Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 052-spinal-disorders-and-injuries-with-cc-mcc
    Ask Trek AI about this page

    Spinal Disorders and Injuries with CC/MCC: Inpatient Reimbursement Overview

    DRG 052 covers inpatient care for spinal disorders and injuries with a Complication or Comorbidity or Major Complication or Comorbidity, including trauma, spinal cord compromise, and complex postoperative courses. It matters for inpatient reimbursement because the presence of these additional diagnoses increases expected resource use and therefore affects Medicare payment under the inpatient prospective payment system.

    Customize your policy alerts

    Sign up for drg 052 policy alerts

    Get alerted when payer policies referencing 052 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 052 Overview

    DRG 052 encompasses inpatient admissions for spinal disorders and injuries where patients present with either a Complication or Comorbidity or a Major Complication or Comorbidity, reflecting more resource-intensive care than cases without these conditions. Typical clinical scenarios include traumatic spinal fractures, spinal cord compression, severe degenerative disease with neurological compromise, and postoperative complications requiring extended hospital management. This Diagnosis-Related Group is important for Medicare payment because the presence of Complication or Comorbidity or Major Complication or Comorbidity elevates relative resource use and influences reimbursement under the inpatient prospective payment system. Accurate coding of diagnoses and procedures within this Diagnosis-Related Group affects case mix and payment determination.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical Trials

    • Acute surgical intervention trials: randomized or prospective cohort studies comparing different operative approaches (eg, decompression alone versus decompression with fusion, or minimally invasive posterior approaches versus open surgery) in patients with traumatic spinal injuries or emergent degenerative pathology presenting with neurologic compromise. These studies focus on the immediate perioperative period, measuring outcomes such as neurologic recovery, complication rates, intraoperative blood loss, length of stay, and readmission within 30 days, addressing the high-acuity management decisions faced by inpatient teams. Results inform surgical decision-making, help define appropriate resource use, and guide reimbursement and utilization strategies for high-cost inpatient episodes in this DRG.
    • Comparative effectiveness and risk-stratification studies in medically complex patients: observational cohort studies and pragmatic trials that evaluate nonoperative versus operative management, timing of intervention, or staging of procedures in patients with significant comorbidities (eg, elderly patients with multi-level degenerative disease, osteoporosis, or polytrauma). These studies often develop and validate prediction models for complications, prolonged mechanical ventilation, or discharge disposition, and examine cost-effectiveness and hospital resource utilization across subgroups. Findings are directly relevant to providers for tailoring treatment plans and to payers for understanding expected outcomes, risk-adjusted reimbursement, and care pathway optimization for DRG 052 populations.
    • Post-discharge outcomes and rehabilitation trials: prospective studies and randomized trials testing inpatient-to-outpatient transitional care protocols, early versus delayed rehabilitation intensity, or specific structured physical therapy and pain-management programs for patients discharged after treatment for spinal disorders and injuries. These studies evaluate functional recovery, return-to-ambulation, chronic pain trajectories, long-term readmissions, and quality-of-life up to 12 months, helping identify interventions that reduce downstream utilization and readmissions. For hospitals and payers, this research highlights interventions that may shorten total episode costs, improve post-discharge outcomes, and inform bundled-payment or value-based care strategies for this DRG.

    Related Codes

    020-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with MCC: Inpatient Reimbursement Overview

    021-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-CC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with CC: Inpatient Reimbursement Overview

    022-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITHOUT-CC-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage without CC/MCC: Inpatient Reimbursement Overview

    023-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITH-MCC-OR-ANTINEOPLASTIC-IMPLANT-OR-EPILEPSY-WITH-NEUROSTIMULATOR

    Craniotomy with Major Device Implant or Complex CNS DRG 023: Inpatient Reimbursement Overview

    024-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITHOUT-MCC

    Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis without MCC: Inpatient Reimbursement Overview

    025-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-MCC

    Craniotomy and Endovascular Intracranial Procedures with MCC: Inpatient Reimbursement Overview

    026-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-CC

    Craniotomy and Endovascular Intracranial Procedures with CC: Inpatient Reimbursement Overview

    027-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITHOUT-CC-MCC

    Craniotomy and Endovascular Intracranial Procedures without CC/MCC: Inpatient Reimbursement Overview

    028-SPINAL-PROCEDURES-WITH-MCC

    Spinal Procedures with MCC: Inpatient Reimbursement Overview

    029-SPINAL-PROCEDURES-WITH-CC-OR-SPINAL-NEUROSTIMULATORS

    Spinal Procedures with CC or Spinal Neurostimulators: Inpatient Reimbursement Overview

    Showing 1–10 of 71

    • More pages

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.