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    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 456-spinal-fusion-except-cervical-with-spinal-curvature-malignancy-infection-or-extensive-fusions-with-mcc
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    Spinal Fusion Except Cervical with MCC: Inpatient Reimbursement Overview

    DRG 456 covers noncervical spinal fusion procedures performed for spinal curvature, malignancy, infection, or extensive multilevel fusions when a Major Complication or Comorbidity is present, reflecting high clinical complexity. This group matters for inpatient reimbursement because its higher resource intensity and increased payment weight are driven by the underlying diagnoses, procedure extent, and documented Major Complication or Comorbidity.

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    DRG 456 Overview

    DRG 456 covers inpatient admissions for noncervical spinal fusion procedures performed in the setting of spinal curvature, malignancy, infection, or unusually extensive fusion procedures when a Major Complication or Comorbidity is present. This Diagnosis-Related Group captures high-complexity surgical spine cases with elevated resource use driven by longer operative time, greater implant and implant-related costs, and increased perioperative management needs. It matters for Medicare payment because the presence of a Major Complication or Comorbidity increases the relative weight and payment rate compared with less complex spinal fusion groups. Accurate coding of the underlying diagnoses, procedure extent, and Major Complication or Comorbidity is essential to assigning the correct Diagnosis-Related Group and associated inpatient reimbursement.

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    Clinical Trials

    • Acute perioperative optimization and complication mitigation trials: Studies focusing on interventions during the index hospitalization to reduce perioperative morbidity and mortality for patients undergoing non-cervical spinal fusion with spinal deformity, malignancy, infection, or multilevel/complex fusion with major complications (MCC). These trials enroll high-risk inpatients (often older adults, immunocompromised patients, or those with metastatic spine disease or spinal infection) and test protocols such as enhanced hemodynamic monitoring, infection-control bundles, blood-conservation strategies, or timing/selection of operative staging. Results are directly relevant to providers managing immediate surgical risk and to payers because successful protocols can reduce intensive care use, returns to the OR, and prolonged length of stay associated with this DRG.
    • Comparative effectiveness studies of surgical approaches and implant strategies: Pragmatic trials or registry-based comparative studies that evaluate different fusion techniques (e.g., posterior-only versus combined anterior-posterior approaches), extent of fusion constructs, use of augmentation for osteoporotic bone, or choice of instrumentation in patients with spinal curvature, tumor-related instability, or infection-related destruction. These studies target heterogeneous inpatient cohorts within this DRG to determine which approaches yield superior short-term clinical outcomes (complication rates, neurological preservation), resource utilization (operative time, transfusions), and 30–90 day readmission profiles. Findings inform surgeons and hospital administrators about value-based choices of technique and implants and help payers assess procedure-related cost-effectiveness and appropriate bundling for reimbursement.
    • Post-discharge functional recovery and readmission prevention research: Prospective cohort studies and interventional trials assessing early rehabilitation protocols, coordinated home health strategies, or outpatient surveillance programs for patients discharged after complex non-cervical fusion for deformity, malignancy, or infection. These studies enroll patients at discharge or within the first 30 days and measure functional recovery, wound healing, opioid and pain outcomes, and readmissions for infection or instrumentation failure. The evidence guides care pathways that can shorten downstream utilization, improve functional outcomes for this high-risk DRG population, and provide payers with data to support post-acute care coverage decisions and risk-adjusted payment models.

    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

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

    Single Level Spinal Fusion Except Cervical without 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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