Find policies, billing codes, payers, states, and providers

Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview

DRG 853 groups inpatient stays for infectious and parasitic diseases requiring operating room procedures plus a Major Complication or Comorbidity; it covers cases with high resource use such as operative source control for severe infections. Correct assignment affects Medicare inpatient reimbursement because operating room procedures and Major Complication or Comorbidity status raise the payment weight for the stay.

Customize your policy alerts

Sign up for Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview policy alerts

Get alerted when relevant policies change without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

DRG 853 Overview

DRG 853 covers hospital admissions for infectious and parasitic diseases that require operating room procedures and include at least one Major Complication or Comorbidity. Typical cases include complex surgical source control or debridement for severe infections, often involving critical care and extended resource use. This grouping matters for Medicare payment because the presence of operating room procedures and a Major Complication or Comorbidity increases relative reimbursement to reflect higher resource intensity. Accurate documentation and coding of procedures and comorbid conditions determine assignment to this Diagnosis-Related Group.

Explore openpayer tools

View all tools

Find policies, billing codes, payers, states, and providers

Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview

Customize your policy alerts

Sign up for Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview policy alerts

Get alerted when relevant policies change without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

DRG 853 Overview

National Payment Rates

Across commercial payers the observed rate range runs from about $43K (BCBS) up to $81K (Cigna), with Anthem and Aetna clustering around $73K–$80K. The widest spread between payer medians is roughly $32K (BCBS median $44K vs. Cigna median $75K). See the table and chart below for full payer percentile detail and distribution.

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($44.6k), average submitted covered charges ($216.0k), average Medicare payment amount ($39.0k), and total discharges (82.3k).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$45K	$220K	$39K	82K

Patient Population

This DRG’s population skews toward Medicare-age beneficiaries, reflecting a higher share of cases coming from the 65+ population rather than predominantly working-age adults. Commercial payers still cover a portion of cases, so the payer mix is mixed but Medicare-dominant. Expect payer distributions to be weighted more heavily to Medicare than to private/commercial coverage.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Across payers in Alaska for DRG 853 the observed contracted amounts span from very low floors of $7.5K (Anthem and BCBS) up to $210K (Cigna), with mean benchmarks clustering around $69K–$120K depending on payer. Cigna sits at the top end while Anthem and Blue Cross Blue Shield show the most notable low-end deviation from national medians. See the table and chart below for payer-level percentiles and distribution.

Key Insights for Alaska

Highest-paying payer: Cigna at $120K (p75) / $120K (median) as the top-tier payer among the listed contracts.
Lowest-paying payer: Anthem/BCBS at $7.5K (p25) with a very low floor compared with other payers in Alaska.
Meaningful deviation: Alaska’s payer spread (from $7.5K to $210K) is wider than typical national medians, driven by Cigna’s and Anthem/BCBS extremes relative to national averages.

Clinical Trials

Acute surgical antimicrobial strategies: randomized or pragmatic trials evaluating perioperative and intraoperative antimicrobial regimens, timing of source-control procedures, and adjunctive sepsis bundles in patients with severe infectious or parasitic diseases who require operative intervention and have major comorbidities (MCC). These studies enroll critically ill inpatients admitted for emergency or planned O.R. procedures for infections such as complicated intra-abdominal sepsis, necrotizing soft tissue infections, or infected prosthetic material, and test endpoints like early organ dysfunction reversal, need for reoperation, and in-hospital mortality. Findings directly inform surgical timing, antibiotic stewardship, and resource use during the highest-cost inpatient phase, which is crucial for clinicians making acute care decisions and for payers managing reimbursement and utilization for DRG 853 admissions.
Comparative effectiveness and pathway trials for operative source control techniques: multicenter observational cohorts or randomized studies comparing different O.R. procedures and surgical approaches (for example, open versus minimally invasive source control, staged debridement schedules, or use of negative-pressure therapy) in patients with complex infectious conditions and significant comorbidity burden. These trials focus on functional recovery, complication rates, length of stay, and need for additional surgical interventions among medically complex inpatients who qualify for this DRG. Results help hospitals and payers understand which procedural pathways reduce readmissions, downstream resource use, and costs while maintaining clinical outcomes for high-acuity infectious disease surgical cases.
Post-discharge outcomes and care-transition studies: prospective observational studies or interventions assessing post-discharge trajectories, antimicrobial therapy adherence, outpatient parenteral antimicrobial therapy (OPAT) safety, and readmission risk stratification in survivors of O.R.-treated infectious diseases with MCC. These investigations enroll patients discharged after operative management for severe infections to evaluate 30- to 90-day readmissions, complications related to comorbid conditions, and the effectiveness of care coordination programs or telehealth follow-up. Evidence from this area is important for payers and providers seeking to reduce costly readmissions, optimize transitional care pathways, and allocate resources toward post-acute services that improve outcomes for patients in DRG 853.

Infectious and Parasitic Diseases with O.R. Procedures with CC: Inpatient Reimbursement Overview

855-INFECTIOUS-AND-PARASITIC-DISEASES-WITH-O-R-PROCEDURES-WITHOUT-CC-MCC

Infectious and Parasitic Diseases with O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

856-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITH-MCC

Postoperative or Post-Traumatic Infections with O.R. Procedures with MCC: Inpatient Reimbursement Overview

857-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITH-CC

Postoperative or Post-Traumatic Infections with O.R. Procedures with CC: Inpatient Reimbursement Overview

858-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITHOUT-CC-MCC

Postoperative or Post-Traumatic Infections with O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

862-POSTOPERATIVE-AND-POST-TRAUMATIC-INFECTIONS-WITH-MCC

Postoperative and Post-Traumatic Infections with MCC: Inpatient Reimbursement Overview

863-POSTOPERATIVE-AND-POST-TRAUMATIC-INFECTIONS-WITHOUT-MCC

Postoperative and Post-Traumatic Infections without MCC: Inpatient Reimbursement Overview

864-FEVER-AND-INFLAMMATORY-CONDITIONS

Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

865-VIRAL-ILLNESS-WITH-MCC

Viral Illness with MCC: Inpatient Reimbursement Overview

866-VIRAL-ILLNESS-WITHOUT-MCC

Viral Illness without MCC: Inpatient Reimbursement Overview

Showing 1–10 of 16

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

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.

Explore openpayer tools

View all tools

National Payment Rates

Mean Rates by Payer — National — DRG 853

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$45K	$220K	$39K	82K

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 853

Key Insights for Alaska

Highest-paying payer: Cigna at $120K (p75) / $120K (median) as the top-tier payer among the listed contracts.
Lowest-paying payer: Anthem/BCBS at $7.5K (p25) with a very low floor compared with other payers in Alaska.
Meaningful deviation: Alaska’s payer spread (from $7.5K to $210K) is wider than typical national medians, driven by Cigna’s and Anthem/BCBS extremes relative to national averages.

Clinical Trials

Acute surgical antimicrobial strategies: randomized or pragmatic trials evaluating perioperative and intraoperative antimicrobial regimens, timing of source-control procedures, and adjunctive sepsis bundles in patients with severe infectious or parasitic diseases who require operative intervention and have major comorbidities (MCC). These studies enroll critically ill inpatients admitted for emergency or planned O.R. procedures for infections such as complicated intra-abdominal sepsis, necrotizing soft tissue infections, or infected prosthetic material, and test endpoints like early organ dysfunction reversal, need for reoperation, and in-hospital mortality. Findings directly inform surgical timing, antibiotic stewardship, and resource use during the highest-cost inpatient phase, which is crucial for clinicians making acute care decisions and for payers managing reimbursement and utilization for DRG 853 admissions.
Comparative effectiveness and pathway trials for operative source control techniques: multicenter observational cohorts or randomized studies comparing different O.R. procedures and surgical approaches (for example, open versus minimally invasive source control, staged debridement schedules, or use of negative-pressure therapy) in patients with complex infectious conditions and significant comorbidity burden. These trials focus on functional recovery, complication rates, length of stay, and need for additional surgical interventions among medically complex inpatients who qualify for this DRG. Results help hospitals and payers understand which procedural pathways reduce readmissions, downstream resource use, and costs while maintaining clinical outcomes for high-acuity infectious disease surgical cases.
Post-discharge outcomes and care-transition studies: prospective observational studies or interventions assessing post-discharge trajectories, antimicrobial therapy adherence, outpatient parenteral antimicrobial therapy (OPAT) safety, and readmission risk stratification in survivors of O.R.-treated infectious diseases with MCC. These investigations enroll patients discharged after operative management for severe infections to evaluate 30- to 90-day readmissions, complications related to comorbid conditions, and the effectiveness of care coordination programs or telehealth follow-up. Evidence from this area is important for payers and providers seeking to reduce costly readmissions, optimize transitional care pathways, and allocate resources toward post-acute services that improve outcomes for patients in DRG 853.

Infectious and Parasitic Diseases with O.R. Procedures with CC: Inpatient Reimbursement Overview

855-INFECTIOUS-AND-PARASITIC-DISEASES-WITH-O-R-PROCEDURES-WITHOUT-CC-MCC

Infectious and Parasitic Diseases with O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

856-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITH-MCC

Postoperative or Post-Traumatic Infections with O.R. Procedures with MCC: Inpatient Reimbursement Overview

857-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITH-CC

Postoperative or Post-Traumatic Infections with O.R. Procedures with CC: Inpatient Reimbursement Overview

858-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITHOUT-CC-MCC

Postoperative or Post-Traumatic Infections with O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

862-POSTOPERATIVE-AND-POST-TRAUMATIC-INFECTIONS-WITH-MCC

Postoperative and Post-Traumatic Infections with MCC: Inpatient Reimbursement Overview

863-POSTOPERATIVE-AND-POST-TRAUMATIC-INFECTIONS-WITHOUT-MCC

Postoperative and Post-Traumatic Infections without MCC: Inpatient Reimbursement Overview

864-FEVER-AND-INFLAMMATORY-CONDITIONS

Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

865-VIRAL-ILLNESS-WITH-MCC

Viral Illness with MCC: Inpatient Reimbursement Overview

866-VIRAL-ILLNESS-WITHOUT-MCC

Viral Illness without MCC: Inpatient Reimbursement Overview

Showing 1–10 of 16

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview

Sign up for Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview policy alerts

DRG 853 Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview

Sign up for Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview policy alerts

DRG 853 Overview

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References