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Diagnosis-Related Group Inpatient Reimbursement

The Diagnosis-Related Group (DRG) inpatient reimbursement methodology is a classification system that categorizes patients according to their diagnoses and the severity of their illness to determine reimbursement.

Please see the Inpatient Hospital Services provider reference module and other IHCP provider publications for specific information regarding the inpatient hospital reimbursement methodologies and billing instructions.

APR-DRG Grouper, Version 36

The 3M All-Patient Refined (APR)-DRG grouper, version 36, is effective for inpatient stays with discharge dates on or after August 1, 2020. See IHCP Provider Bulletin BT202077 for related information.

For a table of relative weights and average lengths of stay, see the APR-DRG, Version 36, Relative Weights and Average Length of Stays (ALOS) document.

The level-of-care (LOC) per diem rates effective August 1, 2020, are as follows:

Service Per Diem Rate
Psychiatric LOC $408.50
Rehabilitation LOC $667.00
Burn/1 LOC $2,850.00
Burn/2 LOC $855.00

 

APR-DRG Grouper, Version 30

The 3M All-Patient Refined (APR)-DRG grouper, version 30, is effective for inpatient stays with discharge dates from October 1, 2015, through July 31, 2020. See IHCP Provider Bulletin BT201559 for related information.

For a table of relative weights and average lengths of stay, see the APR-DRG, Version 30, Relative Weights and Average Length of Stays (ALOS) document.

The LOC per diem rates effective October 1, 2015, through July 31, 2020, are as follows:

Service Per Diem Rate
Psychiatric LOC $408.50
Rehabilitation LOC $667.00
Burn/1 LOC $2,850.00
Burn/2 LOC $855.00

 

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