Skin Grafts for Injuries without CC/MCC DRG Reimbursement

Summary & Overview

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

DRG 905 addresses inpatient skin graft procedures for injuries without Major Complication or Comorbidity or Complication or Comorbidity, covering surgical management of wounds and grafting. This grouping matters because it defines expected resource use and influences Medicare payment under the inpatient prospective payment system.

Skin Grafts for Injuries without CC/MCCDRG Skin Grafts for Injuries without CC/MCCDRG 905Diagnosis-Related GroupInpatient ReimbursementMedicareSurgeryBurn CareWound Management

DRG 905 Overview

DRG 905 covers inpatient admissions for patients who receive skin grafting procedures for traumatic or burn-related injuries without a Major Complication or Comorbidity and without a Complication or Comorbidity. The clinical scope includes surgical debridement and split- or full-thickness grafting for coverage of wounds where no higher-severity diagnoses are present. This Diagnosis-Related Group matters for Medicare payment because it groups cases of similar resource use and assigns a payment weight that affects hospital reimbursement under the inpatient prospective payment system. Accurate assignment of principal and secondary diagnoses and procedure coding determines whether an admission is classified to this Diagnosis-Related Group.

National Payment Rates

Across commercial payers the observed payment range runs roughly from $14K (BCBS minimum/median) up to $58K (Anthem maximum), with payers showing medians between about $14K and $27K. The widest spread is seen with Anthem, from $390 up to $58K, indicating the largest variability across facilities and contracts. See the table and chart below for payer-specific quartiles and distributions.

Mean Rates by Payer — National — DRG 905

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 ($15.6k), average submitted covered charges ($82.3k), average Medicare payment amount ($12.4k), and total discharges (117).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 905 mean payments span from $24K (Blue Cross Blue Shield/Anthem) to $37K (Cigna), reflecting a moderate spread across payers. Cigna’s mean at $37K stands out as a meaningful elevation relative to national averages for similar commercial payers. Reference the table and chart below for payer-level distributions and percentile detail.

Key Insights for Alaska

Highest payer: Cigna at a mean of 37K; Lowest payer: BCBS and Anthem tied at a mean of 24K.
Alaska’s rates range from $24K to $37K across payers, with Cigna notably above national means for comparable payers.

Clinical Trials

Acute surgical technique and graft take optimization studies: randomized or prospective cohort studies testing different skin graft harvesting and fixation techniques, intraoperative wound bed preparation methods, or topical biologic dressings to maximize initial graft take in patients with acute traumatic or burn-related skin defects without major comorbid complications. These trials enroll mainly adult and pediatric inpatients undergoing split-thickness or full-thickness grafting within days of injury and measure early endpoints such as percent graft take at 7–14 days, infection rates, and need for reoperation. Results are directly relevant to surgeons and hospital payers because improved initial graft success reduces length of stay, reoperation rates, and short-term inpatient resource utilization that drive costs in this DRG.
Comparative effectiveness studies of perioperative infection prevention and wound care protocols: pragmatic or cluster-randomized studies comparing alternatives such as different systemic antibiotic strategies, topical antimicrobial regimens, negative-pressure wound therapy adjuncts, or standardized perioperative care bundles for patients receiving skin grafts after injury. These studies focus on typical inpatient populations without major CC/MCC but at varying risk for nosocomial infection (e.g., contaminated traumatic wounds, grafts over exposed structures) and evaluate outcomes including surgical site infection, graft failure, readmission, and antibiotic exposure. Findings inform evidence-based pathways that providers use to standardize care across hospitals and allow payers to identify protocols that reduce complications, readmissions, and associated costs for this DRG.
Post-discharge functional and health economics outcome studies: longitudinal observational cohorts or pragmatic trials assessing longer-term outcomes such as scar quality, functional limb recovery, return-to-work, patient-reported pain and quality of life, and downstream healthcare utilization after inpatient grafting for injury. These studies enroll the typical DRG population discharged without major complications and follow them for months to a year to quantify durable benefits or needs for revision procedures, rehabilitation services, and outpatient wound care. For providers and payers, this research clarifies the post-acute resource needs tied to initial inpatient care decisions and supports value-based care planning, reimbursement models, and allocation of outpatient support to minimize total cost of care and improve patient-centered outcomes.

Related Codes

916-ALLERGIC-REACTIONS-WITHOUT-MCC

Allergic Reactions without MCC: Inpatient Reimbursement Overview

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

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

918-POISONING-AND-TOXIC-EFFECTS-OF-DRUGS-WITHOUT-MCC

Poisoning and Toxic Effects of Drugs without MCC: Inpatient Reimbursement Overview

920-COMPLICATIONS-OF-TREATMENT-WITH-CC

Complications of Treatment with CC: Inpatient Reimbursement Overview

923-OTHER-INJURY-POISONING-AND-TOXIC-EFFECT-DIAGNOSES-WITHOUT-MCC

Other Injury, Poisoning and Toxic Effect Diagnoses without MCC: 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

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

Wound Debridements 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

914-TRAUMATIC-INJURY-WITHOUT-MCC

Traumatic Injury without MCC: Inpatient Reimbursement Overview

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

Wound Debridements for Injuries with CC: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$16K	$82K	$12K	120

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 905

Key Insights for Alaska

Highest payer: Cigna at a mean of 37K; Lowest payer: BCBS and Anthem tied at a mean of 24K.
Alaska’s rates range from $24K to $37K across payers, with Cigna notably above national means for comparable payers.

Clinical Trials

Acute surgical technique and graft take optimization studies: randomized or prospective cohort studies testing different skin graft harvesting and fixation techniques, intraoperative wound bed preparation methods, or topical biologic dressings to maximize initial graft take in patients with acute traumatic or burn-related skin defects without major comorbid complications. These trials enroll mainly adult and pediatric inpatients undergoing split-thickness or full-thickness grafting within days of injury and measure early endpoints such as percent graft take at 7–14 days, infection rates, and need for reoperation. Results are directly relevant to surgeons and hospital payers because improved initial graft success reduces length of stay, reoperation rates, and short-term inpatient resource utilization that drive costs in this DRG.
Comparative effectiveness studies of perioperative infection prevention and wound care protocols: pragmatic or cluster-randomized studies comparing alternatives such as different systemic antibiotic strategies, topical antimicrobial regimens, negative-pressure wound therapy adjuncts, or standardized perioperative care bundles for patients receiving skin grafts after injury. These studies focus on typical inpatient populations without major CC/MCC but at varying risk for nosocomial infection (e.g., contaminated traumatic wounds, grafts over exposed structures) and evaluate outcomes including surgical site infection, graft failure, readmission, and antibiotic exposure. Findings inform evidence-based pathways that providers use to standardize care across hospitals and allow payers to identify protocols that reduce complications, readmissions, and associated costs for this DRG.
Post-discharge functional and health economics outcome studies: longitudinal observational cohorts or pragmatic trials assessing longer-term outcomes such as scar quality, functional limb recovery, return-to-work, patient-reported pain and quality of life, and downstream healthcare utilization after inpatient grafting for injury. These studies enroll the typical DRG population discharged without major complications and follow them for months to a year to quantify durable benefits or needs for revision procedures, rehabilitation services, and outpatient wound care. For providers and payers, this research clarifies the post-acute resource needs tied to initial inpatient care decisions and supports value-based care planning, reimbursement models, and allocation of outpatient support to minimize total cost of care and improve patient-centered outcomes.