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 138-mouth-procedures-without-cc-mcc
    Ask Trek AI about this page

    Mouth Procedures without CC/MCC: Inpatient Reimbursement Overview

    DRG 138 encompasses inpatient admissions for mouth procedures without a Complication or Comorbidity or Major Complication or Comorbidity; it captures straightforward oral surgical cases. This Diagnosis-Related Group matters for inpatient reimbursement because it defines the prospective payment classification for lower-complexity oral surgical hospitalizations under Medicare.

    Customize your policy alerts

    Sign up for drg 138 policy alerts

    Get alerted when payer policies referencing 138 are released or updated.

    Monitor payer policy activity

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

    DRG 138 Overview

    DRG 138 covers inpatient stays for patients undergoing mouth procedures without a Complication or Comorbidity or Major Complication or Comorbidity. It includes operations limited to oral cavity procedures that do not generate additional clinical complexity. This Diagnosis-Related Group matters for Medicare payment because it groups relatively uncomplicated oral surgical hospitalizations into a single prospective payment category, which affects reimbursement relative to resource use and length of stay. Accurate coding and documentation determine assignment to this Diagnosis-Related Group and subsequent payment.

    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

    • Trials comparing surgical techniques and perioperative protocols for elective mouth procedures (e.g., partial excisions, minor reconstructive mucosal work) in patients without significant comorbidities. These studies enroll predominantly adult inpatients scheduled for one-day to short-stay oral surgeries and evaluate outcomes such as operative time, intraoperative blood loss, immediate complication rates, and length of stay; they often include standardized anesthesia and post-op pain management arms. Findings are relevant to providers optimizing operative workflows and to payers because technique or protocol choices that reduce resource use and shorten LOS can lower episode costs while maintaining quality.
    • Comparative effectiveness studies examining different infection prevention and wound-healing strategies after intraoral procedures in generally healthy patients. These trials focus on prophylactic antibiotic strategies, local hemostatic agents, and topical adjuncts to promote mucosal healing, enrolling patients undergoing tooth-sparing resections or other mouth procedures without major systemic disease; endpoints include surgical-site infection, readmission, return to OR, and need for outpatient follow-up care. Results inform clinicians on best practices to minimize post-discharge complications and support payers in coverage decisions that reduce avoidable readmissions and downstream costs.
    • Post-discharge outcomes and patient-reported outcome studies assessing functional recovery, dysphagia, speech, and oral pain in the early postoperative period for patients discharged after mouth procedures without CC/MCC. These observational cohorts or pragmatic trials track time to return to baseline diet, analgesic use, unplanned clinic or ED visits, and patient satisfaction over 30 days, often stratifying by age and social support factors. Data help providers tailor discharge planning and outpatient resources, and help payers identify drivers of short-term utilization and opportunities for targeted case management to prevent costly readmissions or additional outpatient services.

    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

    137-MOUTH-PROCEDURES-WITH-CC-MCC

    Mouth Procedures with 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.