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Alcohol, Drug Abuse or Dependence, Left AMA: Inpatient Reimbursement Overview

DRG 894 addresses inpatient admissions for alcohol, drug abuse, or dependence where the patient leaves against medical advice, encompassing care complexity related to substance use disorders. This matters for inpatient reimbursement because the documented diagnoses, procedures, and discharge disposition determine Diagnosis-Related Group assignment and payment under Medicare rules.

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DRG 894 Overview

DRG 894 covers inpatient stays for patients admitted with alcohol, drug abuse, or dependence who leave against medical advice during the admission. This group captures episodes where the treatment course is interrupted by patient-initiated discharge, affecting resource use and clinical documentation. It matters for Medicare payment because the discharge disposition and documented clinical details influence case assignment and reimbursement under inpatient prospective payment. Accurate coding of substance-related diagnoses and discharge status is essential for correct Diagnosis-Related Group assignment.

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Alcohol, Drug Abuse or Dependence, Left AMA: Inpatient Reimbursement Overview

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DRG 894 Overview

National Payment Rates

Across commercial payers the case rate range spans roughly from $370 to $16K, with median/typical values varying by payer as shown in the table and chart below. The widest spread is seen in Aetna and Cigna where maximums reach $16K while medians sit much lower, indicating greater variability; Anthem and BCBS show lower maximums and tighter interquartile ranges. Refer to the payer table and the accompanying chart for payer-specific percentiles and distributions.

The CMS 2023 data represent national Medicare fee-for-service inpatient payments under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($6.4k), average submitted covered charges ($26.7k), average Medicare payment ($5.1k), and total discharges (2.8k).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$6.4K	$27K	$5.1K	2.8K

Patient Population

This DRG’s population typically skews toward working-age and mixed-age adults rather than being concentrated in the traditional Medicare-age population. Commercial payers (Blue Cross Blue Shield, Cigna, Aetna, Anthem) often cover a sizable portion of cases alongside Medicare, indicating a mixed-age distribution. Overall, the payer mix reflects both Medicare-age and non‑Medicare (working‑age) patients rather than being predominantly Medicare-age.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer means for DRG 894 in Alaska range from $6.5K (Blue Cross Blue Shield) to $11K (Cigna), with Anthem at $8.5K. The Alaska mix skews higher than national averages, where median and mean values are substantially lower for most national payers; Cigna and Anthem in particular stand out above national rates. See the table and chart below for payer-specific percentiles and distribution.

Key Insights for Alaska

Highest-paying payer: Cigna (mean $11K); Lowest-paying payer: BCBS (mean $6.5K).
Alaska payers generally pay well above national means for this DRG, with Cigna and Anthem particularly higher than national averages.

Clinical Trials

Acute withdrawal management trials focusing on short-term inpatient protocols to safely manage alcohol or drug withdrawal symptoms in patients who are medically unstable or at high risk for complications; these studies enroll adults admitted with severe withdrawal or intoxication who may be considering discharge against medical advice, and compare approaches like symptom-triggered monitoring versus standardized medication regimens to reduce adverse events during the hospitalization. This research is relevant to providers and payers because effective inpatient protocols can reduce complications, length of stay, and high-cost readmissions associated with incomplete treatment when patients leave AMA.
Comparative effectiveness studies evaluating models of in-hospital addiction consult services and initiation of evidence-based addiction care (for example, initiating pharmacologic relapse-prevention options or structured psychosocial engagement) versus usual care; these trials typically enroll patients hospitalized for substance-related problems, including those at risk of leaving AMA, and measure outcomes such as rates of AMA discharge, linkage to outpatient treatment, and 30- to 90-day readmission or overdose events. Findings inform hospitals and payers about which service configurations most effectively retain patients in care, improve transitions to community treatment, and reduce downstream utilization and costs.
Post-discharge and pragmatic implementation research examining interventions to improve engagement after premature discharge, such as mobile outreach, rapid outpatient appointment scheduling, or contingency management programs targeted to patients who left AMA; studies target the high-risk subgroup that discontinues inpatient care early and measure real-world outcomes like successful linkage to follow-up addiction services, emergency department revisits, and mortality over months to a year. These studies are important for payers and health systems seeking scalable strategies to mitigate the elevated risk and resource use associated with AMA discharges and to improve long-term outcomes for this vulnerable population.

Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy: Inpatient Reimbursement Overview

896-ALCOHOL-DRUG-ABUSE-OR-DEPENDENCE-WITHOUT-REHABILITATION-THERAPY-WITH-MCC

Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with MCC: Inpatient Reimbursement Overview

897-ALCOHOL-DRUG-ABUSE-OR-DEPENDENCE-WITHOUT-REHABILITATION-THERAPY-WITHOUT-MCC

Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy without MCC: Inpatient Reimbursement Overview

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.

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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 894

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$6.4K	$27K	$5.1K	2.8K

Patient Population

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 894

Key Insights for Alaska

Highest-paying payer: Cigna (mean $11K); Lowest-paying payer: BCBS (mean $6.5K).
Alaska payers generally pay well above national means for this DRG, with Cigna and Anthem particularly higher than national averages.

Clinical Trials

Acute withdrawal management trials focusing on short-term inpatient protocols to safely manage alcohol or drug withdrawal symptoms in patients who are medically unstable or at high risk for complications; these studies enroll adults admitted with severe withdrawal or intoxication who may be considering discharge against medical advice, and compare approaches like symptom-triggered monitoring versus standardized medication regimens to reduce adverse events during the hospitalization. This research is relevant to providers and payers because effective inpatient protocols can reduce complications, length of stay, and high-cost readmissions associated with incomplete treatment when patients leave AMA.
Comparative effectiveness studies evaluating models of in-hospital addiction consult services and initiation of evidence-based addiction care (for example, initiating pharmacologic relapse-prevention options or structured psychosocial engagement) versus usual care; these trials typically enroll patients hospitalized for substance-related problems, including those at risk of leaving AMA, and measure outcomes such as rates of AMA discharge, linkage to outpatient treatment, and 30- to 90-day readmission or overdose events. Findings inform hospitals and payers about which service configurations most effectively retain patients in care, improve transitions to community treatment, and reduce downstream utilization and costs.
Post-discharge and pragmatic implementation research examining interventions to improve engagement after premature discharge, such as mobile outreach, rapid outpatient appointment scheduling, or contingency management programs targeted to patients who left AMA; studies target the high-risk subgroup that discontinues inpatient care early and measure real-world outcomes like successful linkage to follow-up addiction services, emergency department revisits, and mortality over months to a year. These studies are important for payers and health systems seeking scalable strategies to mitigate the elevated risk and resource use associated with AMA discharges and to improve long-term outcomes for this vulnerable population.

Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy: Inpatient Reimbursement Overview

896-ALCOHOL-DRUG-ABUSE-OR-DEPENDENCE-WITHOUT-REHABILITATION-THERAPY-WITH-MCC

Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with MCC: Inpatient Reimbursement Overview

897-ALCOHOL-DRUG-ABUSE-OR-DEPENDENCE-WITHOUT-REHABILITATION-THERAPY-WITHOUT-MCC

Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy without MCC: Inpatient Reimbursement Overview

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

Alcohol, Drug Abuse or Dependence, Left AMA: Inpatient Reimbursement Overview

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DRG 894 Overview

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Alcohol, Drug Abuse or Dependence, Left AMA: Inpatient Reimbursement Overview

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DRG 894 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