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    OpenPayerBilling CodesInfectious and Parasitic Diseases, Systemic or Unspecified SitesDRG 854-infectious-and-parasitic-diseases-with-o-r-procedures-with-cc
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    Infectious and Parasitic Diseases with O.R. Procedures with CC: Inpatient Reimbursement Overview

    DRG 854 includes inpatient stays for infectious and parasitic diseases requiring operating room procedures with a Complication or Comorbidity; it encompasses surgical management of serious infections. This Diagnosis-Related Group matters because the combination of operative care and documented Complication or Comorbidity increases inpatient resource use and thus affects Medicare payment.

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    DRG 854 Overview

    DRG 854 covers hospital admissions for infectious and parasitic diseases that require operating room procedures and have at least a Complication or Comorbidity. Conditions in this group span serious infections needing surgical intervention, such as debridement, drainage, or other operative management for sepsis-related sources or localized infectious processes. This Diagnosis-Related Group matters for Medicare payment because the presence of an operating room procedure plus a Complication or Comorbidity influences the relative resource intensity and payment weight for inpatient reimbursement. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and the corresponding Medicare Severity Diagnosis-Related Group payment impact.

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    National Payment Rates

    Across commercial payers the observed rate range runs from about $370 to $82K, with payer medians clustered between roughly $20K and $36K; the widest spread is seen between the lowest value ($370) and highest value ($82K) as shown in the table and chart below. Blue Cross Blue Shield, Aetna, Cigna, and Anthem exhibit differing median levels, with commercial benchmarks generally above Medicare averages. Refer to the table and chart for payer-specific quartiles and distributions.

    The CMS 2023 figures 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, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 854. These values reflect national aggregates for Medicare FFS and do not include commercial payer data.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $19K$93K$15K21K

    Patient Population

    This DRG’s patient population skews toward a mix of Medicare-age and working-age patients, with a substantial portion of encounters captured in the Medicare FFS population given the CMS discharge volume. While commercial payers (Aetna, Anthem, Cigna, BCBS) also represent a meaningful share of cases, the population is not exclusively Medicare-age and includes working-age adults covered by private/commercial plans. Overall, payer mix is mixed with a notable Medicare presence.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska rates for DRG 854 range broadly across payers, from Anthem's low-end observations (min $7.5K, mean $29K, median $31K) up to Cigna’s substantially higher values (median $48K, mean $50K, max $85K). The most notable deviation from national averages is Cigna’s elevated mean and median in Alaska, which sit well above national medians for major payers. See the table and chart below for payer-level distributions.

    Key Insights for Alaska

    • Highest payer: Cigna (median $48K, mean $50K) and lowest payer: Anthem (median $31K, mean $29K) among listed payers in Alaska.
    • Alaska's payer range spans from about $7.5K (Anthem min) up to $85K (Cigna max); Cigna's mean and median sit meaningfully above national medians for major payers, indicating higher reimbursements in-state for DRG 854.
    • Blue Cross Blue Shield in Alaska shows a median near Anthem ($31K) but a higher 75th percentile ($36K) compared with national BCBS median, suggesting slightly elevated upper-end rates locally.

    Clinical Trials

    • Acute surgical management and perioperative infection control studies: randomized or pragmatic trials evaluating operative timing, prophylactic antimicrobial regimens, and intraoperative infection prevention bundles for patients undergoing operative procedures for severe infectious and parasitic diseases (for example, source-control surgeries for intra-abdominal sepsis or debridement for necrotizing soft-tissue infection). These studies typically enroll hospitalized adults who require O.R. procedures and have one or more complicating comorbidities (the CC component), and they measure outcomes such as postoperative infectious complication rates, need for reoperation, length of stay, and ICU utilization. Results inform best practices that reduce acute morbidity, resource use, and complications that drive DRG payments and downstream costs for providers and payers.
    • Comparative effectiveness trials of antimicrobial strategies and adjunctive therapies in complex infectious presentations: head-to-head or pragmatic studies comparing different systemic antimicrobial approaches (duration, route-switch strategies, narrow- versus broad-spectrum stewardship strategies) or adjunctive interventions (e.g., source-control timing, negative-pressure wound therapy, or immunomodulatory support) in patients with operative management for infectious/parasitic disease and coexisting comorbidities. These studies enroll heterogeneous inpatient populations representative of real-world complexity under DRG 854 and focus on clinical cure, recurrence, antimicrobial resistance emergence, and healthcare resource utilization. Findings guide formulary decisions, antibiotic stewardship policies, and clinical pathways that impact readmissions, antibiotic costs, and overall reimbursement risk for hospitals and payers.
    • Post-discharge outcomes, readmission prevention, and care-transition research: observational cohorts and interventional trials testing enhanced discharge planning, outpatient parenteral antimicrobial therapy (OPAT) models, telehealth follow-up, and home-care coordination specifically for patients who had O.R. procedures for infectious conditions with complicating comorbidities. These studies target the high-risk early post-discharge period to reduce readmissions, catheter-related complications, and outpatient adverse events, enrolling patients discharged after operative management and tracking 30- to 90-day outcomes, quality-of-life, and total cost of care. Evidence from these studies is highly relevant to providers and payers because reducing avoidable readmissions and post-acute complications directly affects DRG-related performance metrics, bundled-payment performance, and overall expenditures.

    Related Codes

    853-INFECTIOUS-AND-PARASITIC-DISEASES-WITH-O-R-PROCEDURES-WITH-MCC

    Infectious and Parasitic Diseases with O.R. Procedures with MCC: 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. 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 854
    Mean Rates by Payer — Alaska — DRG 854