MedicaidReimbursementMedium impact
Inpatient Hospital Services Payment Methodology - Changes to the APR-DRGs Classification System
SC Medicaid - SCDHHS·SC · General Surgery, Orthopedics, Cardiology +1 more·Claims & Billing
Effective date
Oct 1, 2025
We identified it
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.
Action Required
By October 1, 2025: Billing team must verify that billing system is updated to use APR-DRGs Version 42 payment parameters for South Carolina Medicaid inpatient claims. Review updated Hospital Services Provider Manual and Procedure Codes document on SCDHHS website. Contact Provider Service Center at (888) 289-0709 with questions about the new classification system.