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    OpenPayerBilling CodesInjuries, Poisonings and Toxic Effects of DrugsDRG 903-wound-debridements-for-injuries-without-cc-mcc
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    Wound Debridements for Injuries without CC/MCC: Inpatient Reimbursement Overview

    DRG 903 encompasses inpatient stays for wound debridement for injuries without Complication or Comorbidity or Major Complication or Comorbidity and defines the clinical scope as surgical removal of damaged tissue in the absence of additional coded complications. It matters for inpatient reimbursement because assignment to this Diagnosis-Related Group determines the standardized Medicare payment and recognition of resource use for these straightforward debridement cases.

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    DRG 903 Overview

    DRG 903 covers inpatient admissions for wound debridement procedures performed for injuries without Complication or Comorbidity or Major Complication or Comorbidity. Typical cases include surgical removal of necrotic or contaminated tissue from traumatic wounds when no additional coded complications are present. This Diagnosis-Related Group is important for Medicare payment because it groups these procedures into a single reimbursement category that affects hospital payment and resource classification. Accurate coding of the principal procedure and comorbidity status determines assignment to DRG 903.

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    National Payment Rates

    Across commercial payers the observed rate range spans from about $370 up to $45K, with commercial means clustering between roughly $12K and $20K. Anthem shows the widest spread (min $390 to max $45K), as reflected in the table and chart below. Refer to the payer table and the benchmark chart for payer-specific quartiles and medians.

    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 ($11.958k), average submitted covered charges ($56.820k), average Medicare payment ($9.347k), and total discharges (367).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $12K$57K$9.3K370

    Patient Population

    This DRG’s population skews toward a mixed-age group, with a notable portion of cases billed to private/commercial payers as well as Medicare. The presence of 367 Medicare discharges in the CMS data indicates meaningful Medicare-age representation, though commercial payers’ benchmark data confirm substantial working-age coverage as well. Overall the payer mix is mixed rather than exclusively Medicare-age or exclusively working-age.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s DRG 903 rates cluster tightly for Anthem and Blue Cross Blue Shield at $18K, while Cigna shows a substantially higher mean of $28K, producing a state range of $18K–$28K across payers. The most notable deviation from national averages is Cigna’s elevated mean compared with national Cigna benchmarks, which are materially lower. Refer to the table and chart below for payer-level details.

    Key Insights for Alaska

    • Anthem is the highest-paying payer in Alaska at $18K, while BCBS (Blue Cross Blue Shield) also reports $18K; however, Cigna pays notably higher with a mean of $28K, making Cigna the highest mean payer and Anthem/BCBS the lowest.
    • The state range spans from $18K to $28K across payers, with Cigna’s mean ($28K) materially above the national Cigna mean ($19K), indicating a meaningful upward deviation from national rates for that payer.
    • Overall, most payers cluster at $18K in Alaska, producing a compressed state-level distribution except for Cigna which stands out as an outlier on the high end.

    Clinical Trials

    • Acute procedural optimization studies: randomized or controlled trials evaluating different surgical debridement techniques, anesthesia approaches, or timing of debridement in hospitalized patients with traumatic or nontraumatic wounds requiring operative removal of necrotic tissue. These studies typically enroll adult inpatients who present with soft-tissue injuries, lacerations, or contaminated wounds without major comorbid complications (no CC/MCC) to determine which immediate intra‑hospital strategies reduce operative time, intraoperative blood loss, or need for repeat debridement. Results are directly relevant to surgeons, hospital administrators, and payers because optimized acute procedures can shorten length of stay, reduce resource utilization, and lower per‑episode costs while maintaining clinical safety.
    • Comparative effectiveness research on adjunctive wound care modalities: prospective cohorts or randomized trials comparing adjuncts such as negative-pressure wound therapy, advanced dressings, enzymatic debriders, or topical agents used after initial operative debridement in patients without significant comorbid complications. These studies focus on the post‑operative in‑hospital and early post‑discharge phase to assess wound healing rates, time to secondary closure or grafting, infection rates, and need for readmission among relatively healthier injury patients. Findings inform clinicians and payers about which adjunctive therapies offer better healing trajectories or reduced downstream interventions—data that can influence device use policies, bundle payments, and discharge planning.
    • Post-discharge outcomes and health services research: observational studies and registry analyses tracking functional outcomes, outpatient follow‑up adherence, wound-related readmissions, and rehabilitation needs for patients categorized under this DRG after hospital discharge. The population studied includes patients treated with debridement for injuries who did not have CC/MCC during the index stay; research questions include predictors of readmission, gaps in outpatient wound care access, and cost drivers in the 30–90 day post‑acute period. This area is important to providers and payers because it identifies opportunities to reduce avoidable readmissions, optimize transitional care pathways, and design targeted post‑discharge interventions that can improve outcomes and control total episode costs.

    Related Codes

    901-WOUND-DEBRIDEMENTS-FOR-INJURIES-WITH-MCC

    Wound Debridements for Injuries with MCC: Inpatient Reimbursement Overview

    902-WOUND-DEBRIDEMENTS-FOR-INJURIES-WITH-CC

    Wound Debridements for Injuries with CC: Inpatient Reimbursement Overview

    904-SKIN-GRAFTS-FOR-INJURIES-WITH-CC-MCC

    Skin Grafts for Injuries with CC/MCC: Inpatient Reimbursement Overview

    905-SKIN-GRAFTS-FOR-INJURIES-WITHOUT-CC-MCC

    Skin Grafts for Injuries without CC/MCC: Inpatient Reimbursement Overview

    906-HAND-PROCEDURES-FOR-INJURIES

    Hand Procedures for Injuries: Inpatient Reimbursement Overview

    907-OTHER-O-R-PROCEDURES-FOR-INJURIES-WITH-MCC

    Other O.R. Procedures for Injuries with MCC: Inpatient Reimbursement Overview

    908-OTHER-O-R-PROCEDURES-FOR-INJURIES-WITH-CC

    Other O.R. Procedures for Injuries with CC: Inpatient Reimbursement Overview

    909-OTHER-O-R-PROCEDURES-FOR-INJURIES-WITHOUT-CC-MCC

    Other O.R. Procedures for Injuries without CC/MCC: Inpatient Reimbursement Overview

    913-TRAUMATIC-INJURY-WITH-MCC

    Traumatic Injury with MCC: Inpatient Reimbursement Overview

    914-TRAUMATIC-INJURY-WITHOUT-MCC

    Traumatic Injury without MCC: Inpatient Reimbursement Overview

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    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 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 903
    Mean Rates by Payer — Alaska — DRG 903