Breast Biopsy, Local Excision and Other Breast Procedures DRG Reimbursement

Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC: Inpatient Reimbursement Overview

DRG 585 encompasses inpatient breast biopsy, local excision, and other breast procedures without a Complication or Comorbidity or Major Complication or Comorbidity; it applies to admissions where breast-conserving procedures are performed and no significant comorbid conditions are coded. This Diagnosis-Related Group matters for inpatient reimbursement because it establishes the standardized Medicare payment for routine, lower-acuity breast surgical admissions and influences hospital revenue for these services.

Customize your policy alerts

Sign up for drg 585 policy alerts

Get alerted when payer policies referencing 585 are released or updated.

Monitor payer policy activity

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

DRG 585 Overview

DRG 585 covers inpatient admissions for breast biopsy, local excision, and other non-mastectomy breast procedures without a Complication or Comorbidity or Major Complication or Comorbidity. Typical cases include diagnostic or therapeutic partial breast excisions, lumpectomy for benign or early malignant lesions, and related breast-sparing procedures. This Diagnosis-Related Group is important for Medicare payment because it groups similar resource use and sets the base inpatient reimbursement for straightforward, lower-acuity breast surgical admissions. Understanding the clinical scope helps hospitals anticipate payment relative to more complex breast surgery Diagnosis-Related Groups.

Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC: Inpatient Reimbursement Overview

Customize your policy alerts

Sign up for drg 585 policy alerts

Get alerted when payer policies referencing 585 are released or updated.

Monitor payer policy activity

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

DRG 585 Overview

Clinical Trials

Trials evaluating minimally invasive localization and biopsy techniques for small or nonpalpable breast lesions: These studies compare approaches such as image-guided core needle biopsy, wire- and seed-localization assisted lumpectomy, and vacuum-assisted excision in patients presenting with suspicious imaging findings or low-risk lesions. The patient population includes mostly ambulatory or short-stay adult women undergoing diagnostic or therapeutic breast procedures without major comorbidities; outcomes measured include diagnostic yield, margin status, re-excision rates, procedure time, and short-term complications. This research is relevant to providers and payers because optimizing technique can reduce unnecessary inpatient stays, lower repeat procedures, and improve resource utilization and reimbursement alignment under DRG 585.
Comparative effectiveness studies of anesthesia and perioperative pain management strategies for local excision and breast biopsy: These trials assess regional blocks, local anesthetic approaches, and multimodal analgesia versus standard general anesthesia for patients undergoing breast biopsy or excisional procedures. Populations studied are patients eligible for same-day surgery who may have varying risk profiles (elderly patients, those with mild comorbidities, or opioid-sensitive individuals); endpoints include recovery time, postoperative pain scores, opioid consumption, unplanned admissions, and short-term complications. Findings inform clinicians and payers about strategies that can decrease length of stay, reduce postoperative admissions and readmissions, and lower overall costs associated with DRG 585 episodes of care.
Observational and prospective cohort studies tracking short-term surgical outcomes, wound healing, and patient-reported cosmetic and psychosocial outcomes after breast-conserving procedures: These investigations follow patients from the perioperative period through early recovery (weeks to months) to evaluate complication rates (hematoma, infection), reoperation for positive margins, and patient-reported satisfaction and quality-of-life metrics. The studied cohort typically includes patients treated for benign lesions, high-risk lesions, or early-stage malignancy undergoing local excision without major complications; health services outcomes such as follow-up utilization, additional imaging or procedures, and time to adjuvant therapy (if applicable) are also recorded. Results help payers and hospital administrators identify drivers of downstream costs, readmission risk, and quality metrics relevant to reimbursement and care pathways under DRG 585.

References

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.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.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.

Trials evaluating minimally invasive localization and biopsy techniques for small or nonpalpable breast lesions: These studies compare approaches such as image-guided core needle biopsy, wire- and seed-localization assisted lumpectomy, and vacuum-assisted excision in patients presenting with suspicious imaging findings or low-risk lesions. The patient population includes mostly ambulatory or short-stay adult women undergoing diagnostic or therapeutic breast procedures without major comorbidities; outcomes measured include diagnostic yield, margin status, re-excision rates, procedure time, and short-term complications. This research is relevant to providers and payers because optimizing technique can reduce unnecessary inpatient stays, lower repeat procedures, and improve resource utilization and reimbursement alignment under DRG 585.
Comparative effectiveness studies of anesthesia and perioperative pain management strategies for local excision and breast biopsy: These trials assess regional blocks, local anesthetic approaches, and multimodal analgesia versus standard general anesthesia for patients undergoing breast biopsy or excisional procedures. Populations studied are patients eligible for same-day surgery who may have varying risk profiles (elderly patients, those with mild comorbidities, or opioid-sensitive individuals); endpoints include recovery time, postoperative pain scores, opioid consumption, unplanned admissions, and short-term complications. Findings inform clinicians and payers about strategies that can decrease length of stay, reduce postoperative admissions and readmissions, and lower overall costs associated with DRG 585 episodes of care.
Observational and prospective cohort studies tracking short-term surgical outcomes, wound healing, and patient-reported cosmetic and psychosocial outcomes after breast-conserving procedures: These investigations follow patients from the perioperative period through early recovery (weeks to months) to evaluate complication rates (hematoma, infection), reoperation for positive margins, and patient-reported satisfaction and quality-of-life metrics. The studied cohort typically includes patients treated for benign lesions, high-risk lesions, or early-stage malignancy undergoing local excision without major complications; health services outcomes such as follow-up utilization, additional imaging or procedures, and time to adjuvant therapy (if applicable) are also recorded. Results help payers and hospital administrators identify drivers of downstream costs, readmission risk, and quality metrics relevant to reimbursement and care pathways under DRG 585.

OpenPayer

Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC: Inpatient Reimbursement Overview

Sign up for drg 585 policy alerts

DRG 585 Overview

OpenPayer

Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC: Inpatient Reimbursement Overview

Sign up for drg 585 policy alerts

DRG 585 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References