HIV with or without Other Related Condition: Inpatient Reimbursement Overview

DRG 977 addresses inpatient stays for human immunodeficiency virus infection with or without related conditions, including management of opportunistic infections and HIV-related complications. It matters for inpatient reimbursement because Diagnosis-Related Group assignment and documentation of related conditions determine Medicare payment grouping and resource-based hospital reimbursement.

Customize your policy alerts

Sign up for drg 977 policy alerts

Get alerted when payer policies referencing 977 are released or updated.

Monitor payer policy activity

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

DRG 977 Overview

DRG 977 covers inpatient admissions for human immunodeficiency virus infection with or without other related conditions, encompassing primary HIV disease management and associated opportunistic infections or complications. This Diagnosis-Related Group is relevant to inpatient reimbursement because payment is grouped by the principal diagnosis and any documented complications or comorbidities that influence resource use. Accurate coding of HIV and related conditions affects case categorization and the Medicare Severity Diagnosis-Related Group payment assignment. The classification guides hospital billing and reflects clinical complexity during the hospitalization.

Clinical Trials

Acute inpatient antiretroviral management studies: trials in this area evaluate strategies for initiating, modifying, or safely interrupting antiretroviral therapy (ART) during hospitalization for HIV-related or unrelated acute illnesses. Populations include people with newly diagnosed HIV identified during admission, those admitted with opportunistic infections or severe immune suppression, and patients with drug–drug interaction risks from concurrent inpatient therapies. These studies are relevant to clinicians and payers because inpatient ART decisions affect length of stay, complications, readmission risk, and downstream outpatient resource use and costs.
Comparative effectiveness and safety studies of co-infection and comorbidity management: research focused on comparing approaches to diagnosing and managing common inpatient co-conditions (for example, tuberculosis, hepatitis B or C, pneumocystis pneumonia, severe bacterial infections, and cardiopulmonary comorbidities) in people with HIV. These trials or observational comparative studies enroll hospitalized HIV-positive patients with specific co-infections or organ dysfunction to assess outcomes such as mortality, time to clinical stability, adverse events, and need for intensive care. The findings inform hospital protocols, utilization of specialty services, and payer decisions about bundled care pathways and appropriate resource allocation for complex patients in this DRG.
Transitional care, adherence, and health systems outcomes research: interventions tested in this area aim to reduce readmissions and improve linkage to outpatient HIV care after discharge, including models like enhanced discharge planning, case management, telehealth follow-up, and interventions addressing social determinants of health. Study populations are discharged inpatients with HIV who have unstable housing, substance use, mental health comorbidity, or prior gaps in care; endpoints include retention in care, viral suppression, readmission rates, and cost-effectiveness. This research is highly relevant to providers and payers because effective transitional interventions can lower avoidable rehospitalizations, improve long-term outcomes, and optimize reimbursement and care management strategies for the DRG.

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

976-HIV-WITH-MAJOR-RELATED-CONDITION-WITHOUT-CC-MCC

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

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.

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.

Explore openpayer tools

View all tools

Clinical Trials

Acute inpatient antiretroviral management studies: trials in this area evaluate strategies for initiating, modifying, or safely interrupting antiretroviral therapy (ART) during hospitalization for HIV-related or unrelated acute illnesses. Populations include people with newly diagnosed HIV identified during admission, those admitted with opportunistic infections or severe immune suppression, and patients with drug–drug interaction risks from concurrent inpatient therapies. These studies are relevant to clinicians and payers because inpatient ART decisions affect length of stay, complications, readmission risk, and downstream outpatient resource use and costs.
Comparative effectiveness and safety studies of co-infection and comorbidity management: research focused on comparing approaches to diagnosing and managing common inpatient co-conditions (for example, tuberculosis, hepatitis B or C, pneumocystis pneumonia, severe bacterial infections, and cardiopulmonary comorbidities) in people with HIV. These trials or observational comparative studies enroll hospitalized HIV-positive patients with specific co-infections or organ dysfunction to assess outcomes such as mortality, time to clinical stability, adverse events, and need for intensive care. The findings inform hospital protocols, utilization of specialty services, and payer decisions about bundled care pathways and appropriate resource allocation for complex patients in this DRG.
Transitional care, adherence, and health systems outcomes research: interventions tested in this area aim to reduce readmissions and improve linkage to outpatient HIV care after discharge, including models like enhanced discharge planning, case management, telehealth follow-up, and interventions addressing social determinants of health. Study populations are discharged inpatients with HIV who have unstable housing, substance use, mental health comorbidity, or prior gaps in care; endpoints include retention in care, viral suppression, readmission rates, and cost-effectiveness. This research is highly relevant to providers and payers because effective transitional interventions can lower avoidable rehospitalizations, improve long-term outcomes, and optimize reimbursement and care management strategies for the DRG.

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

976-HIV-WITH-MAJOR-RELATED-CONDITION-WITHOUT-CC-MCC

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

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.

Published by

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

HIV with or without Other Related Condition: Inpatient Reimbursement Overview

Sign up for drg 977 policy alerts

DRG 977 Overview

HIV with or without Other Related Condition: Inpatient Reimbursement Overview

Sign up for drg 977 policy alerts

DRG 977 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References