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    OpenPayerBilling CodesInjuries, Poisonings and Toxic Effects of DrugsDRG 907-other-o-r-procedures-for-injuries-with-mcc
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    Other O.R. Procedures for Injuries with MCC: Inpatient Reimbursement Overview

    DRG 907 encompasses other operating room procedures for injuries when a Major Complication or Comorbidity is present, focusing on traumatic operative care with significant clinical complexity. Classification into this Diagnosis-Related Group matters for inpatient reimbursement because it affects hospital payment under the Centers for Medicare & Medicaid Services inpatient prospective payment framework.

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    DRG 907 Overview

    DRG 907 covers inpatient encounters for patients undergoing other operating room procedures related to injuries when a Major Complication or Comorbidity is present. This group captures cases with significant clinical complexity that typically drive higher resource use due to the combination of traumatic operative interventions and severe comorbid conditions. It matters for Medicare payment because classification into this Diagnosis-Related Group influences hospital reimbursement levels under the inpatient prospective payment system. Accurate coding of the principal procedure, injury diagnoses, and presence of a Major Complication or Comorbidity affects case assignment to this Diagnosis-Related Group and thus payment.

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    National Payment Rates

    Across payers the observed mean payment benchmarks range roughly from $35K (BCBS) up to $63K (Cigna), with individual payer medians and percentiles shown in the table and chart below. The widest spread between payer means is about $28K (Cigna vs. BCBS). Benchmark detail is shown for Cigna, Aetna, Anthem, and BCBS in the table and chart that follow.

    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 ($38.5k), average submitted covered charges ($179.4k), average Medicare payment amount ($32.7k), and total discharges (8.8k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $39K$180K$33K8.8K

    Patient Population

    This DRG’s population skews toward Medicare-age patients rather than exclusively working-age, reflecting a higher share of utilization from beneficiaries covered by Medicare fee-for-service. Commercial payers (Cigna, Aetna, Anthem, BCBS) remain represented, indicating a mixed payer mix but with a Medicare tilt. Expect a predominance of older adults in the case mix rather than primarily working-age patients.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    For DRG 907 in Alaska the mean payments range from $60K (Anthem and Blue Cross Blue Shield) up to $92K (Cigna), indicating a modest payor spread within the state. Cigna’s mean of $92K is the most notable deviation above the other state payers and sits higher than many national median values. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna at a mean of $92K; Lowest payers: Anthem and BCBS both at a mean of $60K.
    • Alaska shows a narrow cluster at $60K for Anthem and Blue Cross Blue Shield, with Cigna substantially higher, creating a notable state-level spread compared with national medians where payers are more distributed.

    Clinical Trials

    • Trials evaluating perioperative blood management strategies for patients undergoing non-routine operative procedures for traumatic injuries: These studies focus on reducing transfusion requirements and optimizing hemostasis in patients with varied injury patterns who require uncommonly coded OR procedures (e.g., complex soft-tissue reconstructions, debridements, or limb-salvage operations). The population typically includes adult trauma inpatients with significant bleeding risk or coagulopathy; endpoints include transfusion volume, perioperative complications, and length of stay. This research matters to providers and payers because improved blood management can reduce complication-related costs, ICU time, and readmissions in a heterogeneous surgical-injury cohort common to this DRG.
    • Comparative effectiveness studies of operative techniques and resource use for complex injury repairs categorized outside standard procedure groups: These trials compare different surgical approaches (for example, staged debridement versus single-stage reconstruction, or minimally invasive fixation versus open repair) in patients whose injuries require atypical OR procedures included in this DRG. The studies enroll diverse injury types and severities to assess outcomes such as functional recovery, reoperation rates, device utilization, and total inpatient costs. Findings guide surgeons and hospital administrators on procedure selection that balances clinical effectiveness with inpatient resource utilization and DRG-based reimbursement constraints.
    • Post-discharge outcomes and care-coordination research examining rehabilitation, complication surveillance, and readmission prevention after non-standard operative injury care: These prospective cohort studies follow patients after discharge who underwent uncommon operative procedures for injuries to measure functional outcomes, wound complication rates, durability of repair, and patterns of acute-care reuse. The target population is often medically complex trauma patients with comorbidities or social needs that affect recovery; interventions studied include structured follow-up pathways, home health integration, or enhanced wound surveillance. Results are relevant to payers and providers because reducing preventable readmissions and optimizing post-acute care allocation can improve cost-effectiveness and quality metrics for admissions assigned to this DRG.

    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

    903-WOUND-DEBRIDEMENTS-FOR-INJURIES-WITHOUT-CC-MCC

    Wound Debridements for Injuries without CC/MCC: 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

    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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    Mean Rates by Payer — National — DRG 907
    Mean Rates by Payer — Alaska — DRG 907