MedicaidReimbursementHigh impact
BT202598: IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Aug 1, 2025
We identified it
Jun 18, 2026
Summary
Indiana Health Coverage Programs (IHCP) is updating to APR-DRG version 42 grouper for inpatient hospital stays, with new DRG base rates and relative weights. The DRG base rate increases to $4,346 for in-state hospitals and $5,215.20 for children's hospitals, effective for discharge dates on or after August 1, 2025.
Action Required
Before August 1, 2025: Billing teams at Indiana hospitals must update DRG grouper software to APR-DRG version 42. Contact Solventum at 800-367-2447 for software updates. Review new relative weights table for all DRG codes. Special attention required for DRG 757 with ICD-10 codes F70-F79 which will use DRG payment methodology instead of psychiatric LOC per diem rates. Update cost-to-charge ratios as notified by Myers and Stauffer.