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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 457-spinal-fusion-except-cervical-with-spinal-curvature-malignancy-infection-or-extensive-fusions-with-cc
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    Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, Infection or Extensive Fusions with CC: Inpatient Reimbursement Overview

    DRG 457 addresses noncervical spinal fusion cases complicated by spinal curvature, malignancy, infection, or extensive fusion constructs with a Complication or Comorbidity, and it represents higher-complexity inpatient spine surgery. Proper assignment is important for inpatient reimbursement because it aligns payment with the increased resources required for complex surgical care and comorbidity management.

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    DRG 457 Overview

    DRG 457 covers inpatient spinal fusion procedures excluding cervical levels when performed for patients with spinal curvature, malignancy, infection, or extensive fusion constructs accompanied by a Complication or Comorbidity. This Diagnosis-Related Group captures complex thoracic, thoracolumbar, and lumbar fusion cases with higher resource use driven by surgical complexity, comorbid conditions, and perioperative management. It matters for Medicare payment because classification into this group influences hospital reimbursement rates and reflects elevated inpatient resource intensity. Accurate clinical coding of diagnoses and procedures determines assignment to this Diagnosis-Related Group and the associated payment.

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    Clinical Trials

    • Studies evaluating perioperative strategies to reduce surgical morbidity in complex thoracolumbar fusion for patients with spinal curvature (scoliosis/kyphosis), malignancy, infection, or multilevel deformity: these trials focus on anesthesia protocols, intraoperative blood management, and enhanced recovery pathways in adults undergoing extensive non-cervical fusion with significant comorbidities. The patient population includes older adults and medically complex patients who require long-segment constructs or fusion for deformity, tumor resection, or infection control. Results inform clinicians and payers about interventions that can lower complication rates, shorten length of stay, and reduce resource utilization in a high-cost DRG.
    • Comparative effectiveness trials of surgical techniques and construct options for extensive non-cervical spinal fusion: randomized or pragmatic studies compare approaches such as posterior-only versus combined anterior-posterior procedures, use of osteotomy techniques, or different fixation and grafting strategies in patients with spinal curvature, malignancy-related instability, or extensive multilevel disease. These studies enroll patients requiring complex reconstructions to determine differences in fusion success, reoperation, neurologic outcomes, and perioperative complications. Findings guide surgical decision-making and payer coverage policies by clarifying which techniques provide better long-term outcomes and cost-effectiveness for this high-acuity DRG population.
    • Post-discharge outcomes and utilization research focusing on rehabilitation, readmissions, and long-term functional outcomes after extensive spinal fusion: observational cohorts and prospective registries track recovery trajectories, post-acute care needs, reoperation rates, infection recurrence, and health-related quality of life in patients treated for deformity, malignancy, or spinal infection. The population includes patients discharged to home with home health, skilled nursing facilities, or inpatient rehab following prolonged index hospitalization and CC-level complications. Evidence from these studies helps hospitals and payers optimize discharge planning, bundle payments, and resource allocation by identifying predictors of costly readmissions and durable functional recovery.

    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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    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.