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

BT202077: IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates

Effective date
Aug 1, 2020
Identified
Jun 19, 2026

Summary

Effective for inpatient stays with discharge dates on or after August 1, 2020, the IHCP uses the 3M All-Patient Refined APR-DRG grouper, version 36, and version 30 remains in place for earlier discharges. The DRG base rate is $3,624.35 for acute care hospital services and $4,349.22 for eligible children's hospitals, and the outlier threshold is $59,175. The level-of-care per diem rates are $408.50 for psychiatric, $667.00 for rehabilitation, $3,750.00 for Burn/1 and $1,125.00 for Burn/2, and the capital per diem remains $64.50.

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What to do

Action · 5 steps
01Already effective August 1, 2020: Billing team should check current applicability of these DRG rates and relative weights before using them for inpatient claims.
02Billing procedures for inpatient hospital services have not changed.
03Continue to bill any inpatient stay of less than 24 hours as an outpatient service, following the Inpatient Hospital Services provider reference module for exceptions.
04DRG 757 is paid at the psychiatric LOC rate unless billed with ICD-10 diagnosis codes F70-F79; claims that group to DRG 757 and are billed with F70-F79 pay under the DRG payment methodology instead of the LOC per diem methodology.
05The Hospital Assessment Fee program remains in effect as detailed in IHCP Bulletin BT201939.

Codes mentioned

F70F79

Original notice

BT202077: IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates
in.gov · Always check the source before changing claims.
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Related changes

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BT202598: IHCP announces changes to DRG grouper and inpatient hospital reimbursement ratesMediumEffective Aug 1, 2025 · Claims & BillingBT202059: IHCP announces changes to DRG grouperHighEffective Aug 1, 2020 · Claims & BillingBT202090: IHCP announces updated changes to DRG grouper and cost-to-charge ratiosHighEffective Aug 1, 2020 · Claims & BillingBT2020102: IHCP announces corrections to DRG inpatient hospital reimbursement ratesLowEffective Aug 1, 2020 · Claims & BillingBrowse every Indiana Medicaid (IHCP) change in the policy list

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesCode F70Code F79

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