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    OpenPayerBilling CodesInfectious and Parasitic Diseases, Systemic or Unspecified SitesDRG 870-septicemia-or-severe-sepsis-with-mv-96-hours
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    Septicemia or Severe Sepsis with MV >96 Hours: Inpatient Reimbursement Overview

    DRG 870 encompasses septicemia or severe sepsis requiring invasive mechanical ventilation for more than 96 hours, reflecting severe systemic infection with prolonged respiratory failure. It matters for inpatient reimbursement because it represents one of the highest-acuity Diagnosis-Related Groups with substantially greater resource intensity and payment under Medicare rules.

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    DRG 870 Overview

    DRG 870 covers inpatient hospitalizations for patients with septicemia or severe sepsis who require invasive mechanical ventilation for more than 96 hours, representing high-acuity critical care. This Diagnosis-Related Group captures complex cases with prolonged respiratory support and multiple organ dysfunction that drive resource use. As a high-weight Diagnosis-Related Group, it is a primary driver of higher Medicare reimbursement for intensive care stay and advanced life-sustaining therapies. Accurate diagnosis and procedure documentation directly affect case classification and payment under Centers for Medicare & Medicaid Services rules.

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    National Payment Rates

    Across commercial payers the observed rate range spans from about $53K to $140K among the provided payer benchmarks, with maximums reported up to $230K. The widest spread between payer means and maximums is most pronounced for Anthem and Cigna in the table and chart below. Refer to the table and chart for payer-specific percentiles and distribution details.

    The CMS 2023 data are 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 amount, and total discharges for DRG 870. These figures reflect national Medicare payment and charge measures for the recorded discharges.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $62K$300K$55K27K

    Patient Population

    This DRG’s population includes both Medicare-age and working-age patients, but payment analyses and CMS reporting indicate a substantial Medicare representation given the program’s focus. Commercial payers (e.g., Blue Cross Blue Shield, Cigna, Aetna, Anthem) cover a meaningful portion of cases among non-Medicare adults, so the overall payer mix is mixed with a strong Medicare component. Age distribution therefore spans from working-age adults through Medicare-age beneficiaries.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    For DRG 870 in Alaska the payer rate range spans from $110K to $170K among the reported payers, with BCBS and Anthem clustered at $110K and Cigna markedly higher with a mean of $170K and a max of $280K. This produces a notable deviation above several national medians, driven primarily by Cigna’s elevated values. See the table and chart below for the full payer distribution.

    Key Insights for Alaska

    • Blue Cross Blue Shield (BCBS) and Anthem both report a single benchmark value of $110K, tying as the lowest-paying payers in Alaska for DRG 870.
    • Cigna is the highest-paying payer with a mean of $170K and an upper range up to $280K, creating a wide state payer spread and concentration above national medians.
    • Alaska’s payer means skew higher than many national benchmarks — notably Cigna’s $170K mean exceeds typical national medians for this DRG, indicating a meaningful upward deviation from national rates.

    Clinical Trials

    • Acute critical care intervention trials assessing ventilation strategies, adjunctive hemodynamic support, or early sepsis bundle components in patients with septicemia or severe sepsis requiring mechanical ventilation >96 hours. These studies enroll critically ill adult ICU patients shortly after diagnosis of sepsis and intubation to evaluate interventions aimed at reducing time on the ventilator, organ dysfunction progression, or ICU mortality; they focus on immediate-phase management choices such as lung-protective ventilation settings, fluid-resuscitation protocols, or vasopressor titration strategies. Results are highly relevant to providers and payers because improved early management can shorten ICU length of stay, reduce resource-intensive ventilator days, and lower costs associated with prolonged mechanical ventilation and organ support.
    • Comparative effectiveness and stewardship studies examining antimicrobial regimens, de-escalation timing, or diagnostic stewardship in patients with culture-positive or culture-negative septicemia who remain ventilator-dependent beyond 96 hours. These trials compare antibiotic selection strategies, duration of therapy, and rapid diagnostic-guided approaches in a population at high risk for secondary infections, multidrug-resistant pathogens, and antibiotic-related complications. Findings inform clinicians and payers about optimal antibiotic use that balances clinical outcomes with antimicrobial resistance risk and medication costs, potentially reducing readmissions and downstream expenditures related to complications.
    • Post-discharge outcomes and recovery studies evaluating long-term functional status, cognitive impairment, rehospitalization, and cost-effectiveness of post-ICU rehabilitation programs for survivors of severe sepsis who required >96 hours of mechanical ventilation. These cohort studies or randomized pragmatic trials follow patients after hospital discharge to measure physical functioning, quality of life, caregiver burden, and healthcare utilization, testing interventions such as structured physical therapy, outpatient critical care follow-up, or transitional care models. This research is relevant because patients in this DRG frequently experience prolonged disability and high post-discharge costs; evidence on effective recovery pathways helps payers and health systems plan resource allocation and value-based care strategies.

    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

    854-INFECTIOUS-AND-PARASITIC-DISEASES-WITH-O-R-PROCEDURES-WITH-CC

    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

    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 870
    Mean Rates by Payer — Alaska — DRG 870