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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Skin, Subcutaneous Tissue and BreastDRG 601-non-malignant-breast-disorders-without-cc-mcc
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    Non-Malignant Breast Disorders without CC/MCC: Inpatient Reimbursement Overview

    DRG 601 encompasses inpatient stays for non-malignant breast disorders without Complication or Comorbidity or Major Complication or Comorbidity, covering benign breast conditions and uncomplicated postoperative care. Classification to this Diagnosis-Related Group matters because it sets the prospective payment category used by Medicare for hospital reimbursement and reflects lower expected resource intensity than cases with complications or malignancy.

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    DRG 601 Overview

    DRG 601 covers inpatient admissions for non-malignant breast disorders without Complication or Comorbidity or Major Complication or Comorbidity and typically includes conditions such as benign breast masses, cysts, mastitis without systemic complication, and postoperative care following non-oncologic breast procedures. This Diagnosis-Related Group is used to classify cases with relatively low expected resource use compared with breast admissions that include complications or malignancy. For Medicare payment, assignment to DRG 601 affects the base prospective payment and grouping logic for hospitals billing the Centers for Medicare & Medicaid Services. Accurate clinical coding and documentation determine whether an admission is classified to this Diagnosis-Related Group and thus directly influences reimbursement pathways.

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    • Billing CodesCPT, HCPCS, DRG & more
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    Clinical Trials

    • Prospective randomized trials comparing conservative management strategies (e.g., observation, analgesia, hormonal modulation) versus minimally invasive procedural interventions (such as ultrasound-guided aspiration or image-guided cyst drainage) for symptomatic non-malignant breast masses. These studies enroll adult women presenting acutely or electively with benign cysts, fibroadenomas, mastitis, or symptomatic breast pain to determine short-term symptom relief, need for repeat procedures, and complication rates. Results inform clinicians on which initial interventions reduce inpatient stays, lower complication-related costs, and optimize resource use for payers and hospital case management.
    • Comparative effectiveness studies of diagnostic pathways that evaluate imaging-first versus biopsy-first approaches in patients with suspicious but likely benign breast findings. These observational or pragmatic randomized studies focus on patients with ambiguous imaging (BI-RADS 3–4a scenarios), assessing downstream utilization including additional imaging, core needle biopsies, surgical excisions, length of stay when admitted, and rates of diagnostic certainty. Findings are relevant to providers and payers because they can reduce unnecessary procedures, avoid inpatient admissions for diagnostic workups, and align care with value-based reimbursement by minimizing low-yield resource use.
    • Post-discharge outcomes and care transitions research examining recurrence, readmission, patient-reported outcomes (pain, cosmetic satisfaction), and outpatient follow-up adherence after inpatient management for conditions like complicated mastitis, abscess drainage, or post-procedural complications. These cohort studies or registry analyses target the subpopulation requiring hospital-based care to identify predictors of readmission, outpatient resource needs (wound care, antibiotics), and costs over 30–90 days. Insights help hospitals and payers design discharge planning, outpatient support programs, and bundled payment models to reduce readmissions and total cost of care while maintaining quality for this DRG.

    Related Codes

    570-SKIN-DEBRIDEMENT-WITH-MCC

    Skin Debridement with Major Complication or Comorbidity: Inpatient Reimbursement Overview

    571-SKIN-DEBRIDEMENT-WITH-CC

    Skin Debridement with CC: Inpatient Reimbursement Overview

    572-SKIN-DEBRIDEMENT-WITHOUT-CC-MCC

    Skin Debridement without CC/MCC: Inpatient Reimbursement Overview

    573-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-MCC

    Skin Graft for Skin Ulcer or Cellulitis with MCC: Inpatient Reimbursement Overview

    574-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

    Skin Graft for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

    575-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

    Skin Graft for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

    576-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-MCC

    Skin Graft Except for Skin Ulcer or Cellulitis with MCC: Inpatient Reimbursement Overview

    577-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

    Skin Graft Except for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

    578-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

    Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

    579-OTHER-SKIN-SUBCUTANEOUS-TISSUE-AND-BREAST-PROCEDURES-WITH-MCC

    Other Skin, Subcutaneous Tissue and Breast Procedures with MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 31

    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.