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 Ear, Nose, Mouth and ThroatDRG 146-ear-nose-mouth-and-throat-malignancy-with-mcc
    Ask Trek AI about this page

    Ear, Nose, Mouth and Throat Malignancy with MCC: Inpatient Reimbursement Overview

    DRG 146 groups inpatient encounters for ear, nose, mouth, and throat malignancy with Major Complication or Comorbidity; it captures complex head and neck cancer care with significant resource needs. This grouping matters for inpatient reimbursement because the Major Complication or Comorbidity designation increases expected resource consumption and payment under Medicare.

    Customize your policy alerts

    Sign up for drg 146 policy alerts

    Get alerted when payer policies referencing 146 are released or updated.

    Monitor payer policy activity

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

    DRG 146 Overview

    DRG 146 covers inpatient admissions for malignant neoplasms of the ear, nose, mouth, and throat with Major Complication or Comorbidity present. Typical cases include complex head and neck cancer surgeries, extensive resections, or major complications requiring intensive management. This Diagnosis-Related Group drives higher Medicare reimbursement because the presence of a Major Complication or Comorbidity substantially increases resource use and length of stay. Accurate coding of the primary tumor site, procedures, and accompanying Major Complication or Comorbidity is central to payment assignment.

    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

    • Phase II/III neoadjuvant and adjuvant therapy trials exploring combined modality regimens for advanced head and neck cancers (oral cavity, oropharynx, larynx, hypopharynx, nasal cavity/paranasal sinuses) with major comorbidities: these studies assess the safety, tumor response, and surgical resectability after systemic therapy and/or chemoradiation given before or after surgery in patients who present with locally advanced disease and significant medical complexity. They enroll inpatient surgical candidates who often require perioperative optimization and intensive post‑operative care; findings inform clinicians about operative timing, complication risks, and potential to downstage tumors. For payers and hospital administrators, results guide resource allocation for high‑cost combined treatments, length of stay expectations, and reimbursement planning tied to complication avoidance and readmission reduction.
    • Comparative effectiveness trials evaluating different surgical approaches and perioperative pathways for head and neck malignancies in high‑risk patients: randomized or pragmatic trials compare open resection versus transoral or minimally invasive approaches, or test enhanced recovery after surgery (ERAS) protocols versus standard care in patients with advanced ENT malignancies and major comorbid conditions (e.g., cardiovascular or pulmonary disease). These studies focus on intraoperative blood loss, airway management needs, postoperative complication rates (including wound, fistula, and aspiration), functional outcomes (speech, swallowing), and short‑term resource use such as ICU stays. Results are directly relevant to surgeons, anesthesiologists, and payers because they impact inpatient utilization, complication‑related costs, selection of surgical technique by risk profile, and metrics that drive DRG payments.
    • Post‑discharge and survivorship outcomes research examining long‑term functional recovery, health‑related quality of life, and healthcare utilization after hospitalization for ENT malignancy with major complications: cohort studies and intervention trials evaluate swallowing rehabilitation, nutrition support strategies, tracheostomy decannulation protocols, and multidisciplinary care models to reduce readmissions and chronic care needs among patients discharged after complex head and neck cancer admissions. These studies target the heterogeneous population of survivors who had prolonged inpatient courses, ICU stays, or reconstructive surgery, and measure readmission rates, durable dependency on feeding tubes or ventilatory support, and outpatient service utilization. For providers and payers, evidence from these studies helps design care pathways that reduce downstream costs, improve functional outcomes, and inform bundled payment or value‑based care strategies for this high‑acuity DRG.

    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

    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

    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.