MedicaidAdministrativeMedium impact
MO HealthNet All Patient Refined Diagnosis Related Group (APR-DRG) Calculator Update
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Dec 3, 2025
We identified it
Jun 20, 2026
Summary
Missouri Medicaid (MO HealthNet) has released an updated APR-DRG calculator effective December 3, 2025, which all hospitals must use when submitting inpatient claims. The key revision includes an updated directory of out-of-state hospitals, and all providers must verify they are using the current version to ensure proper claim processing.
Action Required
Immediately: Hospital billing teams must access and implement the updated MO HealthNet APR-DRG calculator from the Hospital provider page or MO HealthNet website. Verify your facility is using the most current version with the updated out-of-state hospital directory. Contact Provider Communications at (833) 222-7916 if assistance is needed. Failure to use the current calculator may result in claim processing delays or denials.