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    v1.0.28
    OpenPayerBilling CodesPre-MDCDRG 007-lung-transplant
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    Lung Transplant: Inpatient Reimbursement Overview

    DRG 007 encompasses inpatient lung transplant procedures and the intensive perioperative and postoperative care required for pulmonary allograft recipients. This Diagnosis-Related Group is important for inpatient reimbursement because it bundles high-cost surgical, critical care, and immunologic management into a single payment category under Medicare.

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    DRG 007 Overview

    DRG 007 covers inpatient admissions for lung transplant procedures, including single and bilateral pulmonary allograft transplants and associated perioperative care. This Diagnosis-Related Group captures the high resource intensity of thoracic surgery, immunosuppression initiation, and complex postoperative management including infection surveillance and respiratory support. It matters for Medicare payment because it groups these extensive services into a single prospectively paid payment category that reflects expected resource use for transplant episodes. Accurate coding and capture of complications or comorbidities influence relative payment within the inpatient prospective payment system.

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    Clinical Trials

    • Trials of perioperative immunosuppression strategies aimed at reducing early acute rejection and infection: these studies compare different induction and maintenance immunosuppressive regimens, timing, or dosing in adult and pediatric patients undergoing single- or double-lung transplantation to determine impacts on biopsy-proven acute rejection, infection rates, and short-term graft function. They focus on the immediate post-transplant inpatient period and early months after discharge, addressing a high-cost, high-risk interval for readmission and complications; results inform inpatient management protocols, length of stay, and payer risk stratification.
    • Comparative effectiveness studies of surgical approaches and airway management techniques for lung transplant recipients with pulmonary hypertension or advanced interstitial lung disease: these trials examine variations such as single versus bilateral lung transplant in specific disease subgroups, use of intraoperative extracorporeal life support versus conventional cardiopulmonary bypass, and strategies for bronchial anastomosis to reduce airway complications. By targeting distinct pre-transplant diagnoses and intraoperative choices, this research evaluates outcomes like perioperative mortality, ventilator days, ICU length of stay, and complication rates that directly affect resource utilization and reimbursement under DRG 007.
    • Longitudinal post-discharge outcomes and health services research studying graft survival, chronic lung allograft dysfunction (CLAD), rehospitalization patterns, and cost-effectiveness of surveillance protocols: these observational cohort studies and pragmatic trials follow lung transplant recipients for months to years to identify predictors of chronic rejection, optimal frequency of surveillance bronchoscopy/imaging, and interventions to reduce readmissions. This area is crucial for providers and payers because it informs long-term care pathways, monitoring intensity, and bundled payment considerations tied to medium- and long-term outcomes after the index hospitalization coded to DRG 007.

    Related Codes

    001-HEART-TRANSPLANT-OR-IMPLANT-OF-HEART-ASSIST-SYSTEM-WITH-MCC

    Heart Transplant or Implant of Heart Assist System with MCC: Inpatient Reimbursement Overview

    002-HEART-TRANSPLANT-OR-IMPLANT-OF-HEART-ASSIST-SYSTEM-WITHOUT-MCC

    Heart Transplant or Implant of Heart Assist System without MCC: Inpatient Reimbursement Overview

    003-ECMO-OR-TRACHEOSTOMY-WITH-MV-96-HOURS-OR-PRINCIPAL-DIAGNOSIS-EXCEPT-FACE-MOUTH-AND-NECK-WITH-MAJOR-O-R-PROCEDURES

    ECMO or Tracheostomy with MV >96 Hours: Inpatient Reimbursement Overview

    004-TRACHEOSTOMY-WITH-MV-96-HOURS-OR-PRINCIPAL-DIAGNOSIS-EXCEPT-FACE-MOUTH-AND-NECK-WITHOUT-MAJOR-O-R-PROCEDURES

    Tracheostomy with Mechanical Ventilation >96 Hours: Inpatient Reimbursement Overview

    005-LIVER-TRANSPLANT-WITH-MCC-OR-INTESTINAL-TRANSPLANT

    Liver Transplant with MCC or Intestinal Transplant: Inpatient Reimbursement Overview

    006-LIVER-TRANSPLANT-WITHOUT-MCC

    Liver Transplant without Major Complication or Comorbidity: Inpatient Reimbursement Overview

    008-SIMULTANEOUS-PANCREAS-AND-KIDNEY-TRANSPLANT

    Simultaneous Pancreas and Kidney Transplant: Inpatient Reimbursement Overview

    010-PANCREAS-TRANSPLANT

    Pancreas Transplant: Inpatient Reimbursement Overview

    011-TRACHEOSTOMY-FOR-FACE-MOUTH-AND-NECK-DIAGNOSES-OR-LARYNGECTOMY-WITH-MCC

    Tracheostomy/Laryngectomy with MCC: Inpatient Reimbursement Overview

    012-TRACHEOSTOMY-FOR-FACE-MOUTH-AND-NECK-DIAGNOSES-OR-LARYNGECTOMY-WITH-CC

    Tracheostomy and Laryngectomy with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 16

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    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.