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APR-DRG Grouper 40 Changes Effective for Dates of Discharge on or after October 1, 2026

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Effective for dates of discharge on or after October 1, 2026, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will process inpatient claims in the All Patient Refined Diagnosis Related Groups (APR-DRG) system using Grouper version 40.0 logic and relative weights that are mapped to the International Classification of Diseases, Tenth Revision (ICD-10) and Hospital Acquired Condition (HAC) version 44.

Note: TMHP will reprocess affected claims with dates of discharge on or after October 1, 2026, as needed 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.