Summary & Overview
Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy without MCC: Inpatient Reimbursement Overview
DRG 897 encompasses inpatient stays for alcohol, drug abuse or dependence without rehabilitation therapy and without Major Complication or Comorbidity, covering medical management and stabilization needs. This classification matters for inpatient reimbursement because it assigns cases to a lower resource-weighted payment category within Medicare's inpatient prospective payment system and depends on precise documentation and coding.
DRG 897 Overview
DRG 897 covers inpatient admissions for alcohol, drug abuse or dependence where rehabilitation therapy is not provided and there is no Major Complication or Comorbidity present. This Diagnosis-Related Group applies to primary substance use disorders that require inpatient medical management, observation, or stabilization rather than inpatient rehabilitation services. It matters for Medicare payment because cases assigned to this Diagnosis-Related Group are grouped into a lower resource-intensity payment category compared with admissions that include rehabilitation or higher-severity comorbid conditions. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and thus the appropriate Medicare inpatient reimbursement.
National Payment Rates
Across commercial payers the negotiated rate range for this DRG spans roughly from $370 up to $23K, with the widest spread observed between low-end BCBS payments (as low as $370) and high-end Cigna/Aetna payments (up to $23K). The payer-specific distributions shown in the table and chart below highlight substantial variation by insurer, with Aetna and Cigna clustering at higher medians and BCBS and Anthem lower. Refer to the table and chart below for payer quartiles and full distributions.