Summary & Overview
Chronic Obstructive Pulmonary Disease without CC/MCC: Inpatient Reimbursement Overview
Diagnosis-Related Group 192 covers inpatient admissions for Chronic Obstructive Pulmonary Disease without CC/MCC, focusing on COPD cases that lack major or secondary complications. Proper classification matters because the DRG determines the bundled Medicare payment for the hospital stay and influences hospital revenue and resource allocation.
DRG 192 Overview
Diagnosis-Related Group 192 covers hospital inpatient stays for patients primarily treated for chronic obstructive pulmonary disease (COPD) without a Major Complication or Comorbidity (MCC) or a Complication or Comorbidity (CC). This DRG reflects cases that require inpatient medical management for COPD exacerbations or related respiratory issues but do not carry the added complexity of significant comorbid conditions. It matters for Medicare payment because the DRG assignment determines the base prospective payment amount for the hospitalization under Medicare reimbursement rules. Accurate clinical documentation and coding are essential to ensure the stay is categorized correctly for payment purposes.
National Payment Rates
Mean payer rates range from $4,527.09 for Medicare up to $11,917.59 across commercial benchmarks, with a widest spread driven by variation between Medicare and the highest commercial means shown in the table and chart below. Commercial payers such as Aetna, Cigna, and Anthem cluster near the $10,500–$11,000 range while Blue Cross Blue Shield and BUCA report lower means. The table and bar chart below summarize the payer distribution.
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.