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SC Medicaid - SCDHHSMedicaid · Reimbursement · Claims & Billing · SC · General Surgery, Orthopedics, Cardiology +1 moreMedium impact

Inpatient Hospital Services Payment Methodology - Changes to the APR-DRGs Classification System

Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 18, 2026

Summary

South Carolina Medicaid is updating their inpatient hospital payment system from APR-DRGs version 32 to version 42, effective October 1, 2025. This affects how general acute care hospitals, distinct part units, and long-term acute care hospitals are reimbursed for inpatient services.

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What to do

by Oct 1, 2025 · 3 steps
01Billing team must verify that billing system is updated to use APR-DRGs Version 42 payment parameters for South Carolina Medicaid inpatient claims.
02Review updated Hospital Services Provider Manual and Procedure Codes document on SCDHHS website.
03Contact Provider Service Center at (888) 289-0709 with questions about the new classification system.

Original notice

Inpatient Hospital Services Payment Methodology - Changes to the APR-DRGs Classification System
scdhhs.gov · Always check the source before changing claims.
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Related policy hubs

SC Medicaid - SCDHHS policiesSC policy changesGeneral SurgeryOrthopedicsCardiologyNeurology

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