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 544-pathological-fractures-and-musculoskeletal-and-connective-tissue-malignancy-without-cc-mcc
    Ask Trek AI about this page

    Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy: Inpatient Reimbursement Overview

    DRG 544 addresses pathological fractures and musculoskeletal and connective tissue malignancies without Complication or Comorbidity or Major Complication or Comorbidity, focusing on cases with lower expected inpatient resource use. Accurate classification affects Medicare inpatient reimbursement by determining the base payment rate for admissions with these specific orthopedic and oncologic diagnoses.

    Customize your policy alerts

    Sign up for drg 544 policy alerts

    Get alerted when payer policies referencing 544 are released or updated.

    Monitor payer policy activity

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

    DRG 544 Overview

    DRG 544 covers inpatient admissions for pathological fractures and musculoskeletal and connective tissue malignancies when no Complication or Comorbidity or Major Complication or Comorbidity is present. It includes primary management of tumor-related bone involvement and fracture stabilization or limited oncologic procedures without higher-severity comorbid conditions. This Diagnosis-Related Group matters for Medicare payment because it groups similar resource use and sets the base inpatient reimbursement for these diagnoses in the absence of complicating conditions.

    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 perioperative intervention studies: randomized or prospective cohort studies comparing different fixation techniques, timing of surgery, or perioperative optimization protocols for patients hospitalized with pathological fractures due to primary bone tumors or metastatic musculoskeletal malignancy. These trials enroll inpatients presenting with fracture-related pain, instability, or neurologic compromise and evaluate short-term outcomes such as perioperative complications, length of stay, need for ICU care, and early functional recovery. Results inform surgeons and hospital administrators about best practices to reduce inpatient morbidity and resource use for this high-risk DRG population.
    • Comparative effectiveness and multimodal oncology management studies: nonrandomized or pragmatic randomized trials assessing the effectiveness of combined local therapies (surgical stabilization, radiotherapy, and image-guided ablation) versus single-modality approaches for controlling tumor-related bone destruction and preventing recurrent pathological fractures. These studies typically include adult oncology patients with musculoskeletal or connective tissue malignancies without major comorbid complications (no CC/MCC) who are candidates for different local treatment strategies, and they measure intermediate outcomes such as reoperation rates, time to subsequent skeletal-related events, pain control, and chemotherapy/radiation treatment continuity. Findings guide oncologists, orthopaedic surgeons, and payers on cost-effective integrated care pathways that balance tumor control, preservation of function, and inpatient resource utilization.
    • Post-discharge functional outcomes and readmission prevention studies: prospective observational cohorts and intervention trials focused on rehabilitation protocols, home health models, and coordinated transition-of-care programs for patients discharged after inpatient treatment of pathological fractures or musculoskeletal malignancy. These studies enroll survivors of inpatient episodes to evaluate measures such as 30- and 90-day readmission rates, sustained mobility, pain management effectiveness, and use of outpatient services or durable medical equipment. Evidence from this research helps payers and case managers design post-acute services that reduce costly readmissions and improve long-term functional outcomes for this vulnerable DRG group.

    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.