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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 Aug. 1, 2020. See IHCP Provider Bulletin BT202090 for related information.

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

See the following table for the level-of-care (LOC) per diem rates effective Aug. 1, 2020.

LOC Per Diem Rates, Effective Aug. 1, 2020

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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