Fees/Payment
Outpatient Hospital RatesJanuary 1, 2023
Outpatient Rate Letter
Rate Calculations
Out-of-State and Border Hospital Reimbursement
January 1, 2022
Outpatient Rate Letter
Rate Calculations
Out-of-State and Border Hospital Reimbursement
January 1, 2021
Outpatient Rate Letter
Rate Calculations
Out-of-State and Border Hospital Reimbursement
January 1, 2020
In-State Hospital APC Rate Letter
Out-of-State Hospital Rate Letter
Rate Calculations
January 1, 2019
In-State Hospital APC Rate Letter
Out-of-State Hospital APC Rate Letter
Rate Calculations
January 1, 2018
In-State Hospital APC Rate Letter
Out-of-State Hospital APC Rate Letter
Rate Calculations
January 1, 2017
In-State Hospital APC Rate Letter
Out-of-State Hospital APC Rate Letter
Rate Calculations
July 1, 2016 - DSS issued outpatient rates effective for dates of service on and after July 1, 2016 using the Ambulatory Payment Classification (APC).
In-State Hospital APC Rate Letters
Out-of-State Hospital APC Rate Letter
July 1, 2015 - DSS issued outpatient rates for FY16.
Hospital Outpatient Rate Letters
General Hospital Outpatient Rates
RCC 901 - Outpatient Fee Change
Inpatient Hospital Rates
January 1, 2023
Inpatient Rate Letter
Rate Calculations
Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group
Out-of-State and Border Hospital Reimbursement
January 1, 2022
Inpatient Rate Letter
Rate Calculations
Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group
Out-of-State and Border Hospital Reimbursement
January 1, 2021
Inpatient Rate Letter
Rate Calculations
Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group
Out-of-State and Border Hospital Reimbursement
January 1, 2020
In-State Hospital DRG Rate Letter
Out-of-State Hospital Rate Letter
Rate Calculations
Inpatient Adjustment Factor Update
DRG Adjustment Factor by Peer Group
January 1, 2019
In-State Hospital DRG Rate Letter
Out-of-State Hospital DRG Rate Letter
Rate Calculations
January 1, 2018
In-State Hospital DRG Rate Letter
Out-of-State Hospital DRG Rate Letter
Rate Calculations
January 1, 2017
In-State Hospital DRG Rate Letter
Out-of-State Hospital DRG Rate Letter
Weights and Outlier Thresholds Under APR-DRG V33 and V34 System
Rate Calculations
January 1, 2015 - DSS issued inpatient rates on December 8, 2014 for admissions on or after January 1, 2015. The letters list the APR-DRG base rates as well as per diem rates for behavioral health and rehabilitation.
In-State Inpatient Hospital Rate Letters
Out-of State and Border Psychiatric Hospital Rate Letter
Out-of-State General Acute Care Hospital Rate Letter
Rate Calculations
DRG Payment Calculator All general acute care hospitals, including border and out-of-state, are now reimbursed using the All Patient Refined Diagnosis Related Groups (APR-DRG) methodology. A hospital can estimate its payment for a claim using the DRG payment calculator. The calculator contains detailed instructions regarding the data to be entered, including a link to 3M's site that must be used to calculate the DRG assignment to be entered in the calculator.
Disproportionate Share Hospital (DSH), Supplemental, and Direct Graduate Medical Education (GME) Payments
SFY14 Hospital Payment Calculation
SFY15 Hospital Payment Calculation
SFY16 GME and DSH Payment Calculation
SFY16 Inpatient Supplemental Payment Calculation
FFY17 DSH Payment Calculation
SFY17 GME Payment Calculation
SFY17 Inpatient Supplemental Payment Calculation
FFY18 DSH Payment Calculation
SFY18 GME Payment Calculation
SFY18 Mid-Sized Inpatient and General Outpatient Supplemental Payments
SFY18 General Inpatient and Small Hospital Inpatient Supplemental Payments
SFY19 GME Payment Calculation
SFY19 Supplemental Payment Calculation
SFY19 DRG Grouper One-time Supplemental Payment
FFY19 DSH Payment Calculation
SFY20 GME Payment Calculation
SFY20 Supplemental Payment Calculation
FFY20 DSH Payment Calculation
SFY21 Supplemental Payment Calculation
SFY21 GME Payment Calculation
FFY21 DSH Payment Calculation
SFY22 Supplemental Payment Calculation
SFY22 GME Payment Calculation
FFY22 DSH Payment Calculation
SFY23 Supplemental Payment Calculation
SFY23 GME Payment Calculation
Organ Acquisition Reimbursement
Rates are for both in- and out-of-state hospitals. Organ acquisition rates are effective for all inpatient claims. Acquisition of the heart, liver, and kidneys will be manually priced based on the submission of RCC 81X. For lung and pancreas acquisition, hospitals must submit most recent Medicare cost reports submitted to CMS. Additional information can be found on Provider Bulletin 2014-79.
| SFY 2015 | SFY 2016 | SFY 2017 | SFY 2018 | SFY 2019 | SFY 2020 |
SFY 2021 |
SFY 2022 | SFY 2023 | |
| Kidney | $71,715 | $64,324 | $70,192 | $79,732 | $82,289 | $91,504 | $79,300 | $83,588 | $83,846 |
| Heart | $81,352 | $96,667 | $81,102 | $100,487 | $87,194 | $120,727 | $113,634 | $109,318 | $115,095 |
| Liver | $86,032 | $93,691 | $119,107 | $115,680 | $164,760 | $168,347 | $135,022 | $174,966 | $125,730 |
| Pancreas* | $174,121 | $50,913 | $7,121 | $134,209 | TBD | TBD | TBD | TBD | TBD |
| Lung* | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD |
Payment will be the lower of charges or state-wide average.
*For lung or pancreas acquisition, hospitals must submit most recent Medicare cost report submitted to CMS.