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 054-nervous-system-neoplasms-with-mcc
    Ask Trek AI about this page

    Nervous System Neoplasms with MCC: Inpatient Reimbursement Overview

    DRG 054 encompasses inpatient admissions for nervous system neoplasms with a Major Complication or Comorbidity, reflecting high clinical complexity. This Diagnosis-Related Group matters for inpatient reimbursement because its higher resource intensity and payment weight affect Medicare payment to hospitals.

    Customize your policy alerts

    Sign up for drg 054 policy alerts

    Get alerted when payer policies referencing 054 are released or updated.

    Monitor payer policy activity

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

    DRG 054 Overview

    DRG 054 covers inpatient admissions for nervous system neoplasms with a Major Complication or Comorbidity present, typically including malignant and selected benign brain and spinal tumors with significant comorbid conditions. This Diagnosis-Related Group groups cases with higher clinical complexity and resource use, which affects Medicare payment weight and hospital reimbursement. Cases in this category often involve neurosurgical procedures, intensive monitoring, and extended inpatient care. Accurate coding of diagnoses and complications is critical to assign the appropriate Diagnosis-Related Group for Medicare payment purposes.

    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

    • Trials of perioperative and intraoperative interventions to reduce neurological morbidity and improve resection outcomes: randomized or controlled studies evaluating strategies such as advanced neuro-monitoring protocols, optimized anesthesia techniques, intraoperative imaging adjuncts, or enhanced surgical workflows in patients undergoing craniotomy or spinal surgery for malignant or benign nervous system tumors with major complications/comorbidities. These studies enroll high-acuity inpatients (often elderly or medically complex) who are at increased risk for neurologic decline, infection, or bleeding, and they measure short-term functional status, complication rates, and length of stay — outcomes that directly affect hospital resource use and reimbursement under this DRG. For providers and payers, evidence that specific perioperative practices reduce complications or shorten ICU/hospital days supports care pathways that can improve quality metrics and control costs for this high-cost patient group.
    • Comparative effectiveness studies of adjunctive medical or supportive therapies during acute inpatient management: observational cohort studies or pragmatic randomized trials comparing approaches such as different corticosteroid regimens, seizure prophylaxis strategies, anticoagulation management, or infection prevention bundles in patients hospitalized with nervous system neoplasms complicated by edema, seizures, thromboembolism, or infection. These trials focus on medically complex inpatients, including those with comorbid organ dysfunction or immunosuppression, to determine which inpatient medical management strategies reduce major complications, readmissions, and in-hospital mortality. Results inform clinical guidelines and payer decisions about acceptable practice patterns and may identify cost-saving care protocols without compromising outcomes in this DRG population.
    • Post-discharge outcomes and rehabilitation effectiveness research: longitudinal studies and randomized or pragmatic trials assessing inpatient-to-outpatient transitions, timing and intensity of inpatient rehabilitation, or early supportive care interventions for patients discharged after treatment for nervous system neoplasms with major complications. These studies evaluate functional recovery, readmission risk, use of home health or skilled nursing, and long-term neurologic outcomes among survivors who often have new or worsened disability, and they identify predictors of resource use and post-acute care needs. Payers and hospitals use this evidence to design discharge planning, bundle payments, and care coordination programs that reduce costly readmissions and align reimbursement with improved functional outcomes 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.