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TMHP to Implement APR-DRG Grouper 40.0 Mapped to ICD-10/HAC Version 43 for Dates of Discharge on or After October 1, 2025

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Effective for dates of discharge on or after October 1, 2025, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will use Grouper 40.0 to process inpatient claims in the All Patient Refined Diagnosis Related Groups (APR-DRG) system. The Grouper 40.0 logic and relative weights will be mapped to the Version 43 International Classification of Diseases, Tenth Revision (ICD-10) and Hospital Acquired Condition (HAC) lists.

The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess affected claims that have discharge dates from October 1, 2025, through the deployment date. All filing deadlines for these claims will be waived.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.