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APR-DRG Grouper 38 Now Available Effective for Dates of Discharge on or after October 1, 2022

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Effective for dates of discharge on or after October 1, 2022, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will map the All Patient Refined-Diagnosis Related Groups (APR-DRG) system to version 40 and process inpatient claims using Grouper version 38 logic and relative weights.

Statistical information about the APR-DRG payment system, which includes relative weights, mean lengths of stay, and day thresholds, can be found on the Texas Medicaid Acute Care Hospital Reimbursement web page.

Impacted claims with dates of discharge on or after October 1, 2022, will be reprocessed, as necessary, to capture APR-DRG changes.

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