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Texas Medicaid

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 All Patient Refined – Diagnosis Related Groups (APR-DRG)

Texas Medicaid uses an All Patient Refined – Diagnosis Related Groups (APR-DRG) payment system for inpatient hospital providers that are reimbursed based on a DRG payment methodology. The APR-DRG methodology focuses on all Medicaid client populations and addresses patient severity of illness and patient risk of mortality in addition to patient resource intensity.

Texas Medicaid DRG Conversion (APR-DRG) Frequently Asked Questions

Note: Effective for admissions on or after September 1, 2013, children’s and rural hospitals are reimbursed using the prospective payment methodology based on APR-DRGs and are no longer reimbursed according to the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) methodology.

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