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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Male Reproductive SystemDRG 726-benign-prostatic-hypertrophy-without-mcc
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    Benign Prostatic Hypertrophy without MCC: Inpatient Reimbursement Overview

    DRG 726 addresses inpatient stays for benign prostatic hypertrophy without Major Complication or Comorbidity, encompassing admissions for surgical and non-surgical management of prostatic enlargement. Correct assignment matters for Medicare inpatient reimbursement because it determines relative payment rates among related Diagnosis-Related Groups based on clinical complexity and resource use.

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    DRG 726 Overview

    DRG 726 covers inpatient admissions for benign prostatic hypertrophy without Major Complication or Comorbidity and typically includes patients admitted for procedures such as transurethral resection of the prostate or observation for urinary obstruction related to benign prostatic enlargement. This Diagnosis-Related Group groups clinically similar cases with comparable resource use to determine Medicare inpatient payment. It is important for reimbursement because the Presence or absence of Major Complication or Comorbidity affects payment relative to other related Diagnosis-Related Groups. Accurate clinical coding and documentation drive correct assignment to this Diagnosis-Related Group and corresponding Medicare payment.

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    Clinical Trials

    • Perioperative minimally invasive vs open surgical technique trials: randomized or prospective cohort studies comparing outcomes of transurethral and minimally invasive prostate procedures versus traditional open prostatectomy in men hospitalized for benign prostatic hyperplasia without major complications. These studies enroll primarily older men with symptomatic bladder outlet obstruction who require inpatient surgical management to assess operative time, perioperative blood loss, catheterization duration, length of stay, and short-term complication rates. Results are directly relevant to providers deciding surgical approach and to payers assessing resource use and costs associated with different inpatient procedures for this DRG.
    • Comparative effectiveness studies of anesthesia and perioperative care pathways: pragmatic trials or observational comparative studies evaluating spinal, regional, or general anesthesia choices and enhanced recovery protocols in patients undergoing prostate surgery for BPH. These investigations focus on typical comorbid elderly men in the inpatient setting, measuring outcomes such as postoperative urinary retention, delirium, respiratory complications, need for intensive care, and total hospital resource utilization. Findings inform clinicians and payers about best practices to minimize complications and length of stay in this relatively high-volume, older patient population.
    • Post-discharge functional and health economics outcomes research: prospective cohort studies or registry-based analyses tracking urinary function, readmission rates, catheter dependence, and health-care utilization in the months following inpatient treatment for BPH without major complications. These studies often include patient-reported urinary symptom scores and quality-of-life measures in community-dwelling older adults to quantify longer-term benefits and costs of different inpatient management strategies. Data are important for providers to counsel patients about expected recovery trajectories and for payers to model downstream costs and value of inpatient interventions associated with this DRG.

    Related Codes

    707-MAJOR-MALE-PELVIC-PROCEDURES-WITH-CC-MCC

    Major Male Pelvic Procedures with CC/MCC: Inpatient Reimbursement Overview

    708-MAJOR-MALE-PELVIC-PROCEDURES-WITHOUT-CC-MCC

    Major Male Pelvic Procedures without CC/MCC: Inpatient Reimbursement Overview

    709-PENIS-PROCEDURES-WITH-CC-MCC

    Penis Procedures with CC/MCC: Inpatient Reimbursement Overview

    710-PENIS-PROCEDURES-WITHOUT-CC-MCC

    Penis Procedures without CC/MCC: Inpatient Reimbursement Overview

    711-TESTES-PROCEDURES-WITH-CC-MCC

    Testes Procedures with CC/MCC: Inpatient Reimbursement Overview

    712-TESTES-PROCEDURES-WITHOUT-CC-MCC

    Testes Procedures without CC/MCC: Inpatient Reimbursement Overview

    713-TRANSURETHRAL-PROSTATECTOMY-WITH-CC-MCC

    Transurethral Prostatectomy with CC/MCC: Inpatient Reimbursement Overview

    714-TRANSURETHRAL-PROSTATECTOMY-WITHOUT-CC-MCC

    Transurethral Prostatectomy without CC/MCC: Inpatient Reimbursement Overview

    715-OTHER-MALE-REPRODUCTIVE-SYSTEM-O-R-PROCEDURES-FOR-MALIGNANCY-WITH-CC-MCC

    Other Male Reproductive System O.R. Procedures for Malignancy with CC/MCC: Inpatient Reimbursement Overview

    716-OTHER-MALE-REPRODUCTIVE-SYSTEM-O-R-PROCEDURES-FOR-MALIGNANCY-WITHOUT-CC-MCC

    Other Male Reproductive System O.R. Procedures for Malignancy without CC/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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