Key facts for DRG 518
- FY2027 relative weight
- 3.7310
- Higher than 84% of all MS-DRGs
- Change vs FY2026
- -0.2%
- FY2026 weight 3.7370
- Geometric mean LOS
- 5.1 days
- Arithmetic mean 7.5 days
- MDC
- 08
- Diseases and Disorders of the Musculoskeletal System and Connective Tissue
- Severity level
- with MCC (major complication or comorbidity)
- Transfer policy
- Post-acute transfer DRG
- Special-pay DRG
TL;DR
MS-DRG 518 is a surgical group in MDC 08 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) at the highest-severity level of its family. CMS assigns it a FY2027 relative weight of 3.7310 with a geometric mean length of stay of 5.1 days and an arithmetic mean of 7.5. Its weight moved down 0.2% from FY2026 (3.7370). That weight is higher than 84% of all surgical and medical MS-DRGs. Its CC/MCC family (DRG 519, DRG 520) spans weights 1.5560 to 3.7310. The v44 Definitions Manual assigns it through 525 operating room procedures codes and 144 neurostimulators codes.
What changed from FY2026 to FY2027
CMS recalibrates every MS-DRG weight annually from the prior year's MedPAR claims. For DRG 518 the FY2027 relative weight is 3.7310 against 3.7370 in FY2026, a fall of 0.16%.
| Metric | FY2026 | FY2027 | Change |
|---|---|---|---|
| Relative weight | 3.7370 | 3.7310 | -0.0060 |
| Geometric mean LOS (days) | 5.3 | 5.1 | -0.2 |
| Arithmetic mean LOS (days) | 7.6 | 7.5 | -0.1 |
CC and MCC family
DRG 518 shares its base definition with 2 other MS-DRGs split by severity. The family's weights span 1.5560 to 3.7310, a 2.40× spread, which is the payment effect of documenting qualifying complications and comorbidities.
| DRG | Title | FY2027 weight | GMLOS |
|---|---|---|---|
| 518 | Back and Neck Procedures Except Spinal Fusion with MCC or Disc Device or Neurostimulator | 3.7310 | 5.1 |
| 519 | Back and Neck Procedures Except Spinal Fusion with CC | 2.0360 | 3.2 |
| 520 | Back and Neck Procedures Except Spinal Fusion without CC/MCC | 1.5560 | 2.1 |
Grouper logic (v44 Definitions Manual)
Operating Room Procedures: 525 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 005T0ZZ | Destruction of Spinal Meninges, Open Approach |
| 005T3ZZ | Destruction of Spinal Meninges, Percutaneous Approach |
| 005T4ZZ | Destruction of Spinal Meninges, Percutaneous Endoscopic Approach |
| 005W0Z3 | Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach |
| 005W0ZZ | Destruction of Cervical Spinal Cord, Open Approach |
| 005W3Z3 | Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Percutaneous Approach |
| 005W3ZZ | Destruction of Cervical Spinal Cord, Percutaneous Approach |
| 005W4Z3 | Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Percutaneous Endoscopic Approach |
| 005W4ZZ | Destruction of Cervical Spinal Cord, Percutaneous Endoscopic Approach |
| 005X0Z3 | Destruction of Thoracic Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach |
| 005X0ZZ | Destruction of Thoracic Spinal Cord, Open Approach |
| 005X3Z3 | Destruction of Thoracic Spinal Cord using Laser Interstitial Thermal Therapy, Percutaneous Approach |
Neurostimulators: 144 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 0JH60BZ | Insertion of Single Array Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60BZ | Insertion of Single Array Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60BZ | Insertion of Single Array Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60BZ | Insertion of Single Array Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60BZ | Insertion of Single Array Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60BZ | Insertion of Single Array Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60CZ | Insertion of Single Array Rechargeable Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60CZ | Insertion of Single Array Rechargeable Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60CZ | Insertion of Single Array Rechargeable Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60CZ | Insertion of Single Array Rechargeable Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60CZ | Insertion of Single Array Rechargeable Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach |
| 0JH60CZ | Insertion of Single Array Rechargeable Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open 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 518 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 518
What is MS-DRG 518?
MS-DRG 518 is "Back and Neck Procedures Except Spinal Fusion with MCC or Disc Device or Neurostimulator", 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 518?
The FY2027 relative weight is 3.7310 (IPPS final rule Table 5, effective October 1, 2026). In FY2026 it was 3.7370, a change of -0.2%.
What is the average length of stay for DRG 518?
CMS reports a geometric mean length of stay of 5.1 days and an arithmetic mean of 7.5 days for FY2027. The geometric mean is used for transfer-payment calculations.
Which DRGs are in the same CC/MCC family as 518?
DRG 519 (Back and Neck Procedures Except Spinal Fusion with CC, weight 2.0360); DRG 520 (Back and Neck Procedures Except Spinal Fusion without CC/MCC, weight 1.5560). The family's weights range from 1.5560 to 3.7310, so documented complications and comorbidities change payment materially.
What documentation supports the severity level of DRG 518?
DRG 518 requires at least one secondary diagnosis on the CMS Major Complication or Comorbidity list, documented as present and clinically addressed during the stay (monitored, evaluated, treated or extending the stay). Conditions such as acute respiratory failure, severe sepsis or acute kidney injury with specified cause qualify only when the attending's note states the diagnosis itself, not just the lab values. Recovery auditors downgrade this group to the CC or base level when the MCC rests on an unconfirmed query or a resolved historical condition, so the query response and the discharge summary must agree.
Which codes group to DRG 518?
The v44 Definitions Manual lists 525 operating room procedures codes and 144 neurostimulators codes for this group. Examples from the operating room procedures list: 005T0ZZ (Destruction of Spinal Meninges, Open Approach); 005T3ZZ (Destruction of Spinal Meninges, Percutaneous Approach); 005T4ZZ (Destruction of Spinal Meninges, Percutaneous Endoscopic Approach); 005W0Z3 (Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach).
Is DRG 518 a post-acute transfer DRG?
Yes. CMS flags DRG 518 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.