← Back to list
APR-DRG Grouper 40 Changes Effective for Dates of Discharge on or after October 1, 2026
Effective date
Oct 1, 2026
Identified
Sep 30, 2026
Summary
Effective October 1, 2026, Texas Medicaid and CSHCN Services Program will transition inpatient claims processing to APR-DRG Grouper 40.0 with updated relative weights mapped to ICD-10 and HAC version 44. TMHP will reprocess affected claims as needed. This is a system upgrade that may impact DRG assignments and reimbursement calculations for inpatient hospital claims.
Get alerts when payers change rules like this one
We check Texas Medicaid and other payers every day and email you when a change matches your specialty and state.
Get Texas Medicaid alertsPolicy Monitoring is free. No card required.
What to do
Action · 4 steps
01Before October 1, 2026: Billing team must coordinate with hospital information systems (HIS) and billing software vendors to ensure systems are updated to support APR-DRG Grouper 40.0 logic and HAC version 44 mapping.
02Verify that all inpatient claim submission workflows correctly route to the new grouper version for discharge dates on or after October 1, 2026.
03Contact TMHP at 800-925-9126 or TMHP-CSHCN Services at 800-568-2413 to confirm implementation timeline and test claim scenarios.
04Monitor for reprocessed claims post-October 1 and reconcile any payment adjustments resulting from grouper updates.
If missed: Failure to ensure proper system configuration may result in claim denials or delayed reprocessing.
Original notice
APR-DRG Grouper 40 Changes Effective for Dates of Discharge on or after October 1, 2026
tmhp.com · Always check the source before changing claims.