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    OpenPayerBilling CodesAlcohol or Drug Use or Induced Organic Mental DisordersDRG 897-alcohol-drug-abuse-or-dependence-without-rehabilitation-therapy-without-mcc
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    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.

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    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.

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    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.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported through 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. These values summarize Medicare payment experience for DRG 897 at the national level.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $8.6K$34K$6.7K19K

    Patient Population

    This DRG’s population is mixed but skews toward working-age adults rather than exclusively Medicare-age beneficiaries; private/commercial payers (e.g., Blue Cross Blue Shield, Cigna, Aetna, Anthem) cover a substantial share alongside Medicare. Medicare still accounts for a meaningful portion of inpatient discharges given the program’s coverage of older adults, so the patient mix includes both Medicare-age and non-Medicare (working-age) individuals. Overall, the population is neither exclusively Medicare-age nor exclusively working-age but represents a blend of both payer cohorts.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Across payers in Alaska for DRG 897, mean payments range from $9.1K (Blue Cross Blue Shield) up to $16K (Cigna). Cigna represents the highest mean; BCBS represents the lowest mean in the state profile. The state’s upper bound (Cigna) sits noticeably above several national comparators while BCBS is meaningfully below national means. See the table and chart below for payer detail and distribution.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $16K) is the top-paying payer in Alaska; lowest payer: BCBS (mean $9.1K).
    • Cigna’s mean ($16K) is above the national mean comparators, while BCBS’s mean ($9.1K) sits below national averages, indicating meaningful upward deviation at the high end and downward deviation at the low end.

    Clinical Trials

    • Trials evaluating brief, inpatient-initiated pharmacologic and psychosocial interventions to reduce withdrawal complications and short-term readmission risk: these studies enroll adult inpatients admitted primarily for alcohol or drug intoxication or withdrawal without need for inpatient rehabilitation services, testing strategies such as targeted medication initiation during the hospital stay combined with brief motivational interviewing. The objective is to determine whether early, hospital-initiated treatment reduces symptom escalation, length of stay, and 30-day return visits; results are directly relevant to hospitalists and payers because effective inpatient protocols can lower acute care utilization and improve allocation of limited inpatient resources.
    • Comparative effectiveness studies assessing different care-transition models for patients discharged without rehabilitation: research in this area compares outcomes across structured linkage-to-outpatient programs, peer-navigation or case-management approaches, and usual-discharge planning among adults who leave the hospital after treatment for substance use disorders but are not transferred to rehab facilities. These trials focus on measures such as engagement in outpatient treatment, overdose events, ED visits, and short-term costs, providing actionable evidence for clinicians and payers on which transition strategies best reduce readmissions and downstream expenditures.
    • Observational and implementation studies examining risk prediction and quality metrics for non-rehab SUD admissions: these cohort-based studies develop and validate clinical risk scores and hospital-level quality indicators (for example, protocols for detecting co-occurring medical or psychiatric conditions, safe discharge practices, and naloxone prescribing or distribution) in populations admitted for alcohol or drug misuse without rehabilitation placement. The goal is to identify patients at high risk of adverse events after discharge and to evaluate scalable process measures that hospitals and payers can use to monitor performance, prioritize interventions, and align reimbursement with improved short-term outcomes.

    Related Codes

    894-ALCOHOL-DRUG-ABUSE-OR-DEPENDENCE-LEFT-AMA

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

    895-ALCOHOL-DRUG-ABUSE-OR-DEPENDENCE-WITH-REHABILITATION-THERAPY

    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

    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 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.

    Mean Rates by Payer — National — DRG 897
    Mean Rates by Payer — Alaska — DRG 897