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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.

APR-DRG Grouper, Version 30

The 3M All-Patient Refined (APR)-DRG grouper, version 30, is effective for inpatient stays with discharge dates on or after October 1, 2015. 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 level-of-care per diem rates effective October 1, 2015, 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

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

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