Summary & Overview
Degenerative Nervous System Disorders without MCC: Inpatient Reimbursement Overview
DRG 057 covers inpatient admissions for degenerative nervous system disorders without Major Complication or Comorbidity and represents cases with comparatively lower expected resource intensity. Proper clinical documentation and coding are critical because DRG assignment directly affects Medicare inpatient prospective payment amounts and hospital reimbursement.
DRG 057 Overview
DRG 057, Degenerative Nervous System Disorders without Major Complication or Comorbidity (MCC), includes inpatient stays for degenerative neurological conditions where no MCC is present, such as certain stages of Parkinson disease, multiple sclerosis, and degenerative spinal cord disorders when managed without complex complications. This Diagnosis-Related Group groups cases with similar clinical characteristics and resource use, affecting base Medicare payment rates and prospective payment system classification. Accurate DRG assignment influences reimbursement level and hospital case-mix reporting. Coding of principal diagnosis and comorbid conditions determines whether a stay qualifies for this DRG versus one with Complication or Comorbidity (CC) or MCC designations.
National Payment Rates
National Benchmarks
State Payment Rates
State: Alaska1 / 49
Alaska Benchmarks
In Alaska, payer rates for DRG 057 range from $20K to $31K, with Anthem and Blue Cross Blue Shield at the low end ($20K) and Cigna at the high end ($31K). The Commercial average is $24K while Medicare’s average total final payment is $20K. Overall, Cigna pays notably more than the other major payers in the state.
Medicare Distribution
| Average Submitted Charges | Average Medicare Contribution | Average Total Final Payment | Discharges |
|---|---|---|---|
| $100K | $18K | $20K | 53 |
Average Submitted Charges is the amount hospitals initially bill — the starting request that is almost never paid in full. Average Medicare Contribution is the portion Medicare directly reimburses the provider. Average Total Final Payment is the total amount ultimately paid, combining Medicare's contribution with the beneficiary's cost-sharing and any other third-party payments.
Key Insights for Alaska
- Cigna is the highest-paying payer with a mean of $31K, while Anthem and Blue Cross Blue Shield are the lowest at $20K, producing a meaningful spread of $11K between the highest and lowest mean rates.
- Commercial average sits at $24K, above Medicare’s average total final payment of $20K, indicating commercial plans generally reimburse more than Medicare for DRG
057.
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.