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    v1.0.28
    OpenPayerBilling CodesInjuries, Poisonings and Toxic Effects of DrugsDRG 915-allergic-reactions-with-mcc
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    Allergic Reactions with MCC: Inpatient Reimbursement Overview

    DRG 915 pertains to inpatient stays for allergic reactions complicated by a Major Complication or Comorbidity, reflecting cases with increased clinical severity and resource needs. Understanding this Diagnosis-Related Group is important for inpatient reimbursement because assignment affects the relative payment weight and overall Medicare payment for the episode.

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    DRG 915 Overview

    DRG 915 covers inpatient encounters for allergic reactions where a Major Complication or Comorbidity is present, typically including severe systemic responses requiring intensive monitoring or organ support. This Diagnosis-Related Group captures higher resource use driven by severity, extended length of stay, and intervention intensity. It is important for Medicare payment because the presence of a Major Complication or Comorbidity increases the relative payment weight compared with lower-severity groupings. Correct clinical documentation and coding determine assignment to this Diagnosis-Related Group and thus influence reimbursement.

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    National Payment Rates

    Across commercial payers the observed rate range spans from about $370 (BCBS minimum) up to $59K (Anthem maximum), with mean payer averages clustering between roughly $15K and $28K. The widest spread is between BCBS’s minimum reported value and Anthem’s maximum (~$59K), reflecting considerable variability across payers. See the table and chart below for payer-level percentiles and distributions.

    The CMS 2023 data reflect national Medicare fee-for-service inpatient payments as published in the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($17.6k), average submitted covered charges ($76.8k), average Medicare payment amount ($14.2k), and total discharges (1.8k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $18K$77K$14K1.8K

    Patient Population

    This DRG’s population is mixed but skews toward Medicare-age patients given the presence of substantial Medicare inpatient utilization and the average Medicare payments reported. Commercial and private payers represent a meaningful portion of cases as well, indicating a mix of working-age and older adults. Overall the distribution leans older rather than exclusively working-age.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska payer means for DRG 915 span from $25K (Blue Cross Blue Shield and Anthem) up to $42K (Cigna), reflecting a substantial within-state spread. Cigna’s mean at $42K is the most notable deviation relative to typical national benchmarks, sitting well above other local payers. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $42K); Lowest payer: Blue Cross Blue Shield/Anthem (mean $25K).
    • Alaska’s payer means range ($25K–$42K) skews higher than some national averages, with Cigna notably above the national Cigna mean context, indicating a meaningful upward deviation for that payer.

    Clinical Trials

    • Acute emergency intervention trials evaluating rapid treatments for severe, life-threatening allergic reactions (anaphylaxis, angioedema) in hospitalized patients: these studies focus on protocols for immediate airway management, dosing and timing of emergency medications, and escalation-of-care algorithms in the ED and inpatient setting. The patient population includes adults and children admitted with an acute allergic reaction accompanied by major complication(s) (e.g., respiratory failure, shock) requiring critical care interventions. Results inform hospital protocols, resource utilization, and short-term outcomes that are directly relevant to providers managing high-acuity cases and payers concerned with cost, length of stay, and avoidance of intensive care utilization.
    • Comparative effectiveness trials of inpatient management strategies for complex allergic reactions with major complications: these trials compare treatment pathways (for example, different corticosteroid regimens, adjunctive immunomodulatory approaches, or observation versus early escalation to intensive monitoring) in patients who have survived the initial emergency phase but remain at high risk for progression or biphasic reactions. The studied population consists of hospitalized patients with severe allergic reactions and comorbidities that complicate management (e.g., chronic respiratory disease, cardiovascular disease, or immunosuppression). Evidence from these studies guides clinicians on best practices to reduce readmissions, minimize complications, and optimize inpatient resource use, which matters to payers tracking post-discharge outcomes and cost-effectiveness.
    • Post-discharge outcomes and health services research examining long-term sequelae, recurrence risk, and systems-level care pathways after a hospitalization for an allergic reaction with major complication: these observational cohort studies and pragmatic trials assess rates of recurrence, adherence to follow-up allergy/immunology care, effectiveness of discharge planning (education, prescriptions like epinephrine autoinjectors, outpatient referrals), and the impact of care coordination on downstream utilization. The population includes survivors of severe inpatient allergic reactions across age groups, with attention to social determinants of health and access to outpatient specialty care. Findings are critical for designing care transitions that lower readmission and ED revisit rates, inform coverage decisions for preventive interventions, and help payers and health systems allocate post-acute resources effectively.

    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

    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

    Showing 1–10 of 19

    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 915
    Mean Rates by Payer — Alaska — DRG 915