Summary & Overview
Intracranial Hemorrhage or Cerebral Infarction with CC or TPA in 24 Hours: Inpatient Reimbursement Overview
DRG 065 includes intracranial hemorrhage or cerebral infarction cases with a Complication or Comorbidity (CC) or when tPA is given within 24 hours, encompassing acute stroke presentations that often require advanced imaging and urgent management. Proper classification into this Diagnosis-Related Group is important for inpatient reimbursement under Medicare because it determines weighting and payment level within the prospective payment system.
DRG 065 Overview
DRG 065 covers hospital admissions for intracranial hemorrhage or cerebral infarction when a Complication or Comorbidity (CC) is present or when tissue plasminogen activator (tPA) is administered within 24 hours. This Diagnosis-Related Group reflects acute cerebrovascular events requiring inpatient care, often involving neurologic assessment, imaging, and potential thrombolytic therapy. It matters for Medicare payment because classification here influences relative weight and reimbursement within the inpatient prospective payment system. Accurate coding of stroke type, tPA administration timing, and CCs affects case assignment and payment.
National Payment Rates
National Benchmarks
State Payment Rates
State: Alaska1 / 49
Alaska Benchmarks
Payer mean payments for DRG 065 range from Medicare's average contribution of $11K up to Cigna's mean of $25K, with commercial means clustering around $16K–$25K. Anthem and Blue Cross Blue Shield both show mean payments near $16K, while Cigna stands out as the highest commercial payer. The commercial average is $19K, illustrating a substantial gap between Medicare and top commercial reimbursement.
Medicare Distribution
| Average Submitted Charges | Average Medicare Contribution | Average Total Final Payment | Discharges |
|---|---|---|---|
| $82K | $11K | $15K | 220 |
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 commercial payer with a mean of $25K, while Medicare has the lowest average Medicare contribution at $11K, indicating a notable gap between commercial and public reimbursement.
- Commercial payer means range from $16K (Anthem, BCBS) to $25K (Cigna), with the commercial average at $19K, producing a payer spread of about $9K between the highest and lowest commercial means.
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.