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MS-DRG and MS-DRG LTCH version 37 fee schedule updates

The HealthChoice and Department of Corrections annual MS-DRG updates to acute inpatient reimbursement include updates to tier designations based on the number of beds and provider type designation as urban or rural as contained within the current final inpatient prospective payment system file.

For charges incurred on and after Oct. 1, 2019, the following changes are effective for the HealthChoice and DOC MS-DRG fee schedules:

MS-DRG

Tier

1

2

3

4

Outlier threshold

$124,291

$95,568

$80,954

$66,024

Marginal cost factor

0.32

0.35

0.41

0.50

Base rate

$11,204

$10,409

$11,755

$10,824

The market basket update factor is 3%.

The next comprehensive MS-DRG fee schedule update will be effective for charges incurred on or after Oct. 1, 2020.

MS-DRG LTCH

For charges incurred on and after Oct. 1, 2019, the following changes are effective for the HealthChoice and DOC MS-DRG LTCH fee schedules:

  • Version 37 of the MS-DRG LTCH fee schedule has a base rate of $54,706. The outlier threshold is $26,778 while the cost-to-charge ratio is 0.233 and market basket update factor is 2.5%.

The next comprehensive MS-DRG LTCH fee schedule update will be effective for charges incurred on or after Oct. 1, 2020.

If you have any questions regarding these adjustments, please call the medical and dental claims administrator toll-free at 800-323-4314. TTY users call 711.