Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • 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.

    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Ear, Nose, Mouth and ThroatDRG 137-mouth-procedures-with-cc-mcc
    Ask Trek AI about this page

    Mouth Procedures with CC/MCC: Inpatient Reimbursement Overview

    DRG 137 includes inpatient admissions for mouth procedures where patients have Complication or Comorbidity or Major Complication or Comorbidity that increase clinical complexity. It matters for inpatient reimbursement because the Diagnosis-Related Group assignment with Complication or Comorbidity or Major Complication or Comorbidity status determines higher Medicare payment weights to reflect increased resource use.

    Customize your policy alerts

    Sign up for drg 137 policy alerts

    Get alerted when payer policies referencing 137 are released or updated.

    Monitor payer policy activity

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

    DRG 137 Overview

    DRG 137 covers inpatient admissions for mouth procedures performed when a qualifying Complication or Comorbidity or Major Complication or Comorbidity is present, such as extensive oral surgery with significant comorbid conditions. It groups cases with higher resource use than uncomplicated mouth procedures and therefore yields higher Medicare payment relative to less complex mouth procedure groups. This classification affects reimbursement because the presence of Complication or Comorbidity or Major Complication or Comorbidity elevates the payment weight used in inpatient prospective payment. DRG 137 is used to align payment with expected hospital resource consumption for these more complex oral surgical admissions.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • 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 perioperative infection prevention trials: randomized or pragmatic studies testing timing, dosing, or delivery methods of perioperative antibiotics, antiseptic mouthwashes, and intraoperative antisepsis protocols in adult and elderly patients undergoing complex oral and maxillofacial procedures with comorbidities (eg, diabetes, COPD, immunosuppression). These trials focus on immediate perioperative outcomes such as surgical site infection, reoperation, and length of stay, which directly affect inpatient resource use and reimbursement under this DRG. Evidence from these studies helps providers optimize protocols to reduce complications and helps payers anticipate costs and justify bundled-care or payment-policy decisions.
    • Comparative effectiveness studies of surgical techniques and care pathways: prospective cohort studies or randomized trials comparing different operative approaches (for example, tooth extraction with alveoloplasty versus conservative debridement, or open versus closed reduction when applicable), anesthesia strategies, or standardized enhanced recovery pathways in medically complex patients undergoing mouth procedures with complicating conditions (CC/MCC). These studies assess outcomes including postoperative complications, transfusion or ICU needs, readmissions, and functional recovery, informing which approaches yield better clinical results and lower total inpatient and post-acute costs. Payers and hospital case managers use this evidence to guide pathway implementation, utilization management, and DRG-based cost containment.
    • Post-discharge outcomes and care coordination research: observational studies and intervention trials evaluating discharge planning models, outpatient follow-up protocols, home nursing, and rehabilitation tailored to patients with significant comorbidities after complex oral procedures. Research measures 30- and 90-day readmission rates, emergency visits for bleeding or infection, patient-reported oral function and nutrition, and total cost of care, identifying which post-discharge strategies reduce readmissions and downstream spending. Results are critical for providers and payers aiming to lower readmission penalties, improve patient recovery, and align incentives under bundled payment or value-based arrangements for DRG 137 episodes.

    Related Codes

    135-SINUS-AND-MASTOID-PROCEDURES-WITH-CC-MCC

    Sinus and Mastoid Procedures with CC/MCC: Inpatient Reimbursement Overview

    136-SINUS-AND-MASTOID-PROCEDURES-WITHOUT-CC-MCC

    Sinus and Mastoid Procedures without CC/MCC: Inpatient Reimbursement Overview

    138-MOUTH-PROCEDURES-WITHOUT-CC-MCC

    Mouth Procedures without CC/MCC: Inpatient Reimbursement Overview

    139-SALIVARY-GLAND-PROCEDURES

    Salivary Gland Procedures: Inpatient Reimbursement Overview

    140-MAJOR-HEAD-AND-NECK-PROCEDURES-WITH-MCC

    Major Head and Neck Procedures with MCC: Inpatient Reimbursement Overview

    141-MAJOR-HEAD-AND-NECK-PROCEDURES-WITH-CC

    Major Head and Neck Procedures with CC: Inpatient Reimbursement Overview

    142-MAJOR-HEAD-AND-NECK-PROCEDURES-WITHOUT-CC-MCC

    Major Head and Neck Procedures without CC/MCC: Inpatient Reimbursement Overview

    143-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITH-MCC

    Other Ear, Nose, Mouth and Throat O.R. Procedures with MCC: Inpatient Reimbursement Overview

    144-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITH-CC

    Other Ear, Nose, Mouth and Throat O.R. Procedures with CC: Inpatient Reimbursement Overview

    145-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITHOUT-CC-MCC

    Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 24

    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.