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    v1.0.28
    OpenPayerBilling CodesMyeloproliferative Diseases and Disorders, Poorly Differentiated NeoplasmsDRG 846-chemotherapy-without-acute-leukemia-as-secondary-diagnosis-with-mcc
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    Chemotherapy without Acute Leukemia as Secondary Diagnosis with MCC: Inpatient Reimbursement Overview

    DRG 846 applies to inpatient stays for chemotherapy when acute leukemia is not a secondary diagnosis and a Major Complication or Comorbidity is present, encompassing higher-acuity chemotherapy encounters. It matters for inpatient reimbursement because assignment to this Diagnosis-Related Group results in higher prospective payment weight to account for increased resource use and complexity.

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    DRG 846 Overview

    DRG 846 covers inpatient admissions for patients receiving chemotherapy where acute leukemia is not listed as a secondary diagnosis and a Major Complication or Comorbidity is present. This Diagnosis-Related Group captures higher resource use related to chemotherapy administration and management of significant comorbid conditions, influencing payment weights and length-of-stay expectations. For Medicare payment, assignment to this Diagnosis-Related Group affects the inpatient prospective payment and reflects increased clinical complexity compared with lower-severity chemotherapy DRGs. Understanding the clinical scope is important for correct coding and assignment within the inpatient reimbursement framework.

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    National Payment Rates

    Across commercial payers the observed rate range spans roughly from $370 up to $91K, with payer medians varying widely by carrier; Aetna and Cigna medians sit near $46K and $39K respectively, while BCBS median is about $20K and Anthem median about $39K. The widest spread between minimum and maximum reported values is seen with Anthem (min $390 to max $91K). See the table and chart below for payer-specific distributions and percentiles.

    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 shows average total payment, average submitted covered charges, average Medicare payment, and total discharges for DRG 846. These figures reflect Medicare FFS payment benchmarks at the national level for 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $31K$130K$25K3.2K

    Patient Population

    This DRG’s population includes a mix of Medicare-age and working-age patients, but billing and payment profiles often reflect a substantial Medicare component given the national Medicare data presented. The age distribution typically spans adults, with many cases falling into the Medicare-age bracket alongside a meaningful share of commercially insured, working-age adults. Payment analyses should therefore consider both Medicare FFS and commercial payer dynamics.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    In Alaska for DRG 846, payer benchmarks span from $40K to $62K across the reported payers, with Blue Cross Blue Shield and Anthem at the low end and Cigna at the high end. Cigna’s mean/median of $62K represents the most notable upward deviation relative to the national context, while BCBS and Anthem at $40K lie below many national medians. See the table and chart below for detailed payer distributions.

    Key Insights for Alaska

    • Blue Cross Blue Shield (BCBS) and Anthem are tied at the lowest observed benchmark of $40K, while Cigna is the highest payer at $62K.
    • Alaska’s payer range is narrow to moderate ($40K–$62K) versus national medians that are generally higher for some payers; Cigna’s $62K median notably exceeds the national medians provided, while BCBS/Anthem at $40K sit below several national medians.

    Clinical Trials

    • Trials evaluating optimization of inpatient chemotherapy administration protocols for patients receiving non-acute leukemia chemotherapeutic regimens: these studies compare different inpatient scheduling, hydration, and antiemetic/supportive care bundles for adults hospitalized to receive systemic chemotherapy for solid tumors or non-acute hematologic malignancies. The patient population includes medically complex inpatients with comorbidities or organ dysfunction who require monitored infusion and supportive measures; the objective is to reduce infusion-related complications, length of stay, and unplanned transfers to higher acuity. Results directly inform hospital clinical pathways and resource utilization decisions and are relevant to payers and case managers aiming to lower inpatient costs while maintaining safety and quality of care.
    • Comparative effectiveness and safety studies of dose-intensity strategies or regimen sequencing in hospitalized patients without acute leukemia: these comparative studies investigate whether adjusted dosing schedules, dose delays, or alternative sequencing of chemotherapeutic agents in medically unstable or frail inpatients lead to similar tumor control with fewer adverse events. The trials enroll patients admitted for planned or urgent administration of systemic therapy for solid tumors or chronic hematologic malignancies (excluding acute leukemia as a secondary diagnosis) who have significant comorbidities or organ impairment. Findings help clinicians decide on inpatient treatment intensity and inform payers about expected complication rates and downstream costs associated with different treatment approaches.
    • Post-discharge outcomes and transitional care interventions for patients hospitalized for chemotherapy administration: these observational cohorts or pragmatic trials assess readmission rates, post-discharge emergency visits, outpatient oncology follow-up, and patient-reported symptom burden after an inpatient chemotherapy stay. Populations include patients discharged after inpatient chemotherapy for non-acute leukemia malignancies, often elderly or with limited social support, and the research tests care coordination strategies (e.g., early outpatient follow-up, phone monitoring, home nursing) to prevent readmissions. This research is important to hospitals and payers because it targets reductions in costly readmissions and uncovers opportunities to improve continuity of care, adherence to outpatient regimens, and overall value of inpatient chemotherapy episodes.

    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

    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

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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 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 846
    Mean Rates by Payer — Alaska — DRG 846