MS-DRG 945: Rehabilitation with CC/MCC

Typical indications

• Stroke rehab
• TKA rehab

Common denial patterns

• IRF medical necessity per 60% rule
• 3-hour therapy threshold

Appeal angles

Document 3-hour therapy tolerance, medical complexity requiring physician oversight, IRF vs SNF distinction.

Context: how MS-DRGs work

MS-DRGs bundle hospital inpatient payment into a single amount per admission. Each DRG has a relative weight that multiplies the hospital's base rate to determine payment. 945 has relative weight 1.3534. Major Complication or Comorbidity (MCC) and Complication or Comorbidity (CC) secondary diagnoses can move a case to a higher-paying DRG within the same family.