Septicemia or Severe Sepsis DRG 872 Payment Rates & Medicare

Summary & Overview

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

DRG 872 encompasses septicemia or severe sepsis admissions without prolonged mechanical ventilation and without Major Complication or Comorbidity, defining a mid-acuity sepsis population relevant for inpatient payments. Correct grouping is important because it influences Medicare reimbursement through Diagnosis-Related Group assignment and reflects hospital resource use for sepsis care absent the highest-acuity respiratory failure or Major Complication or Comorbidity.

SepticemiaDRG Septicemia or Severe Sepsis without MV >96 Hours without MCCDRG 872Diagnosis-Related GroupInpatient ReimbursementMedicareInfectious DiseaseCritical CareHospital CodingSepsis

DRG 872 Overview

DRG 872 covers inpatient admissions for septicemia or severe sepsis where the patient did not receive mechanical ventilation for more than 96 hours and there is no Major Complication or Comorbidity present. This Diagnosis-Related Group captures cases with significant infectious systemic illness that require hospital-level care but lack the highest-acuity respiratory failure and highest-level comorbidity coding. For Medicare payment, this grouping helps determine bundled reimbursement and hospital resource intensity for sepsis care without prolonged mechanical ventilation or Major Complication or Comorbidity. Accurate clinical and coding documentation directly affects assignment to this Diagnosis-Related Group and subsequent Medicare Severity Diagnosis-Related Group relative weight application.

National Payment Rates

Across commercial payers in the benchmarks table, negotiated rates range roughly from $9K to $39K, with payer medians clustering between about $9.6K and $19K depending on carrier. The widest spread is seen between Anthem (max $39K) and BCBS (min $370), reflecting a difference of roughly $39K across the sample. See the table and chart below for payer-specific distributions and quartiles.

Mean Rates by Payer — National — DRG 872

The CMS 2023 data reflect 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 the period. Values summarize national-level payment and discharge activity for Medicare FFS cases in DRG 872.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 872 payer means span from $16K (Blue Cross Blue Shield and Anthem) up to $26K (Cigna), reflecting a $10K range across reported payers. Cigna stands out as the clear high outlier versus the other local payers and exceeds common national medians, while BCBS and Anthem sit at the lower end of the state distribution. See the table and chart below for payer-specific quartiles and spread.

Key Insights for Alaska

Highest payer: Cigna at a mean of 26K, notably above other local payers and above national medians for some payers.
Lowest payer: Blue Cross Blue Shield (BCBS) / Anthem at a mean of 16K, representing the low end of the Alaska range.
Meaningful deviation: Cigna’s mean (26K) is substantially higher than BCBS/Anthem means (16K), indicating a wide state range versus national medians.

Clinical Trials

Acute sepsis resuscitation and bundle implementation trials: randomized or pragmatic studies testing timing and components of early sepsis care (eg, fluid strategies, vasopressor initiation thresholds, antibiotic timing protocols) in adult inpatients with confirmed septicemia or severe sepsis who do not require prolonged mechanical ventilation. These studies focus on the initial 24–72 hours of hospitalization to determine which rapid-care approaches reduce progression to organ dysfunction, ICU transfer, or prolonged ventilation. Results are directly relevant to hospital clinicians and payers because improved early care can shorten length of stay, reduce use of high-cost ICU resources, and lower readmission risk for this DRG group.
Comparative effectiveness studies of adjunctive therapies and diagnostics during the index hospitalization: observational cohorts or randomized trials evaluating the impact of interventions such as biomarker-guided antibiotic stewardship, source-control strategies, or adjunct anti-inflammatory approaches in patients with septicemia/severe sepsis without major complications (no MCC). These trials enroll medically heterogeneous inpatients (medical and surgical) to compare outcomes like in-hospital mortality, antibiotic exposure, and resource utilization across clinically plausible alternatives. Findings inform clinicians and payers about which diagnostics or adjunctive practices offer the best trade-off between clinical benefit and cost for patients classified under this DRG.
Post-discharge outcomes and care-transition research: prospective cohort studies and implementation trials assessing post-acute care, rehabilitation needs, coordinated outpatient follow-up, and readmission-prevention strategies among survivors of septicemia/severe sepsis who were not ventilated >96 hours and lacked major complications. These studies evaluate functional recovery, health-related quality of life, medication adherence, and drivers of 30- and 90-day readmissions across diverse discharge dispositions (home, skilled nursing facility, home health). Results are essential to payers and hospital systems managing DRG 872 because optimizing transitions of care can reduce downstream costs, prevent readmissions, and improve long-term outcomes for this patient population.

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

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

871-SEPTICEMIA-OR-SEVERE-SEPSIS-WITHOUT-MV-96-HOURS-WITH-MCC

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

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Septicemia or Severe Sepsis with MV >96 Hours: Inpatient Reimbursement Overview

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

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

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Other Infectious and Parasitic Diseases Diagnoses without CC/MCC: Inpatient Reimbursement Overview

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

864-FEVER-AND-INFLAMMATORY-CONDITIONS

Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

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Other Infectious and Parasitic Diseases Diagnoses with MCC: Inpatient Reimbursement Overview

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Other Infectious and Parasitic Diseases Diagnoses with CC: Inpatient Reimbursement Overview

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Summary & Overview

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

DRG 872 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