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Acute Care Hospital Reimbursement

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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.

Hospital reimbursement is described in detail in the Inpatient and Outpatient Hospital Services Handbook in the Texas Medicaid Provider Procedures Manual (Vol. 2, Provider Handbooks). 

For more information, visit the Hospital Services web page on HHSC website.

The following files include the diagnosis-related group (DRG) Grouper files and the Standard Dollar Amount (SDA) Add-ons for individual hospitals.