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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 557-tendonitis-myositis-and-bursitis-with-mcc
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    Tendonitis, Myositis and Bursitis with MCC: Inpatient Reimbursement Overview

    DRG 557 covers inpatient admissions for tendonitis, myositis and bursitis when a Major Complication or Comorbidity is present, reflecting higher clinical complexity and resource needs. Understanding this Diagnosis-Related Group is important for inpatient reimbursement because the Major Complication or Comorbidity status increases the payment relative to less severe groupings.

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    DRG 557 Overview

    DRG 557 covers inpatient stays for tendonitis, myositis and bursitis when a Major Complication or Comorbidity is present, indicating more severe clinical complexity or additional resource use. This Diagnosis-Related Group groups hospitalizations primarily for inflammatory and overuse conditions of tendons, muscles and bursa that require inpatient management due to severity or comorbid illness. It matters for Medicare payment because the presence of a Major Complication or Comorbidity elevates the relative weight and reimbursement compared with similar cases without such complicating conditions. Accurate clinical documentation and coding determine whether a case qualifies for this Diagnosis-Related Group and the associated inpatient payment level.

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    Clinical Trials

    • Acute procedural intervention studies focusing on optimizing emergency and inpatient management of severe tendonitis, myositis, and bursitis complicated by major comorbid conditions (MCC). These trials enroll hospitalized adults who present with acute, severe inflammatory soft-tissue conditions often accompanied by systemic illness (for example, uncontrolled diabetes, immunosuppression, or sepsis risk) to evaluate short-term interventions such as image-guided aspiration/injection strategies, peri-procedural antibiotic protocols, or early rehabilitation initiation. This research is relevant to providers and payers because it targets immediate resource utilization, length of stay, and complication rates in high-risk inpatients, informing protocols that may reduce avoidable escalation of care and downstream costs.
    • Comparative effectiveness trials of inpatient multimodal medical management versus stepwise escalation for inflammatory soft-tissue conditions in medically complex patients. These studies compare different conservative regimens (for example, anti-inflammatory strategies, dosing/timing of systemic therapies, and adjunctive immobilization or bracing) in adults with significant comorbidities to determine which approaches best control pain and inflammation while minimizing adverse events and readmissions. Results help clinicians tailor inpatient treatment pathways for patients grouped under this DRG and provide payers evidence about which standard-of-care strategies produce the best clinical and economic outcomes in a population with high baseline risk.
    • Post-discharge outcome and care-transition research assessing rehabilitation, recurrence, and readmission rates after hospital treatment for tendonitis, myositis, or bursitis with MCC. Cohort studies and pragmatic trials follow patients after discharge to evaluate the impact of structured outpatient physical therapy, home health services, medication reconciliation, and comorbidity management on functional recovery, prevention of recurrent flares, and 30- to 90-day readmissions. This area is important for providers and payers because effective transitional care can reduce costly readmissions, improve long-term functional status in patients with complex medical backgrounds, and inform bundled-payment or case-management strategies.

    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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