Summary & Overview
Chronic Obstructive Pulmonary Disease with CC: Inpatient Reimbursement Overview
DRG 191 addresses inpatient admissions for chronic obstructive pulmonary disease with a Complication or Comorbidity, capturing patients with greater resource needs than non-CC COPD cases. Proper DRG assignment matters because the CC designation increases the Medicare Severity Diagnosis-Related Group payment weight and influences hospital reimbursement under the inpatient prospective payment system.
DRG 191 Overview
Diagnosis-Related Group 191 covers hospital admissions for acute exacerbations or complications of chronic obstructive pulmonary disease (COPD) when a Complication or Comorbidity (CC) is present. This DRG groups patients who require increased resource use compared with non-CC COPD cases, often involving respiratory support, bronchodilator therapy, and management of comorbid conditions. It matters for Medicare payment because the presence of a CC elevates the relative weight and prospective payment compared with lower-severity COPD DRGs. Accurate clinical documentation and coding determine assignment to 191 and thus affect inpatient reimbursement.
National Payment Rates
Across payers the mean payment range spans from $6,235.69 for Medicare to $14,379.01 for Aetna, with commercial payers clustered between roughly $9,231.65 and $14,379.01. The widest spread between payer 25th and 75th percentiles appears for Anthem and Aetna, indicating greater variability in contracted rates. See the table and bar chart below for payer-level means and percentile detail.
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.