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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 090-concussion-without-cc-mcc
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    Concussion without CC/MCC: Inpatient Reimbursement Overview

    DRG 090 addresses inpatient admissions for concussion without a Complication or Comorbidity or Major Complication or Comorbidity, encompassing observation and basic neurologic management. Proper classification into this Diagnosis-Related Group is important because it determines the bundled Medicare payment rate for an uncomplicated concussion hospitalization.

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    DRG 090 Overview

    DRG 090 covers patients admitted with a concussion without a Complication or Comorbidity and without a Major Complication or Comorbidity. This Diagnosis-Related Group captures acute head injury presentations that typically require short inpatient stays for observation, neurologic evaluation, and symptomatic management. It matters for Medicare payment because the DRG assignment drives the bundled hospital payment for the episode of care, reflecting expected resource use for uncomplicated concussions. Accurate clinical documentation and coding determine grouping into DRG 090 and thus the applicable reimbursement pathway.

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    Clinical Trials

    • Acute ED and observation management trials: randomized or pragmatic studies evaluating short-term monitoring protocols, criteria for safe discharge from the emergency department or observation status, and use of clinical decision rules (symptom checklists, serial neurologic exams, and targeted imaging strategies) for adults and children with isolated concussion and no complicating comorbidities. These studies enroll patients presenting within hours of head trauma to determine which observation durations and testing algorithms safely reduce unnecessary hospital stays while identifying the rare patient who needs escalation of care; results inform inpatient admission thresholds and resource utilization decisions for payers.
    • Comparative effectiveness studies of post-concussion early interventions: nonblinded comparative cohorts or randomized trials testing early office- or telehealth-based interventions (structured education, graded activity plans, vestibular/oculomotor rehabilitation, and standardized return-to-activity protocols) versus usual care in patients discharged after concussion without complications. These trials focus on predictors of prolonged symptoms and functional recovery in adolescents and young adults, helping providers optimize follow-up care pathways and helping payers understand which outpatient services reduce readmissions, extended utilization, or prolonged disability claims.
    • Longitudinal outcomes and health services research on recovery trajectories and utilization: prospective observational studies and registry-based analyses tracking symptom resolution, neurocognitive outcomes, quality of life, and downstream healthcare use (repeat ED visits, specialty referrals, imaging, and rehabilitation services) over weeks to a year after isolated concussion. Research in this area identifies subgroups at risk for persistent post-concussive symptoms, measures economic impact and return-to-work/school timelines, and generates evidence for care coordination and coverage policies that aim to reduce variability in care and unnecessary downstream costs.

    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

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    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.