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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 305-hypertension-without-mcc
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    Hypertension without MCC: Inpatient Reimbursement Overview

    DRG 305 addresses inpatient stays with a principal diagnosis of hypertension without Major Complication or Comorbidity, focusing on lower-severity hypertension cases managed in the hospital. Correct classification affects Medicare inpatient reimbursement by grouping cases with comparable resource use and establishing the payment level for these admissions.

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    DRG 305 Overview

    DRG 305 covers hospital admissions where the principal diagnosis is hypertension without a Major Complication or Comorbidity. It encompasses patients treated primarily for elevated blood pressure requiring inpatient management but without high-severity comorbid conditions that would escalate classification. This Diagnosis-Related Group matters for Medicare payment because it groups similar resource use and determines base reimbursement for these lower-severity hypertension admissions. Hospitals and coders must assign the correct principal diagnosis and document comorbidities to ensure accurate billing under Medicare rules.

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    Clinical Trials

    • Trials evaluating antihypertensive medication optimization strategies in hospitalized patients with uncomplicated hypertension: these studies compare protocols for initiating, adjusting, or simplifying oral antihypertensive regimens during an acute admission for hypertension-related issues without major complications. The patient population includes adults admitted primarily for elevated blood pressure or symptomatic hypertension but without end-organ failure or major comorbid complications; investigators assess blood pressure control at discharge, short-term safety, medication adherence, and readmission risk. Results are highly relevant to inpatient providers and payers because effective in-hospital optimization can reduce length of stay, prevent early readmissions, and influence outpatient medication costs and utilization patterns.
    • Comparative effectiveness research of care pathways integrating multidisciplinary inpatient education and transition-of-care interventions versus usual discharge processes: these pragmatic studies examine whether structured education, medication reconciliation with pharmacist involvement, and early outpatient follow-up reduce 30- and 90-day readmissions and emergency visits for patients hospitalized with hypertension without major complications. The target population is patients with primary hypertension admissions who often have polypharmacy or variable outpatient follow-up, and the trials measure outcomes such as adherence, blood pressure control after discharge, and cumulative healthcare utilization. Payers and health systems are interested because these interventions aim to improve downstream outcomes and resource use, potentially lowering avoidable spending tied to readmissions and uncontrolled outpatient care.
    • Observational and implementation studies tracking long-term outcomes and risk stratification among patients admitted for hypertension without MCC: these cohort studies follow patients after discharge to identify predictors of progression to more severe cardiovascular or renal disease, assess real-world medication persistence, and validate risk-stratification tools to guide follow-up intensity. The population includes persons with uncomplicated inpatient hypertension episodes, often with comorbidities like diabetes or obesity, and research questions focus on which clinical and social factors predict subsequent complications or healthcare utilization. Findings inform clinicians and payers on targeting preventive resources, tailoring follow-up schedules, and prioritizing high-value interventions to prevent escalation to higher-cost DRG categories.

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    216-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

    217-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    218-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

    219-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with MCC: Inpatient Reimbursement Overview

    220-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    221-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

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    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.
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