HIV with Major Related Condition without CC/MCC DRG Reimbursement

DRG 976 Overview

DRG 976 covers inpatient admissions for human immunodeficiency virus infection accompanied by a major related condition but without a Major Complication or Comorbidity or a Complication or Comorbidity. Typical cases include patients with significant HIV-related illness requiring medical management, monitoring, and supportive care during the hospital stay. This Diagnosis-Related Group matters for Centers for Medicare & Medicaid Services payment because it assigns a bundled reimbursement level reflecting moderate resource intensity for HIV admissions without additional complicating diagnoses. Proper coding of the primary diagnosis and any comorbid conditions determines eligibility for this Diagnosis-Related Group.

HIV with Major Related Condition without CC/MCC: Inpatient Reimbursement Overview

DRG 976 encompasses inpatient stays for human immunodeficiency virus infection with a major related condition but without a Major Complication or Comorbidity or a Complication or Comorbidity, and defines a mid-range resource group for Medicare reimbursement. Accurate clinical documentation and coding of the principal diagnosis and related conditions affect placement in this Diagnosis-Related Group and therefore influence inpatient payment.

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DRG 976 Overview

Clinical Trials

Acute inpatient management trials evaluating optimized protocols for treating HIV-related major opportunistic infections or complications: these studies enroll hospitalized adults with advanced HIV disease presenting with severe opportunistic infections (such as cryptococcal meningitis, severe bacterial infections, or opportunistic pulmonary disease) to assess timing and combination of antimicrobial therapies, supportive care bundles, and monitoring strategies. The objective is to reduce in-hospital morbidity and mortality and shorten length of stay by identifying evidence-based acute interventions; results are directly relevant to clinicians setting inpatient care pathways and to payers focusing on cost drivers like ICU utilization and readmission risk.
Comparative effectiveness studies of antiretroviral therapy (ART) initiation strategies and drug regimen selection in the context of major comorbidity management: these trials or prospective cohort studies compare outcomes of immediate versus deferred ART start, or different ART classes, in hospitalized patients with a major related condition (without additional CC/MCC), assessing virologic suppression, drug–drug interactions, and short-term adverse events. This research addresses the clinical question of how best to integrate HIV-specific treatment with concurrent management of the presenting major condition; findings inform providers on safe, effective regimen choices during hospitalization and help payers evaluate downstream costs related to treatment complications or improved viral control.
Post-discharge outcomes and care-transition research focused on linkage to outpatient HIV care, adherence support, and prevention of readmission: these pragmatic trials and implementation studies enroll patients discharged after an admission for HIV with a major related condition to test interventions such as rapid outpatient appointments, case management, and mobile health adherence supports. The goal is to measure effects on 30- and 90-day readmissions, retention in care, and sustained viral suppression; this area is critical for hospitals and payers because effective transitions reduce avoidable readmissions, downstream acute care costs, and long-term disease progression.

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 evaluating optimized protocols for treating HIV-related major opportunistic infections or complications: these studies enroll hospitalized adults with advanced HIV disease presenting with severe opportunistic infections (such as cryptococcal meningitis, severe bacterial infections, or opportunistic pulmonary disease) to assess timing and combination of antimicrobial therapies, supportive care bundles, and monitoring strategies. The objective is to reduce in-hospital morbidity and mortality and shorten length of stay by identifying evidence-based acute interventions; results are directly relevant to clinicians setting inpatient care pathways and to payers focusing on cost drivers like ICU utilization and readmission risk.
Comparative effectiveness studies of antiretroviral therapy (ART) initiation strategies and drug regimen selection in the context of major comorbidity management: these trials or prospective cohort studies compare outcomes of immediate versus deferred ART start, or different ART classes, in hospitalized patients with a major related condition (without additional CC/MCC), assessing virologic suppression, drug–drug interactions, and short-term adverse events. This research addresses the clinical question of how best to integrate HIV-specific treatment with concurrent management of the presenting major condition; findings inform providers on safe, effective regimen choices during hospitalization and help payers evaluate downstream costs related to treatment complications or improved viral control.
Post-discharge outcomes and care-transition research focused on linkage to outpatient HIV care, adherence support, and prevention of readmission: these pragmatic trials and implementation studies enroll patients discharged after an admission for HIV with a major related condition to test interventions such as rapid outpatient appointments, case management, and mobile health adherence supports. The goal is to measure effects on 30- and 90-day readmissions, retention in care, and sustained viral suppression; this area is critical for hospitals and payers because effective transitions reduce avoidable readmissions, downstream acute care costs, and long-term disease progression.

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 without CC/MCC: Inpatient Reimbursement Overview

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DRG 976 Overview

HIV with Major Related Condition without CC/MCC: Inpatient Reimbursement Overview

Sign up for drg 976 policy alerts

DRG 976 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References