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 Musculoskeletal System and Connective TissueDRG 428-multiple-level-combined-anterior-and-posterior-spinal-fusion-except-cervical-without-cc-mcc
    Ask Trek AI about this page

    Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC: Inpatient Reimbursement Overview

    DRG 428 encompasses multiple level combined anterior and posterior spinal fusion procedures except cervical when no Major Complication or Comorbidity or Complication or Comorbidity is present. This classification defines inpatient resource grouping for Medicare reimbursement and hinges on precise documentation of surgical approach and comorbidity severity.

    Customize your policy alerts

    Sign up for drg 428 policy alerts

    Get alerted when payer policies referencing 428 are released or updated.

    Monitor payer policy activity

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

    DRG 428 Overview

    DRG 428 covers multiple level combined anterior and posterior spinal fusion procedures outside the cervical region in inpatient admissions without Major Complication or Comorbidity and without Complication or Comorbidity. This Diagnosis-Related Group applies to complex thoracic and lumbar fusion surgeries that use both anterior and posterior approaches across multiple vertebral levels. It matters for Medicare payment because case classification into this group affects inpatient reimbursement relative to less extensive fusion procedures. Accurate coding and documentation of surgical approach and comorbidity status determine assignment to this Diagnosis-Related Group.

    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

    • Perioperative enhanced recovery and blood management protocols: randomized or pragmatic trials comparing multimodal enhanced recovery after surgery (ERAS) pathways versus standard perioperative care for adults undergoing combined anterior-posterior multilevel thoracolumbar fusion. These studies enroll patients with degenerative deformity, multilevel stenosis, or spondylolisthesis requiring complex reconstruction and evaluate outcomes such as intraoperative blood loss, transfusion rates, opioid consumption, length of stay, and early complication rates. Results inform clinicians and payers about interventions that can reduce resource utilization, shorten hospital stays, and lower complication-related costs in a high-cost DRG population.
    • Comparative effectiveness of surgical approaches and instrumentation for multilevel combined anterior-posterior fusion: prospective cohort studies or randomized trials comparing variations in surgical technique (for example staged versus single-sitting combined approaches, anterior interbody graft type, or augmentation strategies) and fixation constructs in patients undergoing noncervical multilevel combined fusions. These studies focus on fusion success, reoperation rates, functional outcomes, and device- or approach-specific complication profiles over 1–2 years, addressing heterogeneous pathology and surgical complexity typical of this DRG. Evidence from these studies guides surgeons and payers on which approaches provide better long-term value, reduce the need for costly revisions, and optimize alignment and functional recovery.
    • Post-discharge recovery, rehabilitation, and cost-effectiveness studies: longitudinal observational studies and randomized trials testing different post-acute care pathways (inpatient rehab, home-based physical therapy, tele-rehabilitation, and structured care-management programs) in patients discharged after complex combined anterior-posterior multilevel fusion. Patient-centered outcomes include functional status, return-to-activity, readmission and complication rates, and total episode-of-care costs over 90 days to one year. Findings are directly relevant to payers and healthcare systems seeking to design rehabilitative services and bundled-payment models that improve recovery while containing post-discharge expenditures for this resource-intensive DRG.

    Related Codes

    402-SINGLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL

    Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical: Inpatient Reimbursement Overview

    426-MULTIPLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-MCC-OR-CUSTOM-MADE-ANATOMICALLY-DESIGNED-INTERBODY-FUSION-DEVICE

    Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device: Inpatient Reimbursement Overview

    427-MULTIPLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-CC

    Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC: Inpatient Reimbursement Overview

    429-COMBINED-ANTERIOR-AND-POSTERIOR-CERVICAL-SPINAL-FUSION-WITH-MCC

    Combined Anterior and Posterior Cervical Spinal Fusion with MCC: Inpatient Reimbursement Overview

    430-COMBINED-ANTERIOR-AND-POSTERIOR-CERVICAL-SPINAL-FUSION-WITHOUT-MCC

    Combined Anterior and Posterior Cervical Spinal Fusion without MCC: Inpatient Reimbursement Overview

    447-MULTIPLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-MCC-OR-CUSTOM-MADE-ANATOMICALLY-DESIGNED-INTERBODY-FUSION-DEVICE

    Multiple Level Spinal Fusion Except Cervical with MCC: Inpatient Reimbursement Overview

    448-MULTIPLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITHOUT-MCC

    Multiple Level Spinal Fusion Except Cervical without MCC: Inpatient Reimbursement Overview

    450-SINGLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-MCC-OR-CUSTOM-MADE-ANATOMICALLY-DESIGNED-INTERBODY-FUSION-DEVICE

    Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Device: Inpatient Reimbursement Overview

    451-SINGLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITHOUT-MCC

    Single Level Spinal Fusion Except Cervical without MCC: Inpatient Reimbursement Overview

    456-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-SPINAL-CURVATURE-MALIGNANCY-INFECTION-OR-EXTENSIVE-FUSIONS-WITH-MCC

    Spinal Fusion Except Cervical with MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 104

    • More pages

    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.