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    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 448-multiple-level-spinal-fusion-except-cervical-without-mcc
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    Multiple Level Spinal Fusion Except Cervical without MCC: Inpatient Reimbursement Overview

    DRG 448 covers multiple level spinal fusion procedures except cervical when no Major Complication or Comorbidity is present, focusing on thoracic and lumbar multilevel fusion cases that require significant operative resources. This classification matters for inpatient reimbursement because it determines payment grouping under the Medicare inpatient prospective payment system and is sensitive to documented comorbidities and procedure details.

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    DRG 448 Overview

    DRG 448 covers multiple level spinal fusion procedures outside the cervical region without the presence of a Major Complication or Comorbidity. It encompasses patients undergoing thoracic, lumbar, or lumbosacral multilevel fusion for degenerative, traumatic, neoplastic, or deformity indications when no Major Complication or Comorbidity is coded. This Diagnosis-Related Group is important for Medicare payment because it groups cases with similar resource use and drives inpatient prospective payment Hospital reimbursement under Medicare rules. Accurate coding of levels fused and comorbid conditions affects classification into this Diagnosis-Related Group and therefore the payment.

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    Clinical Trials

    • Perioperative optimization and complication reduction trials testing enhanced recovery after surgery (ERAS) protocols and multimodal pain/smoking/nutrition interventions in adults undergoing multiple-level thoracolumbar spinal fusion (excluding cervical). These studies enroll patients with degenerative deformity, multilevel stenosis, or spondylolisthesis who are scheduled for elective multilevel fusion and evaluate metrics such as intraoperative blood loss, transfusion need, opioid consumption, infection and wound complication rates, and length of stay. Results are highly relevant to providers and payers because reducing perioperative complications and LOS directly impacts resource utilization, readmission risk, and total cost of care for this high-acuity DRG.
    • Comparative effectiveness trials of surgical techniques and adjuncts for multilevel non-cervical fusion, such as open versus minimally invasive approaches, different fusion constructs (posterolateral fusion versus interbody/circumferential constructs), and the use of biologics or bone graft substitutes to enhance fusion. These studies recruit heterogeneous adult patients with multilevel pathology to compare functional outcomes, fusion rates, reoperation frequency, operative time, and long-term disability. Payers and hospital systems use this evidence to determine which approaches yield better long-term value, lower reoperation rates, and more predictable postacute resource needs for patients assigned to this DRG.
    • Post-discharge outcomes and rehabilitation studies examining recovery trajectories, return-to-function, opioid tapering, and rates of long-term disability or readmission among patients after multiple-level thoracolumbar fusion. These prospective cohort or pragmatic trials target patients during the transition from inpatient to outpatient care, testing structured rehabilitation programs, telehealth follow-up, and care-coordination interventions to decrease chronic pain and unplanned utilization. Understanding postacute outcomes informs discharge planning, durable medical equipment and therapy utilization, and payer strategies to reduce costly readmissions and long-term claims associated with this 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

    428-MULTIPLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL-WITHOUT-CC-MCC

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

    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

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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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