CMS finalized three new MS-DRGs — 523, 524 and 525 — in its fiscal 2027 inpatient prospective payment system final rule, published Aug. 4 and effective Oct. 1.
The new DRG family, “Extensive or Complex Spinal Fusion Procedures Except Cervical,” is meant to better align payment with the resource intensity of the most complicated fusion cases, separating them from lower-acuity fusions that had been grouped together, according to the rule.
The change stemmed from separate requests from SI-Bone and Carlsmed. Each company had asked CMS to reassign cases using their respective implants, SI-Bone’s iFuse Bedrock Granite pelvic fixation system and Carlsmed’s Aprevo interbody fusion device, into existing higher-paying DRGs. Rather than grant either request individually, CMS created a shared DRG family that captures extensive fusion cases using either device, or both.
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