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 451-single-level-spinal-fusion-except-cervical-without-mcc
    Ask Trek AI about this page

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

    DRG 451 encompasses single level spinal fusion procedures outside the cervical spine without a Major Complication or Comorbidity; it addresses resource use for single-segment lumbar or thoracolumbar fusions. Proper classification into this Diagnosis-Related Group matters for inpatient reimbursement because the assigned Diagnosis-Related Group determines the Medicare prospective payment for the hospital stay.

    Customize your policy alerts

    Sign up for drg 451 policy alerts

    Get alerted when payer policies referencing 451 are released or updated.

    Monitor payer policy activity

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

    DRG 451 Overview

    DRG 451 covers single level spinal fusion procedures outside the cervical region without a Major Complication or Comorbidity and is commonly assigned for lumbar or thoracolumbar fusion at one motion segment. This Diagnosis-Related Group captures cases where the primary surgical intervention is a single-level posterior, anterior, or combined approach spinal fusion without high-severity comorbid conditions. It matters for Medicare payment because the Diagnosis-Related Group assignment drives the inpatient prospective payment amount, influencing hospital reimbursement for resource use associated with operative time, implants, and postoperative care. Accurate coding of diagnoses and procedures determines whether a case is grouped to DRG 451 versus other fusion-related or higher-severity Diagnosis-Related Groups.

    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 pain management and opioid-sparing protocols: trials evaluate multimodal analgesia regimens, regional anesthesia techniques (such as erector spinae plane or paraspinal blocks), and non-opioid adjuncts in adults undergoing single-level lumbar or thoracic fusion without major complications. The patient population includes primarily middle-aged to older adults with degenerative disc disease, spondylolisthesis, or spinal stenosis scheduled for elective single-level fusion, focusing on intraoperative and immediate postoperative pain, opioid consumption, and early mobilization. This research is relevant to providers for optimizing perioperative care pathways and reducing complications, and to payers because effective protocols can shorten length of stay, lower opioid-related adverse events, and reduce readmission risk, all impacting costs for this DRG.
    • Comparative effectiveness of surgical approaches and intraoperative technology for single-level non-cervical fusion: randomized or prospective cohort studies compare surgical techniques (eg, minimally invasive posterior lumbar interbody fusion versus open fusion), implant strategies, or use of navigation/neuromonitoring to assess fusion rates, operative time, blood loss, and complication profiles. Studies enroll patients indicated for a single-level fusion without major comorbid complications and examine mid-term outcomes such as reoperation rates and functional scores at 6–24 months. This area informs surgeons and hospitals about which approaches deliver better clinical outcomes and resource use for this specific DRG population, helping payers evaluate value and reimbursement policies tied to procedure selection and device utilization.
    • Post-discharge recovery, rehabilitation, and health-economic outcomes: observational studies and pragmatic trials assess outpatient rehabilitation intensity, home-based physical therapy, remote monitoring, and care-coordination interventions to improve functional recovery, return-to-work, and reduce post-acute utilization among patients discharged after single-level spinal fusion. The population includes patients transitioning from inpatient to outpatient care, often with variable social support and comorbidities influencing recovery; outcomes measured include readmissions, emergency visits, patient-reported outcomes, and total episode-of-care costs over 90 days to one year. These studies are critical for providers and payers because optimizing post-discharge pathways can lower downstream costs, decrease avoidable readmissions, and improve long-term functional outcomes for patients classified under 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

    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

    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.