Rehabilitation with CC/MCC DRG Reimbursement & Medicare

Summary & Overview

Rehabilitation with CC/MCC: Inpatient Reimbursement Overview

DRG 945 covers inpatient rehabilitation cases with Major Complication or Comorbidity or Complication or Comorbidity for patients needing intensive multidisciplinary therapy; it encompasses conditions such as post-stroke, complex neurologic recovery, and significant orthopedic rehabilitation complicated by medical issues. This Diagnosis-Related Group matters for inpatient reimbursement because the presence and documentation of Major Complication or Comorbidity or Complication or Comorbidity drive higher case-mix weighting and affect Medicare payment.

Rehabilitation with CC/MCCDRG Rehabilitation with CC/MCCDRG 945Diagnosis-Related GroupInpatient ReimbursementMedicarePhysical Medicine and RehabilitationStroke RehabilitationNeurologic RecoveryOrthopedic Rehabilitation

DRG 945 Overview

DRG 945 (Rehabilitation with Major Complication or Comorbidity/Complication or Comorbidity) captures inpatient stays where the primary focus is intensive rehabilitation for patients who also have significant medical complications or comorbidities. Typical cases include patients requiring multidisciplinary therapy after stroke, severe musculoskeletal injury, or neurologic events with concurrent medical instability. This Diagnosis-Related Group influences Medicare payment because case mix and documented complication or comorbidity levels affect reimbursement relative to standard rehabilitation DRGs. Accurate clinical documentation of the rehabilitation need and the presence of Major Complication or Comorbidity or Complication or Comorbidity is central to payment assignment.

National Payment Rates

Across commercial payers the reported rate range for DRG 945 spans roughly $2.6K up to $43K based on the payer-specific distributions shown in the table and chart below, with individual payer medians varying substantially. The widest spread is observed at Blue Cross Blue Shield, where values extend from the low thousands to as high as $43K, indicating substantial variability across claims. Refer to the table and chart below for payer-level quartiles and extremes.

Mean Rates by Payer — National — DRG 945

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska, DRG 945 shows payer means ranging from $24K to $37K across the state payers, with Blue Cross Blue Shield and Anthem at the low end and Cigna at the high end. Cigna’s mean of $37K represents the most notable deviation above the other state payers and is materially higher than several national payer medians used for context. See the table and chart below for detailed distributions by payer.

Key Insights for Alaska

Highest payer: Cigna (payer_code CIGNA) with a mean of $37K; Lowest payers: Blue Cross Blue Shield and Anthem (payer_codes BCBS and ANTHEM) both at $24K.
Alaska’s payer range spans from $24K to $37K, with Cigna notably above the other state payers and higher than the national mean context for Cigna-related benchmarks.

Clinical Trials

Rehabilitation intervention trials comparing multidisciplinary inpatient therapy intensities and modalities: randomized or pragmatic comparative studies test different combinations or doses of physical, occupational, and speech therapy for patients admitted primarily for inpatient rehabilitation with complicating comorbidities or complications (CC/MCC), such as post-stroke with cardiac disease or post-orthopedic surgery with infection. These studies focus on short-term functional gains, length of stay, and discharge disposition among medically complex rehab patients to determine optimal therapy plans. Results inform providers on tailoring intensity to clinical complexity and help payers evaluate value relative to cost and LOS for this high-resource DRG.
Transitional care and readmission-reduction studies targeting post-discharge outcomes: cohort studies and randomized studies of discharge planning, early home-based therapy, tele-rehabilitation follow-up, or enhanced case management for patients leaving inpatient rehabilitation who have CC/MCC (for example, people with multisystem disease, cognitive impairment, or high fall risk). The objective is to reduce 30‑ and 90‑day readmissions, emergency visits, and functional decline by addressing medication reconciliation, caregiver training, and continuity of therapy. This research is relevant to hospitals and payers because reductions in readmissions and improved community function can lower downstream costs and improve reimbursement metrics tied to post-acute outcomes.
Comparative effectiveness and prognostic research on patient selection and risk stratification for inpatient rehab versus alternative settings: observational studies and predictive-model development use administrative data and clinical measures to identify which medically complex patients (e.g., advanced cardiac or pulmonary disease, multiple pressure injuries, or concurrent infection) benefit most from inpatient rehabilitation rather than skilled nursing or home-based rehab. These studies examine functional trajectories, complications, and cost-effectiveness across care settings to guide appropriate site-of-care decisions. Findings help clinicians and utilization managers optimize placement, justify resource allocation for the DRG, and align payer authorization policies with expected outcomes.

Related Codes

949-AFTERCARE-WITH-CC-MCC

Aftercare with CC/MCC: Inpatient Reimbursement Overview

939-O-R-PROCEDURES-WITH-DIAGNOSES-OF-OTHER-CONTACT-WITH-HEALTH-SERVICES-WITH-MCC

O.R. Procedures with Diagnoses of Other Contact with Health Services with MCC: Inpatient Reimbursement Overview

941-O-R-PROCEDURES-WITH-DIAGNOSES-OF-OTHER-CONTACT-WITH-HEALTH-SERVICES-WITHOUT-CC-MCC

O.R. Procedures with Diagnoses of Other Contact with Health Services without CC/MCC: Inpatient Reimbursement Overview

946-REHABILITATION-WITHOUT-CC-MCC

Rehabilitation without CC/MCC: Inpatient Reimbursement Overview

951-OTHER-FACTORS-INFLUENCING-HEALTH-STATUS

Other Factors Influencing Health Status: Inpatient Reimbursement Overview

940-O-R-PROCEDURES-WITH-DIAGNOSES-OF-OTHER-CONTACT-WITH-HEALTH-SERVICES-WITH-CC

O.R. Procedures with Diagnoses of Other Contact with Health Services with CC: Inpatient Reimbursement Overview

947-SIGNS-AND-SYMPTOMS-WITH-MCC

Signs and Symptoms with Major Complication or Comorbidity: Inpatient Reimbursement Overview

948-SIGNS-AND-SYMPTOMS-WITHOUT-MCC

Signs and Symptoms without MCC: Inpatient Reimbursement Overview

950-AFTERCARE-WITHOUT-CC-MCC

Aftercare without CC/MCC: Inpatient Reimbursement Overview

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.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$16K	$53K	$14K	2.2K

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 945

Key Insights for Alaska

Highest payer: Cigna (payer_code CIGNA) with a mean of $37K; Lowest payers: Blue Cross Blue Shield and Anthem (payer_codes BCBS and ANTHEM) both at $24K.
Alaska’s payer range spans from $24K to $37K, with Cigna notably above the other state payers and higher than the national mean context for Cigna-related benchmarks.

Clinical Trials

Rehabilitation intervention trials comparing multidisciplinary inpatient therapy intensities and modalities: randomized or pragmatic comparative studies test different combinations or doses of physical, occupational, and speech therapy for patients admitted primarily for inpatient rehabilitation with complicating comorbidities or complications (CC/MCC), such as post-stroke with cardiac disease or post-orthopedic surgery with infection. These studies focus on short-term functional gains, length of stay, and discharge disposition among medically complex rehab patients to determine optimal therapy plans. Results inform providers on tailoring intensity to clinical complexity and help payers evaluate value relative to cost and LOS for this high-resource DRG.
Transitional care and readmission-reduction studies targeting post-discharge outcomes: cohort studies and randomized studies of discharge planning, early home-based therapy, tele-rehabilitation follow-up, or enhanced case management for patients leaving inpatient rehabilitation who have CC/MCC (for example, people with multisystem disease, cognitive impairment, or high fall risk). The objective is to reduce 30‑ and 90‑day readmissions, emergency visits, and functional decline by addressing medication reconciliation, caregiver training, and continuity of therapy. This research is relevant to hospitals and payers because reductions in readmissions and improved community function can lower downstream costs and improve reimbursement metrics tied to post-acute outcomes.
Comparative effectiveness and prognostic research on patient selection and risk stratification for inpatient rehab versus alternative settings: observational studies and predictive-model development use administrative data and clinical measures to identify which medically complex patients (e.g., advanced cardiac or pulmonary disease, multiple pressure injuries, or concurrent infection) benefit most from inpatient rehabilitation rather than skilled nursing or home-based rehab. These studies examine functional trajectories, complications, and cost-effectiveness across care settings to guide appropriate site-of-care decisions. Findings help clinicians and utilization managers optimize placement, justify resource allocation for the DRG, and align payer authorization policies with expected outcomes.