Chemotherapy w/ CC DRG 847 Reimbursement & Medicare

Summary & Overview

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

DRG 847 covers inpatient chemotherapy admissions without acute leukemia as a secondary diagnosis but with a Complication or Comorbidity that affects resource use. This group is important for inpatient reimbursement because the Complication or Complication or Comorbidity designation alters payment weight and reflects higher expected resource consumption.

Chemotherapy without Acute Leukemia as Secondary Diagnosis with CCDRG Chemotherapy without Acute Leukemia as Secondary Diagnosis with CCDRG 847Diagnosis-Related GroupInpatient ReimbursementMedicareOncologyInfusion TherapyHospital CodingProcedure Coding

DRG 847 Overview

DRG 847 covers inpatient admissions for chemotherapy administration where acute leukemia is not listed as a secondary diagnosis and a Complication or Comorbidity is present. This Diagnosis-Related Group applies to medical oncology encounters focused on cytotoxic, hormonal, or targeted anticancer therapies given during a hospital stay. It matters for Medicare payment because the presence of a Complication or Comorbidity influences relative payment weight and resource intensity compared with non-CC chemotherapy admissions. Accurate coding of the principal diagnosis, secondary conditions, and procedure codes determines assignment to this Diagnosis-Related Group and the associated inpatient reimbursement.

National Payment Rates

Across commercial payers the payment distribution spans from about $11K (BCBS minimum) up to $46K (Anthem maximum), with mean values clustering in the $11K–$21K range. The widest spread is seen with Anthem (min $390 to max $46K), indicating the largest payer-level variability. See the table and chart below for payer-specific medians, quartiles, and extremes.

Mean Rates by Payer — National — DRG 847

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 ($14.6k), average submitted covered charges ($61.9k), average Medicare payment ($11.2k), and total discharges (7.9k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 847 mean payments range from $20K to $32K across the represented payers, with Blue Cross Blue Shield and Anthem clustered at $20K and Cigna at $32K. The most notable deviation from national patterns is Cigna’s substantially higher mean in Alaska relative to the other local payers and common national medians. See the table and chart below for payer-specific distributions.

Key Insights for Alaska

Highest payer: Cigna (mean $32K) — notably above other payers in Alaska.
Lowest payers: BCBS and Anthem (means $20K) — both sit well below Cigna and align at the state minimum.
State-level mean spread ($20K–$32K) shows Cigna materially exceeds the other local benchmarks and is higher than typical national medians for some payers.

Clinical Trials

Trials evaluating novel outpatient chemotherapy delivery models and supportive-care protocols for adult patients receiving cytotoxic or targeted systemic therapy without concurrent acute leukemia: these studies investigate methods such as shorter infusion schedules, ambulatory infusion centers, and enhanced antiemetic or growth-factor prophylaxis to reduce inpatient admission length and prevent chemotherapy-related complications. The patient population includes solid-tumor and non-leukemia hematologic malignancy patients admitted for chemotherapy complications or administration who have comorbidities (CC) increasing risk of toxicity. Findings are relevant to providers and payers because optimized delivery and supportive care can lower inpatient utilization, reduce complication rates, and inform pathway-based reimbursement and resource allocation.
Comparative effectiveness studies assessing dose-intensity strategies and toxicity management protocols in patients with cancer and significant comorbid conditions: these trials compare different dosing regimens, treatment intervals, or adjunctive supportive interventions (for example, primary prophylactic growth factors versus reactive use) to balance disease control against treatment-related morbidity. Target populations are hospitalized adults receiving systemic therapy without secondary acute leukemia but with comorbidities that classify them in the CC category; outcomes include hospitalization days, transfusion needs, infection rates, and functional status. Results guide clinicians and payers on which protocols achieve equivalent oncologic outcomes with fewer complications and lower inpatient costs, informing DRG utilization patterns and bundled-payment considerations.
Post-discharge and outcomes research focused on transitional care, readmission reduction, and quality-of-life measurement for chemotherapy patients with complications: these observational and interventional studies test post-discharge care bundles, home-based nursing follow-up, telemonitoring, and symptom-management education to prevent readmissions and identify late adverse events. The studies enroll patients recently discharged after inpatient chemotherapy encounters complicated by comorbid conditions, tracking 30- to 90-day readmissions, emergency visits, patient-reported outcomes, and total cost of care. Evidence from this area is crucial for providers and payers to develop discharge criteria, case management strategies, and payment models that reduce costly readmissions while maintaining patient safety and quality.

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

839-CHEMOTHERAPY-WITH-ACUTE-LEUKEMIA-AS-SECONDARY-DIAGNOSIS-WITHOUT-CC-MCC

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

842-LYMPHOMA-AND-NON-ACUTE-LEUKEMIA-WITHOUT-CC-MCC

Lymphoma and Non-Acute Leukemia without CC/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

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

Myeloproliferative Disorders or Poorly Differentiated Neoplasms: Inpatient Reimbursement Overview

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

Lymphoma and Leukemia with Major O.R. 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

841-LYMPHOMA-AND-NON-ACUTE-LEUKEMIA-WITH-CC

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

850-ACUTE-LEUKEMIA-WITH-OTHER-PROCEDURES

Acute Leukemia with Other Procedures: Inpatient Reimbursement Overview

837-CHEMOTHERAPY-WITH-ACUTE-LEUKEMIA-AS-SECONDARY-DIAGNOSIS-OR-WITH-HIGH-DOSE-CHEMOTHERAPY-AGENT-WITH-MCC

Chemotherapy with Acute Leukemia as Secondary Diagnosis or with High Dose Chemotherapy Agent with MCC: Inpatient Reimbursement Overview

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Summary & Overview

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

DRG 847 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