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 Respiratory SystemDRG 198-interstitial-lung-disease-without-cc-mcc
    Ask Trek AI about this page

    Interstitial Lung Disease without CC/MCC: Inpatient Reimbursement Overview

    DRG 198 encompasses inpatient cases of interstitial lung disease without a Complication or Comorbidity or Major Complication or Comorbidity, defining a lower-resource clinical subgroup for payment. Proper assignment matters for inpatient reimbursement because it determines base Medicare payment and resource categorization for hospitals.

    Customize your policy alerts

    Sign up for drg 198 policy alerts

    Get alerted when payer policies referencing 198 are released or updated.

    Monitor payer policy activity

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

    DRG 198 Overview

    DRG 198 covers inpatient admissions for interstitial lung disease without a Complication or Comorbidity or Major Complication or Comorbidity present. It includes conditions such as idiopathic pulmonary fibrosis and other diffuse parenchymal lung diseases when the clinical course is uncomplicated by additional major diagnoses. This Diagnosis-Related Group matters for Medicare payment because it groups similar resource use and influences base reimbursement for hospitals caring for these patients. Accurate coding and documentation of comorbid conditions determine whether cases remain in this DRG or escalate to higher-paying groups.

    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

    • Acute inpatient therapeutic trials testing anti-inflammatory or antifibrotic strategies aimed at reducing respiratory failure and need for prolonged mechanical ventilation in hospitalized patients with acute exacerbations of interstitial lung disease (ILD). These studies enroll patients admitted with acute worsening of ILD symptoms, often hypoxemia or new infiltrates on imaging, and assess short-term endpoints such as time to wean from oxygen or ventilator, ICU length of stay, and in-hospital mortality. This research is directly relevant to providers and payers because preventing progression to respiratory failure can shorten high-cost inpatient stays, reduce use of critical care resources, and improve discharge disposition.
    • Comparative effectiveness studies evaluating diagnostic and management pathways for hospitalized ILD patients without major complications (no CC/MCC), such as early high-resolution CT plus multidisciplinary consultation versus standard workup, or different corticosteroid strategies. These trials focus on patients admitted for new or worsening dyspnea attributable to ILD but who do not meet severity thresholds that define CC/MCC, measuring outcomes like diagnostic yield, length of stay, readmission rates, and functional status at discharge. Payers and hospital administrators benefit from evidence identifying efficient care pathways that optimize resource use while ensuring accurate diagnosis and appropriate treatment intensity for this mid-acuity population.
    • Post-discharge outcomes and care-transition studies examining rehabilitation, outpatient monitoring, and readmission prevention for patients discharged after hospitalization for ILD without CC/MCC. These pragmatic studies follow patients after discharge to evaluate interventions such as structured pulmonary rehabilitation, telemonitoring of oxygen needs, or coordinated outpatient specialist follow-up, with outcomes including 30- and 90-day readmissions, outpatient utilization, and patient-reported respiratory function. For providers and payers, improving post-discharge management can reduce costly readmissions, support better long-term functional outcomes, and inform bundled payment or case management strategies for this DRG.

    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

    165-MAJOR-CHEST-PROCEDURES-WITHOUT-CC-MCC

    Major Chest Procedures without CC/MCC: 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

    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.