HIV with Major Related Condition with CC DRG Reimbursement

DRG 975 Overview

DRG 975 covers inpatient admissions for human immunodeficiency virus with a Major Complication or Comorbidity and a Complication or Comorbidity that significantly increase resource use. This Diagnosis-Related Group applies when patients with human immunodeficiency virus present with serious concurrent conditions such as opportunistic infections or significant organ dysfunction. It matters for Medicare payment because the presence of a Major Complication or Comorbidity and a Complication or Comorbidity increases the relative resource intensity and affects the inpatient reimbursement rate under inpatient prospective payment systems. Accurate documentation and coding of the primary diagnosis and all Major Complication or Comorbidity and Complication or Comorbidity are central to proper assignment to this Diagnosis-Related Group.

HIV with Major Related Condition with CC: Inpatient Reimbursement Overview

DRG 975 addresses inpatient stays for human immunodeficiency virus with a Major Complication or Comorbidity and a Complication or Comorbidity, involving significant additional resource needs. Correct classification under this Diagnosis-Related Group affects Medicare inpatient reimbursement by reflecting higher expected costs for care when serious comorbid conditions are present.

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DRG 975 Overview

Clinical Trials

Acute inpatient management trials focusing on optimization of opportunistic infection (OI) treatment strategies in patients hospitalized with advanced HIV and a major related condition (for example, severe bacterial pneumonia, cryptococcal meningitis, or disseminated mycobacterial disease). These studies enroll patients during the index hospitalization to compare timing, dosing, or adjunctive therapies for life‑threatening OIs and evaluate short‑term clinical endpoints such as in‑hospital mortality, ICU transfer, and length of stay. Results inform clinicians on best practices for immediate care and help payers anticipate resource intensity and justify coverage for high‑cost acute interventions.
Comparative effectiveness research examining antiretroviral therapy (ART) strategies and drug‑drug interaction management in patients with HIV complicated by a major related condition and at least one complicating condition (CC). These studies follow hospitalized patients through the transition to maintenance ART (or ART modifications) to determine which regimens or monitoring approaches reduce readmissions, adverse events, and treatment failure in populations with comorbid organ dysfunction, concomitant OI therapy, or polypharmacy. Findings are important for hospitals and payers because they affect post‑discharge medication costs, readmission rates, and long‑term disease control for a high‑resource patient subgroup.
Post‑discharge outcomes and care‑coordination trials that test interventions to improve linkage to outpatient HIV care, adherence support, and management of comorbidities for patients discharged after hospitalization with HIV and a major related condition with CC. These pragmatic trials evaluate models such as intensive case management, telehealth follow‑up, or community‑based support to reduce 30‑ and 90‑day readmissions, emergency department use, and cumulative costs while improving viral suppression and quality of life. Payers and providers value this research because effective transitional care can lower avoidable utilization and downstream expenditures for a population at high risk of recurrent hospital use.

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.

Clinical Trials

Acute inpatient management trials focusing on optimization of opportunistic infection (OI) treatment strategies in patients hospitalized with advanced HIV and a major related condition (for example, severe bacterial pneumonia, cryptococcal meningitis, or disseminated mycobacterial disease). These studies enroll patients during the index hospitalization to compare timing, dosing, or adjunctive therapies for life‑threatening OIs and evaluate short‑term clinical endpoints such as in‑hospital mortality, ICU transfer, and length of stay. Results inform clinicians on best practices for immediate care and help payers anticipate resource intensity and justify coverage for high‑cost acute interventions.
Comparative effectiveness research examining antiretroviral therapy (ART) strategies and drug‑drug interaction management in patients with HIV complicated by a major related condition and at least one complicating condition (CC). These studies follow hospitalized patients through the transition to maintenance ART (or ART modifications) to determine which regimens or monitoring approaches reduce readmissions, adverse events, and treatment failure in populations with comorbid organ dysfunction, concomitant OI therapy, or polypharmacy. Findings are important for hospitals and payers because they affect post‑discharge medication costs, readmission rates, and long‑term disease control for a high‑resource patient subgroup.
Post‑discharge outcomes and care‑coordination trials that test interventions to improve linkage to outpatient HIV care, adherence support, and management of comorbidities for patients discharged after hospitalization with HIV and a major related condition with CC. These pragmatic trials evaluate models such as intensive case management, telehealth follow‑up, or community‑based support to reduce 30‑ and 90‑day readmissions, emergency department use, and cumulative costs while improving viral suppression and quality of life. Payers and providers value this research because effective transitional care can lower avoidable utilization and downstream expenditures for a population at high risk of recurrent hospital use.

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.

HIV with Major Related Condition with CC: Inpatient Reimbursement Overview

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DRG 975 Overview

HIV with Major Related Condition with CC: Inpatient Reimbursement Overview

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DRG 975 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References