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Indiana Medicaid (IHCP)Medicaid · Reimbursement · Claims & Billing · INMedium impact

BT202598: IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates

Effective date
Aug 1, 2025
Identified
Jun 18, 2026

Summary

The IHCP selected the Solventum All-Patient Refined Diagnosis-Related Group (APR-DRG) grouper, version 42, for inpatient DRG assignments. This change is already effective for inpatient stays with discharge dates on or after Aug. 1, 2025. The DRG base rate for in-state hospitals will be $4,346, and the grouper version 36 remains in place for inpatient stays with discharge dates before Aug. 1, 2025.

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What to do

Action · 5 steps
01Already effective Aug.
021, 2025: Billing procedures for inpatient hospital services have not changed.
03Continue to bill any inpatient stay that is less than 24 hours as an outpatient service, and follow the Inpatient Hospital Services provider reference module for exceptions.
04Claims that group to DRG 757 will pay at the psychiatric level of care rate unless they are billed with ICD-10 diagnosis codes F70 through F79, in which case they pay under the DRG payment methodology.
05Check current applicability of these rates with the IHCP before relying on them.

Codes mentioned

F70F79

Original notice

BT202598: IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates
in.gov · Always check the source before changing claims.
View original ↗

Related changes

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Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesCode F70Code F79

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