Summary & Overview

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.

Chemotherapy without Acute Leukemia as Secondary Diagnosis with Major Complication or ComorbidityDRG Chemotherapy without Acute Leukemia as Secondary Diagnosis with MCCDRG 846Diagnosis-Related GroupInpatient ReimbursementMedicareOncologyHematologyInfusion TherapyHospital Coding

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.

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.

Mean Rates by Payer — National — DRG 846

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.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$31K	$130K	$25K	3.2K

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.

OpenPayer

Summary & Overview

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

DRG 846 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