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.

The relative weights and average length of stays (ALOS) associated with APR-DRG, version 30, are available here.

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 IHCP provider publications for specific information regarding the inpatient hospital reimbursement methodologies and billing instructions.