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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

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.

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

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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.

HIV with Extensive O.R. Procedures with MCC: Inpatient Reimbursement Overview

970-HIV-WITH-EXTENSIVE-O-R-PROCEDURES-WITHOUT-MCC

HIV with Extensive O.R. Procedures without MCC: Inpatient Reimbursement Overview

974-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-MCC

HIV with Major Related Condition with MCC: Inpatient Reimbursement Overview

975-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-CC

HIV with Major Related Condition with CC: Inpatient Reimbursement Overview

977-HIV-WITH-OR-WITHOUT-OTHER-RELATED-CONDITION

HIV with or without Other Related Condition: Inpatient Reimbursement Overview

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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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.

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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.

HIV with Extensive O.R. Procedures with MCC: Inpatient Reimbursement Overview

970-HIV-WITH-EXTENSIVE-O-R-PROCEDURES-WITHOUT-MCC

HIV with Extensive O.R. Procedures without MCC: Inpatient Reimbursement Overview

974-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-MCC

HIV with Major Related Condition with MCC: Inpatient Reimbursement Overview

975-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-CC

HIV with Major Related Condition with CC: Inpatient Reimbursement Overview

977-HIV-WITH-OR-WITHOUT-OTHER-RELATED-CONDITION

HIV with or without Other Related Condition: Inpatient Reimbursement Overview

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

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

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DRG 976 Overview

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

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DRG 976 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References