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 Respiratory SystemDRG 165-major-chest-procedures-without-cc-mcc
    Ask Trek AI about this page

    Major Chest Procedures without CC/MCC: Inpatient Reimbursement Overview

    DRG 165 encompasses major chest procedures without a Complication or Comorbidity or Major Complication or Comorbidity, covering significant thoracic resections and related surgeries. This Diagnosis-Related Group is important for inpatient reimbursement because it defines payment for high-resource thoracic operations under Centers for Medicare & Medicaid Services Medicare rules.

    Customize your policy alerts

    Sign up for drg 165 policy alerts

    Get alerted when payer policies referencing 165 are released or updated.

    Monitor payer policy activity

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

    DRG 165 Overview

    DRG 165 covers major chest procedures without a Complication or Comorbidity or Major Complication or Comorbidity. It includes inpatient stays for significant thoracic surgical interventions such as lobectomy, pneumonectomy, and other major resections when no CC or MCC is coded. This Diagnosis-Related Group matters because it groups cases with substantial resource use into a payment category used by the Centers for Medicare & Medicaid Services for Medicare inpatient reimbursement. Accurate coding of procedures and comorbid conditions determines assignment to this Diagnosis-Related Group and impacts hospital 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

    • Acute perioperative intervention studies evaluating techniques to reduce intraoperative morbidity and short-term complications in patients undergoing major chest procedures (such as thoracotomy, lobectomy, or esophagectomy) without complicating comorbid conditions. These trials enroll adult surgical patients in the operating room and immediate postoperative period to test optimized anesthesia protocols, blood-sparing strategies, enhanced recovery pathways, or minimally invasive approaches versus standard care. Results inform clinicians about immediate safety and efficacy differences and help payers anticipate resource use, length of stay, and complication-related costs for this DRG.
    • Comparative effectiveness trials comparing surgical approaches or perioperative care bundles in relatively uncomplicated major chest procedure cases to determine which strategies best reduce hospital length of stay and readmission. These studies typically randomize patients fit for major chest surgery without CC/MCC to techniques such as open versus video-assisted procedures, different chest tube management protocols, or standardized physiotherapy regimens. Findings guide providers on practice patterns that optimize short-term outcomes and allow payers to evaluate value-based reimbursement models tied to efficient, high-quality inpatient care.
    • Post-discharge outcomes and health services research following patients who had major chest procedures without CC/MCC to measure functional recovery, late complications (e.g., persistent air leak, surgical site issues), and health-related quality of life over 30–90 days. Cohort studies or pragmatic trials assess how discharge planning, home health services, and early outpatient follow-up affect rehospitalization and patient-reported outcomes in a lower-complexity surgical cohort. This research is relevant to care managers and payers because it identifies interventions that reduce costly readmissions and improve transitions of care for beneficiaries captured under DRG 165.

    Related Codes

    163-MAJOR-CHEST-PROCEDURES-WITH-MCC

    Major Chest Procedures with MCC: Inpatient Reimbursement Overview

    164-MAJOR-CHEST-PROCEDURES-WITH-CC

    Major Chest Procedures with CC: Inpatient Reimbursement Overview

    166-OTHER-RESPIRATORY-SYSTEM-O-R-PROCEDURES-WITH-MCC

    Other Respiratory System O.R. Procedures with MCC: Inpatient Reimbursement Overview

    167-OTHER-RESPIRATORY-SYSTEM-O-R-PROCEDURES-WITH-CC

    Other Respiratory System O.R. Procedures with CC: Inpatient Reimbursement Overview

    168-OTHER-RESPIRATORY-SYSTEM-O-R-PROCEDURES-WITHOUT-CC-MCC

    Other Respiratory System O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    173-ULTRASOUND-ACCELERATED-AND-OTHER-THROMBOLYSIS-WITH-PRINCIPAL-DIAGNOSIS-PULMONARY-EMBOLISM

    Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism: Inpatient Reimbursement Overview

    175-PULMONARY-EMBOLISM-WITH-MCC-OR-ACUTE-COR-PULMONALE

    Pulmonary Embolism with MCC or Acute Cor Pulmonale: Inpatient Reimbursement Overview

    176-PULMONARY-EMBOLISM-WITHOUT-MCC

    Pulmonary Embolism without MCC: Inpatient Reimbursement Overview

    177-RESPIRATORY-INFECTIONS-AND-INFLAMMATIONS-WITH-MCC

    Respiratory Infections and Inflammations with MCC: Inpatient Reimbursement Overview

    178-RESPIRATORY-INFECTIONS-AND-INFLAMMATIONS-WITH-CC

    Respiratory Infections and Inflammations with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 40

    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.