Key facts for DRG 516
- FY2027 relative weight
- 2.1180
- Higher than 65% of all MS-DRGs
- Change vs FY2026
- +1.9%
- FY2026 weight 2.0780
- Geometric mean LOS
- 4.0 days
- Arithmetic mean 5.0 days
- MDC
- 08
- Diseases and Disorders of the Musculoskeletal System and Connective Tissue
- Severity level
- with CC (complication or comorbidity)
- Transfer policy
- Post-acute transfer DRG
- Special-pay DRG
TL;DR
MS-DRG 516 is a surgical group in MDC 08 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) at the middle severity level of its family. CMS assigns it a FY2027 relative weight of 2.1180 with a geometric mean length of stay of 4.0 days and an arithmetic mean of 5.0. Its weight moved up 1.9% from FY2026 (2.0780). That weight is higher than 65% of all surgical and medical MS-DRGs. Its CC/MCC family (DRG 515, DRG 517) spans weights 1.5730 to 3.1890. The v44 Definitions Manual assigns it through 4626 operating room procedures codes.
What changed from FY2026 to FY2027
CMS recalibrates every MS-DRG weight annually from the prior year's MedPAR claims. For DRG 516 the FY2027 relative weight is 2.1180 against 2.0780 in FY2026, a rise of 1.92%.
| Metric | FY2026 | FY2027 | Change |
|---|---|---|---|
| Relative weight | 2.0780 | 2.1180 | +0.0400 |
| Geometric mean LOS (days) | 4.0 | 4.0 | +0.0 |
| Arithmetic mean LOS (days) | 5.1 | 5.0 | -0.1 |
CC and MCC family
DRG 516 shares its base definition with 2 other MS-DRGs split by severity. The family's weights span 1.5730 to 3.1890, a 2.03× spread, which is the payment effect of documenting qualifying complications and comorbidities.
| DRG | Title | FY2027 weight | GMLOS |
|---|---|---|---|
| 515 | Other Musculoskeletal System and Connective Tissue O.R. Procedures with MCC | 3.1890 | 6.7 |
| 516 | Other Musculoskeletal System and Connective Tissue O.R. Procedures with CC | 2.1180 | 4.0 |
| 517 | Other Musculoskeletal System and Connective Tissue O.R. Procedures without CC/MCC | 1.5730 | 2.3 |
Grouper logic (v44 Definitions Manual)
Operating Room Procedures: 4626 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 008F0ZZ | Division of Olfactory Nerve, Open Approach |
| 008F3ZZ | Division of Olfactory Nerve, Percutaneous Approach |
| 008F4ZZ | Division of Olfactory Nerve, Percutaneous Endoscopic Approach |
| 008G0ZZ | Division of Optic Nerve, Open Approach |
| 008G3ZZ | Division of Optic Nerve, Percutaneous Approach |
| 008G4ZZ | Division of Optic Nerve, Percutaneous Endoscopic Approach |
| 008H0ZZ | Division of Oculomotor Nerve, Open Approach |
| 008H3ZZ | Division of Oculomotor Nerve, Percutaneous Approach |
| 008H4ZZ | Division of Oculomotor Nerve, Percutaneous Endoscopic Approach |
| 008J0ZZ | Division of Trochlear Nerve, Open Approach |
| 008J3ZZ | Division of Trochlear Nerve, Percutaneous Approach |
| 008J4ZZ | Division of Trochlear Nerve, Percutaneous Endoscopic Approach |
Documentation and denial exposure
As a surgical DRG, assignment depends on a qualifying operating-room procedure being coded from the operative report; a missing or non-OR procedure code drops the stay into a medical DRG in MDC 08 with a lower weight. Because this family splits by severity, auditors target CC and MCC capture: each secondary diagnosis must be documented as present, monitored, evaluated or treated during the stay to survive a DRG-validation review. Typical inpatient denial codes for this group: CARC 16 (claim lacks information needed to group the stay), CARC 50 (the admission or procedure is judged not medically necessary), CARC 97 (a service is bundled into the DRG payment).
How QuickIntell uses DRG 516 data
QuickCode groups inpatient encounters against the current v44 logic, flags CC and MCC candidates that lack supporting documentation, and shows the weight difference across the family before the claim drops. QuickScribe captures the attending's language that supports severity, and QuickRCM works DRG-validation denials with the grouper evidence attached.
Frequently asked questions — DRG 516
What is MS-DRG 516?
MS-DRG 516 is "Other Musculoskeletal System and Connective Tissue O.R. Procedures with CC", a surgical Medicare Severity Diagnosis-Related Group in MDC 08, Diseases and Disorders of the Musculoskeletal System and Connective Tissue. Medicare pays inpatient stays grouped here at the hospital's base rate multiplied by the DRG relative weight.
What is the FY2027 relative weight for DRG 516?
The FY2027 relative weight is 2.1180 (IPPS final rule Table 5, effective October 1, 2026). In FY2026 it was 2.0780, a change of +1.9%.
What is the average length of stay for DRG 516?
CMS reports a geometric mean length of stay of 4.0 days and an arithmetic mean of 5.0 days for FY2027. The geometric mean is used for transfer-payment calculations.
Which DRGs are in the same CC/MCC family as 516?
DRG 515 (Other Musculoskeletal System and Connective Tissue O.R. Procedures with MCC, weight 3.1890); DRG 517 (Other Musculoskeletal System and Connective Tissue O.R. Procedures without CC/MCC, weight 1.5730). The family's weights range from 1.5730 to 3.1890, so documented complications and comorbidities change payment materially.
What documentation supports the severity level of DRG 516?
DRG 516 is reached when the stay carries a secondary diagnosis from the CMS Complication or Comorbidity list but none from the MCC list. Common CC captures include chronic kidney disease stage 3 and above, uncontrolled diabetes with manifestations, malnutrition of specified severity and heart failure of a stated type. Each must be documented by the treating clinician and show clinical relevance in the record; a condition listed only in the problem list without assessment is the most frequent reason a CC is removed on audit and the stay drops to the base DRG.
Which codes group to DRG 516?
The v44 Definitions Manual lists 4626 operating room procedures codes for this group. Examples from the operating room procedures list: 008F0ZZ (Division of Olfactory Nerve, Open Approach); 008F3ZZ (Division of Olfactory Nerve, Percutaneous Approach); 008F4ZZ (Division of Olfactory Nerve, Percutaneous Endoscopic Approach); 008G0ZZ (Division of Optic Nerve, Open Approach).
Is DRG 516 a post-acute transfer DRG?
Yes. CMS flags DRG 516 under the post-acute care transfer policy, so a discharge to a qualifying post-acute setting before the geometric mean length of stay is paid a per-diem amount rather than the full DRG payment. It is also a special-pay DRG.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.
- IPPS FY2027 Final Rule Table 5 (CMS-1849-F)Version v44 FY2027 · effective 2026-10-01 · file CMS-1849-F Table 5.txtSHA-256 01003dd571c1e2f5…
- IPPS FY2026 Final Rule Table 5 (CMS-1833-F)Version v43 FY2026 · effective 2025-10-01 · file CMS-1833-F Table 5.txtSHA-256 bf8c390d14b3cd3e…
- ICD-10 MS-DRG Definitions Manual v44 (text)Version v44 · effective 2026-10-01 · file fy2027-fr-icd10-ms-drg-definitions-manual-files-v44.zipSHA-256 ae4f6c11727fe91f…
Disclaimer
This page is an operational reference compiled from the CMS IPPS FY2027 final rule (Table 5) and the v44 ICD-10 MS-DRG Definitions Manual. Relative weights are national factors; actual payment depends on each hospital's wage-adjusted base rate, add-ons, outliers and transfer adjustments. Nothing here is legal, clinical or billing advice; verify grouping against your encoder and the published CMS files.