Medicaid Hospital Reimbursement

Fees/Payment

Outpatient Hospital Rates


Inpatient Hospital Rates


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.


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


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.


 SFY20 SFY21 SFY22 SFY23 SFY24 SFY25 SFY26 SFY27
Kidney $91,504 $79,300 $83,588 $83,846 $87,107 $88,129 $91,081 $83,089
Heart $120,727 $113,634 $109,318 $115,095 $162,517 $208,804 $213,969 $237,796
Liver $168,347 $135,022 $174,966 $125,730 $139,351 $141,723 $122,923 $115,321
Pancreas* See Below See Below See Below See Below See Below See Below See Below See Below
Lung* See Below See Below See Below See Below See Below See Below See Below See Below

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.