Comorbidity. It groups high-resource surgical cases involving hematologic malignancies where no additional coded complications elevate payment. This Diagnosis-Related Group matters for Medicare payment because it defines the bundled prospective payment for the hospital stay based on clinical complexity and resource use. Accurate coding of procedures and comorbidities is essential to assign the correct Diagnosis-Related Group and corresponding reimbursement level.

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    National Payment Rates

    Payer rates for DRG 822 range from a low of $11K (Cigna minimum) up to $44K (Anthem maximum), with mean benchmarks clustering around $12K–$20K depending on payer. The widest spread observed across payers is $33K (Anthem max $44K vs Cigna min $11K). Refer to the payer benchmark table and accompanying chart below for payer-specific percentiles and distributions for Anthem, Cigna, Aetna, and BCBS.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($12.9k), average submitted covered charges ($68.8k), average Medicare payment ($9.7k), and total discharges (679) for DRG 822.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $13K$69K$9.7K680

    Patient Population

    This DRG’s population skews toward a mixed-age cohort but leans more toward Medicare-age patients given substantial representation in inpatient Medicare FFS discharges. The case mix includes both working-age commercially insured patients and older Medicare beneficiaries, so the payer mix is blended rather than exclusively commercial or exclusively Medicare. Payer distribution typically reflects higher Medicare utilization relative to many exclusively working-age DRGs.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    In Alaska, DRG 822 reimburses between $19K and $29K across payers, reflecting a relatively tight state range. Cigna stands out at a mean of $29K, materially above Anthem and Blue Cross Blue Shield at $19K each and modestly higher than national Cigna benchmarks. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $29K); Lowest payers: Anthem and Blue Cross Blue Shield (mean $19K).
    • Alaska’s rates range from $19K to $29K across payers, with Cigna noticeably above both Anthem and Blue Cross Blue Shield and modestly above national means for Cigna.

    Clinical Trials

    • Perioperative and intraoperative management trials investigating optimized surgical approaches and supportive care for patients with lymphoma or leukemia undergoing major operating room procedures; these studies enroll inpatient adults or children with active hematologic malignancies who require major resections, biopsies, or device implantations and test protocols for transfusion thresholds, perioperative antimicrobial prophylaxis, and strategies to minimize bleeding and infection risk. Research in this area addresses immediate procedural complications and resource utilization, directly informing hospital protocols, length-of-stay, and reimbursement drivers for this DRG.
    • Comparative effectiveness studies evaluating different systemic therapy sequencing or timing in relation to major O.R. procedures, such as trials comparing neoadjuvant versus adjuvant systemic regimens or timing of chemotherapy relative to surgery; these typically include patients with lymphoma or leukemia where surgical intervention is part of diagnostic management or symptom control, and measure outcomes like complication rates, readmissions, and short-term disease control. Findings are relevant to clinicians and payers because they influence decision-making about when to perform inpatient procedures versus outpatient treatment, affect perioperative morbidity, and alter cost and case mix for DRG 822 admissions.
    • Post-discharge outcomes and care-transition research focusing on readmission prevention, rehabilitation needs, and outpatient care coordination for patients discharged after major O.R. procedures for lymphoma or leukemia; cohorts include recently discharged inpatients with complex needs (e.g., cytopenias, central lines, or infection risk), and studies test interventions such as structured discharge planning, home nursing support, or early outpatient monitoring to reduce 30-day readmissions and emergency visits. These studies are important to providers and payers because they target downstream utilization and penalties tied to readmissions, impacting overall cost-effectiveness and quality metrics associated with this DRG.

    Related Codes

    820-LYMPHOMA-AND-LEUKEMIA-WITH-MAJOR-O-R-PROCEDURES-WITH-MCC

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

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

    Lymphoma and Leukemia with Major O.R. Procedures with CC: 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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    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 822
    Mean Rates by Payer — Alaska — DRG 822