Septicemia or Severe Sepsis without MV >96 Hours with MCC: Inpatient Reimbursement Overview

DRG 871 addresses inpatient admissions for septicemia or severe sepsis without prolonged mechanical ventilation but with at least one Major Complication or Comorbidity, reflecting higher clinical complexity. Correct assignment influences Medicare inpatient reimbursement because the Diagnosis-Related Group determines relative payment rates tied to expected resource use.

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DRG 871 Overview

DRG 871 covers inpatient stays for patients treated for septicemia or severe sepsis who do not require mechanical ventilation for more than 96 hours and have at least one Major Complication or Comorbidity. This Diagnosis-Related Group captures higher-acuity infectious and systemic inflammatory cases where resource use is increased due to the presence of serious comorbid conditions. It matters for Medicare payment because classification into this Diagnosis-Related Group drives higher reimbursement relative to lower-severity groups, reflecting greater expected hospital resource consumption. Accurate coding of sepsis and Major Complication or Comorbidity documentation directly affects assignment to DRG 871 and associated payment.

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Septicemia or Severe Sepsis without MV >96 Hours with MCC: Inpatient Reimbursement Overview

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DRG 871 Overview

National Payment Rates

Across payers the observed rate range runs from about $18K (BCBS) up to $65K (Anthem), with a mean-centered spread where payer means fall between roughly $18K and $32K; the widest single-payer spread (min-to-max) is seen with Anthem (min ~$390 to max $65K). See the accompanying table and chart below for payer-level detail. Payer comparisons use national commercial plan samples (Cigna, Aetna, Anthem, BCBS).

The CMS 2023 data represent 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 871 based on 2023 claims.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$18K	$85K	$15K	560K

Patient Population

This DRG’s patient population skews toward Medicare-age patients, reflecting a heavier representation of older adults relative to working-age commercial populations. While commercial payers (Cigna, Aetna, Anthem, BCBS) also cover a portion of cases, the prevalence in Medicare fee-for-service suggests Medicare-age predominance rather than primarily working-age. The mix is therefore weighted toward older adults with a meaningful but smaller commercial payer share.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer mean rates in Alaska range from about $29K to $48K across the reported payers, with Cigna at the high end (mean $48K, max $83K) and Anthem and Blue Cross Blue Shield clustered at the low end (mean $29K, max $48K). The state displays a wide top-end spread driven by Cigna’s $83K maximum, which is a notable deviation above national averages. See the table and chart below for payer-level detail.

Key Insights for Alaska

Highest payer: Cigna (max $83K, mean $48K, median $46K) is the top-paying payer in Alaska, substantially above other local payers.
Lowest payer: Anthem/Blue Cross Blue Shield (both share identical benchmarks with max $48K, mean $29K, median $30K) are the lowest-paying payers in the state.
Alaska’s mean rates skew higher than national means for similar payers (Cigna’s mean $48K notably exceeds national Cigna mean $32K), indicating a meaningful upward deviation at the top end of the market.

Clinical Trials

Acute immunomodulatory or sepsis bundle intervention trials: randomized studies testing timing and components of early sepsis care bundles (e.g., fluid strategies, vasopressor initiation thresholds, source-control timing and adjunctive immunomodulatory therapies) in adult inpatients presenting with septicemia or severe sepsis who do not require prolonged mechanical ventilation. These trials focus on the initial 24–72 hours of hospitalization to determine whether specific acute interventions reduce organ dysfunction, intensive care utilization, or mortality. Results directly inform inpatient care pathways, resource use, and short-term cost drivers relevant to payers and hospital reimbursement under this high-acuity DRG.
Comparative effectiveness studies of antimicrobial stewardship and diagnostic strategies: pragmatic trials or cohort studies comparing rapid molecular pathogen/ resistance testing plus targeted antimicrobial therapy versus standard culture-driven approaches in patients with bloodstream infections and severe sepsis without prolonged ventilation. These studies enroll heterogeneous hospitalized adults with sepsis to evaluate time to appropriate therapy, antibiotic exposure, length of stay, and rates of complications or readmission. Findings influence antibiotic costs, length-of-stay and downstream readmission risks that affect reimbursement and case-mix adjustment for this DRG.
Post-acute outcomes and care-transition research: longitudinal cohort studies or interventional trials testing discharge planning models, early outpatient follow-up, and rehabilitation interventions aimed at reducing post-discharge morbidity, functional decline, and 30–90 day readmissions among survivors of septicemia/severe sepsis without prolonged mechanical ventilation. These studies target patients discharged from the inpatient stay classified under this DRG to quantify long-term resource utilization, patient-centered outcomes, and preventable readmissions. Results are relevant to payers and hospitals seeking to improve bundled-payment performance and reduce avoidable downstream costs associated with sepsis survivors.

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.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.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.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 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.

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National Payment Rates

Mean Rates by Payer — National — DRG 871

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$18K	$85K	$15K	560K

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 871

Key Insights for Alaska

Highest payer: Cigna (max $83K, mean $48K, median $46K) is the top-paying payer in Alaska, substantially above other local payers.
Lowest payer: Anthem/Blue Cross Blue Shield (both share identical benchmarks with max $48K, mean $29K, median $30K) are the lowest-paying payers in the state.
Alaska’s mean rates skew higher than national means for similar payers (Cigna’s mean $48K notably exceeds national Cigna mean $32K), indicating a meaningful upward deviation at the top end of the market.

Clinical Trials

Acute immunomodulatory or sepsis bundle intervention trials: randomized studies testing timing and components of early sepsis care bundles (e.g., fluid strategies, vasopressor initiation thresholds, source-control timing and adjunctive immunomodulatory therapies) in adult inpatients presenting with septicemia or severe sepsis who do not require prolonged mechanical ventilation. These trials focus on the initial 24–72 hours of hospitalization to determine whether specific acute interventions reduce organ dysfunction, intensive care utilization, or mortality. Results directly inform inpatient care pathways, resource use, and short-term cost drivers relevant to payers and hospital reimbursement under this high-acuity DRG.
Comparative effectiveness studies of antimicrobial stewardship and diagnostic strategies: pragmatic trials or cohort studies comparing rapid molecular pathogen/ resistance testing plus targeted antimicrobial therapy versus standard culture-driven approaches in patients with bloodstream infections and severe sepsis without prolonged ventilation. These studies enroll heterogeneous hospitalized adults with sepsis to evaluate time to appropriate therapy, antibiotic exposure, length of stay, and rates of complications or readmission. Findings influence antibiotic costs, length-of-stay and downstream readmission risks that affect reimbursement and case-mix adjustment for this DRG.
Post-acute outcomes and care-transition research: longitudinal cohort studies or interventional trials testing discharge planning models, early outpatient follow-up, and rehabilitation interventions aimed at reducing post-discharge morbidity, functional decline, and 30–90 day readmissions among survivors of septicemia/severe sepsis without prolonged mechanical ventilation. These studies target patients discharged from the inpatient stay classified under this DRG to quantify long-term resource utilization, patient-centered outcomes, and preventable readmissions. Results are relevant to payers and hospitals seeking to improve bundled-payment performance and reduce avoidable downstream costs associated with sepsis survivors.

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.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.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.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.

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

Septicemia or Severe Sepsis without MV >96 Hours with MCC: Inpatient Reimbursement Overview

Sign up for drg 871 policy alerts

DRG 871 Overview

OpenPayer

Septicemia or Severe Sepsis without MV >96 Hours with MCC: Inpatient Reimbursement Overview

Sign up for drg 871 policy alerts

DRG 871 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