Hand Procedures for Injuries DRG Reimbursement & Medicare

Summary & Overview

Hand Procedures for Injuries: Inpatient Reimbursement Overview

DRG 906 encompasses inpatient surgical repair and management of traumatic hand injuries requiring operative care and associated inpatient resources. Understanding this Diagnosis-Related Group is important for how Medicare bundles payment for the hospitalization based on procedure complexity, comorbid conditions, and documented resource use.

Hand Procedures for InjuriesDRG Hand Procedures for InjuriesDRG 906Diagnosis-Related GroupInpatient ReimbursementMedicareOrthopedic SurgeryPlastic SurgeryTrauma Surgery

DRG 906 Overview

DRG 906 covers inpatient admissions for surgical repair and related management of hand injuries, including fractures, tendon lacerations, nerve injuries, and complex soft tissue trauma requiring operative intervention and perioperative care. This Diagnosis-Related Group captures resource use tied to operative time, anesthesia, inpatient nursing needs, and postanesthesia recovery specific to hand procedure complexity. It matters for Medicare payment because the Diagnosis-Related Group assignment determines bundled payment for the hospital stay and influences case-mix reimbursement for facilities treating acute hand trauma. Accurate coding of procedures and associated diagnoses affects the Diagnosis-Related Group classification and thus the Medicare inpatient payment amount.

National Payment Rates

Across commercial payers the rate range for DRG 906 spans from about $370 up to $67K, with payer means varying from roughly $17K (BCBS) to $32K (Cigna). The widest spread is seen between the minimum and maximum reported values ($370 to $67K). See the table and chart below for payer-specific percentiles and distributions.

Mean Rates by Payer — National — DRG 906

The CMS 2023 data reflects national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($20.9k), average submitted covered charges ($102.2k), average Medicare payment amount ($16.1k), and total discharges (369).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer rates for DRG 906 in Alaska range from about $7.5K at the low end up to $84K at the high end across payers, with most payers clustering near the $31K–$49K band. Cigna stands out with a notably higher mean ($49K) and median ($47K) compared with other local payers and national medians, while Anthem and Blue Cross Blue Shield sit closer to the state median of $31K. See the table and chart below for payer-specific distributions and percentiles.

Key Insights for Alaska

Highest payer: Cigna (median $47K, mean $49K); Lowest payer: Anthem (median $31K, mean $31K) and BCBS shows a lower 25th percentile at $25K indicating more low-end variability.
Alaska’s rates skew higher for Cigna compared with national medians, while Anthem and BCBS medians (~$31K) are near or slightly above national medians, indicating Cigna is the most notable deviation from national norms.

Clinical Trials

Acute surgical technique trials evaluating timing and method of operative repair for traumatic hand injuries, such as randomized or prospective cohort studies comparing early primary repair versus delayed reconstruction for tendon lacerations, nerve injuries, or complex soft-tissue defects. These studies enroll adults and children presenting with traumatic hand injuries who require operative management and focus on perioperative outcomes like reoperation rates, infection, and short-term functional recovery. Results inform surgeons and payers about resource use, length of stay, and complication risks associated with different acute surgical approaches, guiding triage, coding, and reimbursement decisions.
Comparative effectiveness studies of fixation and reconstruction strategies for hand fractures and joint injuries, including prospective registries or non-inferiority trials comparing internal fixation methods (e.g., plates, screws, pinning) and soft-tissue reconstruction techniques. These trials typically recruit patients with specific fracture patterns (metacarpal, phalangeal, intra-articular) and evaluate longer-term outcomes such as time to union, range of motion, return-to-work, and need for secondary procedures. Providers and payers rely on this evidence to determine which techniques yield best functional outcomes with acceptable cost and reoperation profiles, impacting DRG-related utilization and reimbursement planning.
Post-discharge rehabilitation and outcomes research assessing functional recovery, occupational therapy models, and patient-reported outcomes following operative or nonoperative management of hand injuries, often using randomized designs or pragmatic cohort studies to compare therapy intensity, tele-rehabilitation, or standardized protocols. These studies include diverse patient groups stratified by injury severity, comorbidities, and work demands, and measure metrics such as time to return to daily activities, persistent disability, and long-term healthcare utilization. Findings are critical for discharge planning, coverage decisions for outpatient rehabilitation services, and predicting downstream costs and quality-of-life outcomes tied to this DRG.

Complications of Treatment without CC/MCC: Inpatient Reimbursement Overview

913-TRAUMATIC-INJURY-WITH-MCC

Traumatic Injury with MCC: Inpatient Reimbursement Overview

915-ALLERGIC-REACTIONS-WITH-MCC

Allergic Reactions 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

919-COMPLICATIONS-OF-TREATMENT-WITH-MCC

Complications of Treatment with Major Complication or Comorbidity: Inpatient Reimbursement Overview

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

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

Wound Debridements for Injuries with 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

920-COMPLICATIONS-OF-TREATMENT-WITH-CC

Complications of Treatment with CC: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$21K	$100K	$16K	370