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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 097-non-bacterial-infection-of-nervous-system-except-viral-meningitis-with-mcc
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    Non-Bacterial Infection of Nervous System Except Viral Meningitis with MCC: Inpatient Reimbursement Overview

    DRG 097 encompasses non-bacterial infections of the nervous system except viral meningitis when a Major Complication or Comorbidity is present; it addresses high-acuity neuroinfectious conditions requiring intensive inpatient resources. Proper classification influences Medicare inpatient reimbursement because the Major Complication or Comorbidity status increases the payment weight to account for greater clinical complexity and resource consumption.

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    DRG 097 Overview

    DRG 097 covers non-bacterial infections of the nervous system excluding viral meningitis when a Major Complication or Comorbidity is present, such as severe encephalitis, myelitis, or other acute neuroinflammatory conditions with significant organ dysfunction. This Diagnosis-Related Group captures high-acuity infectious neurologic admissions that drive longer lengths of stay and higher resource use. It matters for Medicare payment because the presence of a Major Complication or Comorbidity elevates reimbursement to reflect increased intensity of care and ancillary services. Accurate clinical coding and documentation determine assignment to this Diagnosis-Related Group and associated inpatient payment.

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    Clinical Trials

    • Trials evaluating rapid diagnostic and immunomodulatory strategies for acute non-bacterial central nervous system infections with major complications: studies in this category focus on early diagnostic algorithms (advanced CSF biomarker panels, multiplex PCR, and neuroimaging protocols) combined with timing and dosing of broad immunomodulatory interventions (for example, corticosteroids or other anti-inflammatory regimens) during the initial hospitalization. The patient population includes adults and older adults admitted with encephalitis, spinal infections, or other non-bacterial CNS infections who develop major complications such as seizures, altered consciousness, or respiratory failure. This research is relevant to providers and payers because faster, accurate diagnosis and optimized acute treatment can reduce ICU utilization, shorten LOS, and lower costs associated with complications and prolonged supportive care.
    • Comparative effectiveness studies of infectious vs immune-mediated etiologies and care pathways in severe non-bacterial CNS infection: these observational and pragmatic randomized studies compare outcomes across diagnostic-based care pathways (for example, empiric antiviral and supportive care versus protocols that escalate to targeted immunotherapies when autoimmune or parainfectious causes are suspected). They enroll heterogeneous inpatients with non-bacterial CNS infections who have major complications, stratifying by age, comorbidity, and severity, to determine which diagnostic-to-treatment sequences yield better neurologic recovery and lower resource use. Findings inform clinicians and payers about which care pathways provide the best balance of clinical benefit and cost-effectiveness for high-acuity patients coded to this DRG.
    • Post-discharge rehabilitation, readmission prevention, and long-term outcome studies for survivors with major neurologic sequelae: prospective cohort and interventional trials in this area test structured inpatient-to-outpatient transition programs, early multidisciplinary rehabilitation regimens, and remote-monitoring strategies aimed at reducing 30- and 90-day readmissions and improving functional recovery in patients who required ICU-level care during hospitalization. The target population is survivors of non-bacterial CNS infections with major complications (cognitive impairment, motor deficits, or seizure disorders) who are at high risk for rehospitalization and durable disability. These studies are important to payers and providers because improved transitions and rehabilitation can lower downstream costs, reduce readmissions tied to complications or medication issues, and improve long-term quality metrics tied to 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

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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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