Comprehensive Guide to 2026 Diagnosis Related Groups (DRG) Codes
December 23, 2025
Understanding the structure and significance of Diagnosis Related Groups (DRGs) is crucial for anyone involved in healthcare administration, medical billing, or hospital management. These classification systems serve as the backbone of hospital reimbursement models, especially within Medicare and other insurance programs, facilitating standardized payments based on patient diagnoses and severity levels. As healthcare evolves, so do the coding systems, making it essential to stay updated on the latest DRG codes and their applications for 2026.
The concept of DRGs was initially developed in the mid-1960s at Yale University, aiming to create an efficient framework for monitoring healthcare quality and resource utilization in hospitals. This patient classification system links specific diagnoses and procedures to associated costs, enabling more predictable and equitable hospital reimbursements. The first large-scale implementation of DRGs occurred in the late 1970s in New Jersey, where the state employed them as the basis for a prospective payment system, providing hospitals with fixed payments for treating patients within each DRG category. This approach shifted the focus toward cost-containment and efficiency.
The significance of DRGs grew further with legislative changes. In 1982, the Tax Equity and Fiscal Responsibility Act (TEFRA) amended Medicare reimbursement limits to incorporate case-mix adjustments based on DRGs. Subsequently, in 1983, Congress integrated the DRG system into the Social Security Act, establishing a nationwide prospective payment system applicable to most Medicare beneficiaries. This transition marked a fundamental shift in hospital funding, emphasizing diagnosis-based payments aligned with patient severity.
Below is an extensive list of DRG codes for 2026, categorized by medical specialty, procedure type, and severity. These codes are vital for accurate billing, reporting, and reimbursement processes. Healthcare providers and billing specialists should familiarize themselves with these classifications to ensure compliance and optimize revenue cycles.
List of Diagnosis Related Groups (DRGs) for 2026
“`markdown
| DRG Code | Description |
| ——– | ———– |
| 001 | Heart transplant or implant of heart assist system with Major Complication or Comorbidity (MCC) |
| 002 | Heart transplant or implant of heart assist system without MCC |
| 003 | ECMO or tracheostomy with mechanical ventilation >96 hours, or principal diagnosis excluding face, mouth, and neck with major operating room procedures |
| 004 | Tracheostomy with mechanical ventilation >96 hours, or principal diagnosis excluding face, mouth, and neck without major operating room procedures |
| 005 | Liver transplant with MCC or intestinal transplant |
| 006 | Liver transplant without MCC |
| 007 | Lung transplant |
| 008 | Simultaneous pancreas and kidney transplant |
| 010 | Pancreas transplant |
| 011 | Tracheostomy for face, mouth, and neck diagnoses or laryngectomy with MCC |
| 012 | Tracheostomy for face, mouth, and neck diagnoses or laryngectomy with CC (Chronic Condition) |
| 013 | Tracheostomy for face, mouth, and neck diagnoses or laryngectomy without CC/MCC |
| 014 | Allogeneic bone marrow transplant |
| 016 | Autologous bone marrow transplant with CC/MCC |
| 017 | Autologous bone marrow transplant without CC/MCC |
| 018 | Chimeric antigen receptor (CAR) T-cell therapy and other immunotherapies |
| 019 | Simultaneous pancreas and kidney transplant with hemodialysis |
| 020 | Intracranial vascular procedures with principal diagnosis of hemorrhage with MCC |
| 021 | Intracranial vascular procedures with hemorrhage and CC |
| 022 | Intracranial vascular procedures with hemorrhage without CC/MCC |
| 023 | Craniotomy with major device implant or acute complex CNS diagnosis with MCC or chemotherapy implant or epilepsy with neurostimulator |
| 024 | Craniotomy with major device implant or acute complex CNS diagnosis without MCC |
| 025 | Craniotomy and endovascular intracranial procedures with MCC |
| 026 | Craniotomy and endovascular intracranial procedures with CC |
| 027 | Craniotomy and endovascular intracranial procedures without CC/MCC |
| 028 | Spinal procedures with MCC |
| 029 | Spinal procedures with CC or spinal neurostimulators |
| 030 | Spinal procedures without CC/MCC |
| 031 | Ventricular shunt procedures with MCC |
| 032 | Ventricular shunt procedures with CC |
| 033 | Ventricular shunt procedures without CC/MCC |
| 034 | Carotid artery stent procedures with MCC |
| 036 | Carotid artery stent procedures without CC/MCC |
| 038 | Extracranial procedures with CC |
| 040 | Peripheral, cranial nerve, and other nervous system procedures with MCC |
| 042 | Peripheral, cranial nerve, and other nervous system procedures without CC/MCC |
| 053 | Spinal disorders and injuries without CC/MCC |
| 055 | Nervous system neoplasms without MCC |
| 057 | Degenerative nervous system disorders without MCC |
| 059 | Multiple sclerosis and cerebellar ataxia with CC |
| 061 | Ischemic stroke, pre-cerebral occlusion, or transient ischemia with thrombolytic agent with MCC |
| 063 | Ischemic stroke, pre-cerebral occlusion, or transient ischemia with thrombolytic agent without CC/MCC |
| 065 | Intracranial hemorrhage or cerebral infarction with CC or TPA within 24 hours |
| 067 | Nonspecific CVA and pre-cerebral occlusion without infarction with MCC |
| 069 | Transient ischemia without thrombolytic therapy |
| 071 | Nonspecific cerebrovascular disorders with CC |
| 073 | Cranial and peripheral nerve disorders with MCC |
| 075 | Viral meningitis with CC/MCC |
| 077 | Hypertensive encephalopathy with MCC |
| 079 | Hypertensive encephalopathy without CC/MCC |
| 081 | Nontraumatic stupor and coma without MCC |
| 083 | Traumatic stupor and coma over 1 hour with CC |
| 085 | Traumatic stupor and coma under 1 hour with MCC |
| 087 | Traumatic stupor and coma under 1 hour without CC/MCC |
| 089 | Concussion with CC |
| 091 | Other nervous system disorders with MCC |
| 093 | Other nervous system disorders without CC/MCC |
| 095 | Bacterial and tuberculous infections of nervous system with CC |
| 097 | Nonbacterial infections of nervous system, excluding viral meningitis, with MCC |
| 099 | Nonbacterial infections of nervous system, excluding viral meningitis, without CC/MCC |
| 100 | Seizures with MCC |
| 101 | Seizures without MCC |
| 102 | Headaches with MCC |
| 103 | Headaches without MCC |
| 113 | Orbital procedures with CC/MCC |
| 114 | Orbital procedures without CC/MCC |
| 115 | Extraocular procedures (except orbit) |
| 116 | Intraocular procedures with CC/MCC |
| 117 | Intraocular procedures without CC/MCC |
| 121 | Acute major eye infections with CC/MCC |
| 122 | Acute major eye infections without CC/MCC |
| 123 | Neurological eye disorders |
| 124 | Other eye disorders with MCC |
| 125 | Other eye disorders without MCC |
| 135 | Sinus and mastoid procedures with CC/MCC |
| 136 | Sinus and mastoid procedures without CC/MCC |
| 137 | Mouth procedures with CC/MCC |
| 138 | Mouth procedures without CC/MCC |
| 139 | Salivary gland procedures |
| 140 | Major head and neck procedures with MCC |
| 141 | Major head and neck procedures with CC |
| 142 | Major head and neck procedures without CC/MCC |
| 143 | Other ear, nose, mouth, and throat O.R. procedures with MCC |
| 144 | Other ear, nose, mouth, and throat O.R. procedures with CC |
| 145 | Other ear, nose, mouth, and throat O.R. procedures without CC/MCC |
| 146 | Ear, nose, mouth, and throat malignancy with MCC |
| 147 | Ear, nose, mouth, and throat malignancy with CC |
| 148 | Ear, nose, mouth, and throat malignancy without CC/MCC |
| 149 | Dysquilibrium |
| 150 | Epistaxis with MCC |
| 151 | Epistaxis without MCC |
| 152 | Otitis media and URI with MCC |
| 153 | Otitis media and URI without MCC |
| 154 | Other ear, nose, mouth, and throat diagnoses with MCC |
| 163 | Major chest procedures with MCC |
| 164 | Major chest procedures with CC |
| 165 | Major chest procedures without CC/MCC |
| 166 | Other respiratory system O.R. procedures with MCC |
| 167 | Other respiratory system O.R. procedures with CC |
| 168 | Other respiratory system O.R. procedures without CC/MCC |
| 175 | Pulmonary embolism with MCC or acute cor pulmonale |
| 176 | Pulmonary embolism without MCC |
| 177 | Respiratory infections and inflammations with MCC |
| 178 | Respiratory infections and inflammations with CC |
| 179 | Respiratory infections and inflammations without CC/MCC |
| 180 | Respiratory neoplasms with MCC |
| 181 | Respiratory neoplasms with CC |
| 182 | Respiratory neoplasms without CC/MCC |
| 183 | Major chest trauma with MCC |
| 184 | Major chest trauma with CC |
| 185 | Major chest trauma without CC/MCC |
| 186 | Pleural effusion with MCC |
| 187 | Pleural effusion with CC |
| 188 | Pleural effusion without CC/MCC |
| 189 | Pulmonary edema and respiratory failure |
| 190 | Chronic obstructive pulmonary disease (COPD) with MCC |
| 191 | COPD with CC |
| 192 | COPD without CC/MCC |
| 193 | Simple pneumonia and pleurisy with MCC |
| 194 | Simple pneumonia and pleurisy with CC |
| 195 | Simple pneumonia and pleurisy without CC/MCC |
| 196 | Interstitial lung disease with MCC |
| 197 | Interstitial lung disease with CC |
| 198 | Interstitial lung disease without CC/MCC |
| 199 | Pneumothorax with MCC |
| 200 | Pneumothorax with CC |
| 201 | Pneumothorax without CC/MCC |
| 202 | Bronchitis and asthma with CC/MCC |
| 203 | Bronchitis and asthma without CC/MCC |
| 204 | Respiratory signs and symptoms |
| 205 | Other respiratory diagnoses with MCC |
| 206 | Other respiratory diagnoses without MCC |
| 207 | Respiratory diagnoses with ventilator support >96 hours |
| 208 | Respiratory diagnoses with ventilator support ≤96 hours |
| 215 | Other heart assist system implants |
| 216 | Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with MCC |
| 217 | Cardiac valve and other procedures with catheterization with CC |
| 218 | Cardiac valve and other procedures without catheterization with MCC |
| 219 | Cardiac valve and other procedures without catheterization with MCC |
| 220 | Cardiac valve and other procedures without catheterization with CC |
| 221 | Cardiac valve and other procedures without catheterization without CC/MCC |
| 222 | Cardiac defibrillator implant with catheterization and AMI, HF, or shock with MCC |
| 223 | Cardiac defibrillator implant with catheterization without MCC |
| 224 | Cardiac defibrillator implant without catheterization with MCC |
| 225 | Cardiac defibrillator generator procedures |
| 226 | Percutaneous cardiovascular procedures with drug-eluting stent and MCC |
| 227 | Percutaneous cardiovascular procedures with drug-eluting stent without MCC |
| 228 | Percutaneous procedures with non-drug-eluting stent and MCC |
| 229 | Percutaneous procedures with non-drug-eluting stent without MCC |
| 230 | Other vascular procedures with MCC |
| 231 | Other vascular procedures with CC |
| 232 | Other vascular procedures without CC/MCC |
| 233 | Upper limb and toe amputations with MCC |
| 234 | Upper limb and toe amputations with CC |
| 235 | Upper limb and toe amputations without CC/MCC |
| 236 | Cardiac pacemaker device replacements with MCC |
| 237 | Cardiac pacemaker device replacements without MCC |
| 238 | Cardiac pacemaker revisions with MCC |
| 239 | Cardiac pacemaker revisions without CC/MCC |
| 240 | Vein ligation and stripping |
| 241 | Other circulatory system O.R. procedures |
| 242 | AICD lead procedures |
| 243 | Endovascular cardiac valve replacement and related procedures with MCC |
| 244 | Endovascular cardiac valve replacement without MCC |
| 245 | Aortic and heart assist procedures except pulsation balloon with MCC |
| 246 | Aortic and heart assist procedures except pulsation balloon without MCC |
| 247 | Other major cardiovascular procedures with MCC |
| 248 | Other major cardiovascular procedures with CC |
| 249 | Other major cardiovascular procedures without CC/MCC |
| 250 | Percutaneous and intracardiac procedures with MCC |
| 251 | Percutaneous and intracardiac procedures without MCC |
| 252 | Major myocardial infarction, discharged alive with MCC |
| 253 | Discharged alive with CC |
| 254 | Without CC/MCC |
| 255 | Circulatory disorders (except MI) with cardiac catheterization and MCC |
| 256 | Circulatory disorders (except MI) with cardiac catheterization without MCC |
| 257 | Acute and subacute endocarditis with MCC |
| 258 | Endocarditis with CC |
| 259 | Endocarditis without CC/MCC |
| 260 | Heart failure and shock with MCC |
| 261 | Heart failure and shock with CC |
| 262 | Heart failure and shock without CC/MCC |
| 263 | Deep vein thrombophlebitis with CC/MCC |
| 264 | Deep vein thrombophlebitis without CC/MCC |
| 265 | Cardiac arrest, unexplained, with MCC |
| 266 | Cardiac arrest, unexplained, with CC |
| 267 | Cardiac arrest, unexplained, without CC/MCC |
| 268 | Peripheral vascular disorders with MCC |
| 269 | Peripheral vascular disorders with CC |
| 270 | Peripheral vascular disorders without CC/MCC |
| 271 | Atherosclerosis with MCC |
| 272 | Atherosclerosis without MCC |
| 273 | Hypertension with MCC |
| 274 | Hypertension without MCC |
| 275 | Congenital and valvular heart disorders with MCC |
| 276 | Congenital and valvular heart disorders without MCC |
| 277 | Arrhythmias and conduction disorders with MCC |
| 278 | Arrhythmias and conduction disorders with CC |
| 279 | Arrhythmias and conduction disorders without CC/MCC |
| 280 | Angina pectoris |
| 281 | Syncope and collapse |
| 282 | Chest pain |
| 283 | Other circulatory diagnoses with MCC |
| 284 | Other circulatory diagnoses with CC |
| 285 | Other circulatory diagnoses without CC/MCC |
| 286 | Other endovascular cardiac procedures with MCC |
| 287 | Other endovascular cardiac procedures without MCC |
| 288 | Aortic and heart assist procedures, excluding pulsation balloon, with MCC |
| 289 | Aortic and heart assist procedures, excluding pulsation balloon, without MCC |
| 290 | Other major cardiovascular procedures with MCC |
| 291 | Other major cardiovascular procedures with CC |
| 292 | Other major cardiovascular procedures without CC/MCC |
| 293 | Percutaneous and intracardiac procedures with MCC |
| 294 | Percutaneous and intracardiac procedures without MCC |
| 295 | Major MI, discharged alive with MCC |
| 296 | MI, discharged alive with CC |
| 297 | MI, discharged alive without CC/MCC |
| 298 | MI, expired with MCC |
| 299 | MI, expired with CC |
| 300 | MI, expired without CC/MCC |
(Note: The list continues extensively covering various cardiac, vascular, respiratory, neurological, and other specialized diagnoses and procedures. For comprehensive coding, refer to official CMS resources and coding manuals.)
Familiarity with these classifications ensures precise billing and compliance, which are vital for hospital operations and financial health. Modern healthcare increasingly relies on advanced data analysis and artificial intelligence, which can enhance patient outcomes and operational efficiency. To understand more about this, explore how AI improves healthcare, and the profound influence it has on medical services. Additionally, the role of data collection in healthcare cannot be overstated; it underpins the accuracy of coding systems like DRGs and supports clinical decision-making. Discover why data gathering is essential in healthcare to appreciate its importance.
Regular updates to DRG codes and understanding their application are fundamental for professionals in healthcare finance, coding, and administration. Staying current ensures compliance, optimizes reimbursements, and ultimately improves patient care delivery.