Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • 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.

    v1.0.30
    OpenPayerBilling CodesMultiple Significant TraumaDRG 964-other-multiple-significant-trauma-with-cc
    Ask Trek AI about this page

    Other Multiple Significant Trauma with CC: Inpatient Reimbursement Overview

    DRG 964 encompasses patients with multiple significant traumatic injuries including at least one Complication or Comorbidity but no Major Complication or Comorbidity, representing a high-resource inpatient trauma population. Understanding this Diagnosis-Related Group is important because it determines Medicare inpatient reimbursement and influences hospital case-mix index and payment under the prospective payment framework.

    Customize your policy alerts

    Sign up for drg 964 policy alerts

    Get alerted when payer policies referencing 964 are released or updated.

    Monitor payer policy activity

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

    DRG 964 Overview

    DRG 964 covers hospital admissions for patients with multiple significant traumatic injuries where at least one injury is a Complication or Comorbidity and there is no Major Complication or Comorbidity present. This Diagnosis-Related Group aggregates complex trauma care that typically requires multisystem evaluation, operative or nonoperative interventions, and extended inpatient resource use. It matters for Medicare payment because it groups resource intensity for reimbursement and affects hospital case-mix and prospective payment calculations. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and related payment implications.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • 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 hemostasis and resuscitation trials: randomized or pragmatic studies testing timing, ratios, and protocols for blood product transfusion, tranexamic acid administration windows, and damage-control resuscitation strategies in adult and adolescent patients with multiple significant traumatic injuries and at least one complicating comorbidity (eg, anticoagulation, advanced age). These trials focus on the hyperacute phase (prehospital and first 24 hours) to reduce mortality and control hemorrhage, and are relevant because early management drives ICU needs, procedure utilization, and short-term mortality that heavily influence inpatient resource use and DRG cost variability. Providers benefit from evidence to optimize protocols across trauma centers, while payers and hospital administrators need data on which acute approaches reduce expensive downstream interventions and length of stay.
    • Comparative effectiveness studies of operative versus nonoperative management across injury patterns and comorbid conditions: multicenter observational cohorts or randomized studies evaluating outcomes for specific combinations of injuries (eg, polytrauma with pelvic fracture plus thoracic injury) and common complicating conditions (eg, chronic heart disease, diabetes). These studies examine functional outcomes, complication rates, reoperation or readmission frequency, and resource utilization during the index hospitalization and up to 90 days, helping determine which management pathways produce better recovery with fewer complications in the multiple-significant-trauma population with a CC. Such evidence guides surgical decision-making and care pathways, directly impacting inpatient costs, DRG assignment complexity, and payer decisions about bundled payments or prior authorization for high-cost procedures.
    • Post-discharge recovery, complications surveillance, and rehabilitation effectiveness studies: prospective cohort studies and pragmatic trials testing timing/intensity of inpatient-to-outpatient rehabilitation, transitional care interventions, and surveillance strategies to detect late complications (eg, infection, thromboembolism, wound failure) in survivors of multiple significant trauma who had concurrent complicating conditions. These studies target the subacute period (discharge to 12 months), measure functional status, readmissions, and need for home health or long-term care, and are important because post-acute outcomes drive total cost of care, long-term disability rates, and readmission penalties that affect both providers and payers managing patients classified under this DRG.

    Related Codes

    955-CRANIOTOMY-FOR-MULTIPLE-SIGNIFICANT-TRAUMA

    Craniotomy for Multiple Significant Trauma: Inpatient Reimbursement Overview

    956-LIMB-REATTACHMENT-HIP-AND-FEMUR-PROCEDURES-FOR-MULTIPLE-SIGNIFICANT-TRAUMA

    Limb Reattachment, Hip and Femur Procedures for Multiple Significant Trauma: Inpatient Reimbursement Overview

    957-OTHER-O-R-PROCEDURES-FOR-MULTIPLE-SIGNIFICANT-TRAUMA-WITH-MCC

    Other O.R. Procedures for Multiple Significant Trauma with MCC: Inpatient Reimbursement Overview

    958-OTHER-O-R-PROCEDURES-FOR-MULTIPLE-SIGNIFICANT-TRAUMA-WITH-CC

    Other O.R. Procedures for Multiple Significant Trauma with CC: Inpatient Reimbursement Overview

    959-OTHER-O-R-PROCEDURES-FOR-MULTIPLE-SIGNIFICANT-TRAUMA-WITHOUT-CC-MCC

    Other O.R. Procedures for Multiple Significant Trauma without CC/MCC: Inpatient Reimbursement Overview

    963-OTHER-MULTIPLE-SIGNIFICANT-TRAUMA-WITH-MCC

    Other Multiple Significant Trauma with MCC: Inpatient Reimbursement Overview

    965-OTHER-MULTIPLE-SIGNIFICANT-TRAUMA-WITHOUT-CC-MCC

    Other Multiple Significant Trauma without CC/MCC: Inpatient Reimbursement Overview

    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.