Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • 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.

    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 540-osteomyelitis-with-cc
    Ask Trek AI about this page

    Osteomyelitis with Complication or Comorbidity: Inpatient Reimbursement Overview

    DRG 540 pertains to osteomyelitis admissions with at least one Complication or Comorbidity, covering bone infections that often need surgery and prolonged antimicrobial therapy. It matters for inpatient reimbursement because Complication or Comorbidity status alters Diagnosis-Related Group assignment and therefore Medicare payment for the episode of care.

    Customize your policy alerts

    Sign up for drg 540 policy alerts

    Get alerted when payer policies referencing 540 are released or updated.

    Monitor payer policy activity

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

    DRG 540 Overview

    DRG 540 covers hospital admissions for osteomyelitis when at least one Complication or Comorbidity is present, encompassing acute and chronic bone infections that commonly require surgical debridement, prolonged intravenous antibiotics, and close multidisciplinary care. This Diagnosis-Related Group is important for Medicare payment because the presence of a Complication or Comorbidity affects resource use, length of stay, and inpatient reimbursement under Centers for Medicare & Medicaid Services policy. Accurate clinical documentation of infection severity, wound management, and comorbid conditions informs correct assignment to DRG 540. Proper DRG assignment impacts hospital funding for the intensity of services delivered during the inpatient stay.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • 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

    • Acute surgical and antimicrobial timing trials: studies investigating optimal timing and combination of surgical debridement versus incision-and-drainage with adjunctive systemic antimicrobial regimens for hospitalized patients with osteomyelitis complicated by comorbid conditions (eg, diabetes, peripheral vascular disease). These trials enroll inpatients presenting with acute or acute-on-chronic bone infection to compare immediate versus staged operative approaches and to evaluate duration/intensity of IV antimicrobial therapy in the perioperative period. Results inform hospital-based care pathways, resource utilization (operating room time, length of stay), and payer decisions about coverage for inpatient versus early step-down to outpatient parenteral therapy.
    • Comparative effectiveness studies of diagnostic and imaging strategies: prospective studies comparing diagnostic workflows (eg, plain radiography, MRI, nuclear medicine imaging, and guided bone biopsy) and their impact on diagnostic accuracy, time to definitive therapy, and avoidance of unnecessary procedures in patients with suspected complicated osteomyelitis and coexisting soft tissue infection or hardware. These studies focus on heterogeneous inpatient populations where comorbidities (renal dysfunction, implanted devices) complicate diagnostics, assessing which strategies yield faster, cost-effective diagnoses and reduce inappropriate antimicrobial exposure. Findings are relevant to clinicians deciding diagnostic sequencing and to payers evaluating the value of advanced imaging or image-guided biopsy in reducing downstream costs and complications.
    • Post-discharge outcomes and care-transition interventions: pragmatic trials and cohort studies testing structured discharge programs (early outpatient parenteral antimicrobial therapy coordination, wound-care nursing, vascular/metabolic optimization, and remote monitoring) versus usual discharge practices for survivors of osteomyelitis with complications. These studies target medically complex patients at high risk for readmission, recurrent infection, or prolonged rehabilitation needs, measuring readmission rates, functional recovery, and total episode-of-care costs over 30–180 days. Evidence guides hospital case managers and payers on which transitional care models reduce rehospitalization, long-term disability, and overall expenditures for this high-risk 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

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

    Single Level Spinal Fusion Except Cervical without 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.