drg payment parameters for state fiscal year 2013-2014 ... · 0573 uncomplic head trauma 1.7266...
TRANSCRIPT
DRG Base Rate 2750.96
0011 Liver &/or Intest Transpl 9.2609 25,476.37
0012 Liver &/or Intest Transpl 10.1871 28,024.30
0013 Liver &/or Intest Transpl 12.8415 35,326.45
0014 Liver &/or Intest Transpl 24.2504 66,711.88
0021 Heart &/or Lung Transpl 13.4667 37,046.35
0022 Heart &/or Lung Transpl 14.9717 41,186.55
0023 Heart &/or Lung Transpl 20.3386 55,950.68
0024 Heart &/or Lung Transpl 31.0113 85,310.85
0031 Bone Marrow Transpl 7.2182 19,856.98
0032 Bone Marrow Transpl 10.1061 27,801.48
0033 Bone Marrow Transpl 17.0285 46,844.72
0034 Bone Marrow Transpl 29.5885 81,396.78
0041 Trach, MV 96+ Hrs, w Ext Proc 8.1175 22,330.92
0042 Trach, MV 96+ Hrs, w Ext Proc 10.4077 28,631.17
0043 Trach, MV 96+ Hrs, w Ext Proc 13.8078 37,984.71
0044 Trach, MV 96+ Hrs, w Ext Proc 20.7998 57,219.42
0051 Trach, MV 96+ Hrs, w/o Ext Proc 6.6101 18,184.12
0052 Trach, MV 96+ Hrs, w/o Ext Proc 7.9197 21,786.78
0053 Trach, MV 96+ Hrs, w/o Ext Proc 9.7403 26,795.18
0054 Trach, MV 96+ Hrs, w/o Ext Proc 14.4893 39,859.48
0061 Pancreas Transpl 8.2428 22,675.61
0062 Pancreas Transpl 10.7141 29,474.06
0063 Pancreas Transpl 12.1529 33,432.14
0064 Pancreas Transpl 19.0210 52,326.01
0201 Craniotomy for Trauma 2.4075 6,622.94
0202 Craniotomy for Trauma 3.3970 9,345.01
0203 Craniotomy for Trauma 5.1414 14,143.79
0204 Craniotomy for Trauma 10.4961 28,874.35
0211 Craniotomy Exc for Trauma 2.6585 7,313.43
0212 Craniotomy Exc for Trauma 3.6234 9,967.83
0213 Craniotomy Exc for Trauma 5.8014 15,959.42
0214 Craniotomy Exc for Trauma 11.3609 31,253.38
0221 Ventricular Shunt Procs 1.5842 4,358.07
0222 Ventricular Shunt Procs 2.3700 6,519.78
0223 Ventricular Shunt Procs 5.4372 14,957.52
0224 Ventricular Shunt Procs 11.4354 31,458.33
0231 Spinal Procs 1.8771 5,163.83
0232 Spinal Procs 2.7459 7,553.86
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement Rate
DRG Payment Parameters for State Fiscal Year 2013-2014
Effective July 1, 2013
Notes:
In accordance with Legislative mandate which was passed in the 2011 Session, hospital rates shall be calculated
annually effective July 1 of each year. PLEASE NOTE THAT THE AGENCY POSTS THE RATES TO THE
AGENCY'S HCRA WEBSITE EACH JULY. The hospital is responsible for notifying the county of any interim
adjustments to its per diem rates.
Effective July 1, 2013, the Agency will be implementing a new hospital inpatient payment method utilizing
Diagnosis-Related Groups (DRG) for Florida Medicaid. With this reimbursement change, there will no longer be
any hospital inpatient per diem rates posted. The only exception is for the State Mental Health Hospitals which will
continue to be reimbursed per diem. Hospital inpatient DRG rate worksheets will be posted instead of per diems.
Hospital outpatient per diem rates will continue to be posted.
Participating hospitals must provide HCRA eligible inpatient UB 04 claim forms to the applicant’s county of
residence using the APR-DRG grouping method (not Medicare). If the DRG code provided in field 71 on the UB
04 claim form is not on the APR-DRG Inpatient Hospital Reimbursement Rates list posted on the HCRA website, it
is not reimbursable through HCRA.
APR-DRG
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
0233 Spinal Procs 5.5433 15,249.40
0234 Spinal Procs 10.3811 28,557.99
0241 Extracranial Vascular Procs 1.3889 3,820.81
0242 Extracranial Vascular Procs 1.9258 5,297.80
0243 Extracranial Vascular Procs 4.0270 11,078.12
0244 Extracranial Vascular Procs 8.8228 24,271.17
0261 Oth Nerv Sys & Related Procs 1.7120 4,709.64
0262 Oth Nerv Sys & Related Procs 2.3729 6,527.75
0263 Oth Nerv Sys & Related Procs 3.6293 9,984.06
0264 Oth Nerv Sys & Related Procs 8.0748 22,213.45
0401 Spinal Dis & Injuries 1.2791 3,518.75
0402 Spinal Dis & Injuries 1.5228 4,189.16
0403 Spinal Dis & Injuries 2.1670 5,961.33
0404 Spinal Dis & Injuries 5.9875 16,471.37
0411 Nervous Sys Malig 1.0541 2,899.79
0412 Nervous Sys Malig 1.1222 3,087.13
0413 Nervous Sys Malig 1.6227 4,463.98
0414 Nervous Sys Malig 3.2713 8,999.22
0421 Degen Nerv Sys Dis Exc Ms 0.7572 2,083.03
0422 Degen Nerv Sys Dis Exc Ms 0.9433 2,594.98
0423 Degen Nerv Sys Dis Exc Ms 1.4404 3,962.48
0424 Degen Nerv Sys Dis Exc Ms 4.0126 11,038.50
0431 Mult Sclerosis 1.0590 2,913.27
0432 Mult Sclerosis 1.2929 3,556.72
0433 Mult Sclerosis 2.1503 5,915.39
0434 Mult Sclerosis 4.9488 13,613.95
0441 Intracranial Hemorrhage 1.1356 3,123.99
0442 Intracranial Hemorrhage 1.5275 4,202.09
0443 Intracranial Hemorrhage 2.3055 6,342.34
0444 Intracranial Hemorrhage 5.0753 13,961.95
0451 CVA & Precereb Occl w Infarct 0.9794 2,694.29
0452 CVA & Precereb Occl w Infarct 1.1871 3,265.66
0453 CVA & Precereb Occl w Infarct 1.7829 4,904.69
0454 CVA & Precereb Occl w Infarct 4.0851 11,237.95
0461 Nonspec CVA w/o Infarct 0.9319 2,563.62
0462 Nonspec CVA w/o Infarct 1.0882 2,993.59
0463 Nonspec CVA w/o Infarct 1.4986 4,122.59
0464 Nonspec CVA w/o Infarct 2.5736 7,079.87
0471 Transient Ischemia 0.7909 2,175.73
0472 Transient Ischemia 0.8525 2,345.19
0473 Transient Ischemia 1.1223 3,087.40
0474 Transient Ischemia 2.4394 6,710.69
0481 Nerve Disorders 0.7991 2,198.29
0482 Nerve Disorders 0.9166 2,521.53
0483 Nerve Disorders 1.2718 3,498.67
0484 Nerve Disorders 3.4152 9,395.08
0491 Bact & Tub Inf of Nervous Sys 1.2504 3,439.80
0492 Bact & Tub Inf of Nervous Sys 2.5534 7,024.30
0493 Bact & Tub Inf of Nervous Sys 3.3204 9,134.29
0494 Bact & Tub Inf of Nervous Sys 5.8385 16,061.48
0501 Non-Bact Inf of Nerv Sys 0.8603 2,366.65
0502 Non-Bact Inf of Nerv Sys 1.4891 4,096.45
0503 Non-Bact Inf of Nerv Sys 2.5175 6,925.54
0504 Non-Bact Inf of Nerv Sys 6.1859 17,017.16
0511 Viral Meningitis 0.6700 1,843.14
0512 Viral Meningitis 0.9848 2,709.15
0513 Viral Meningitis 1.8071 4,971.26
0514 Viral Meningitis 4.4631 12,277.81
0521 Nontraumatic Stupor & Coma 0.7446 2,048.36
0522 Nontraumatic Stupor & Coma 0.8833 2,429.92
0523 Nontraumatic Stupor & Coma 1.2714 3,497.57
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
0524 Nontraumatic Stupor & Coma 3.4898 9,600.30
0531 Seizure 0.6697 1,842.32
0532 Seizure 0.8179 2,250.01
0533 Seizure 1.2152 3,342.97
0534 Seizure 3.2654 8,982.98
0541 Migraine & Oth Headaches 0.7000 1,925.67
0542 Migraine & Oth Headaches 0.8315 2,287.42
0543 Migraine & Oth Headaches 1.1382 3,131.14
0544 Migraine & Oth Headaches 1.9479 5,358.59
0551 Head Trauma w Coma >1 Hr 0.8758 2,409.29
0552 Head Trauma w Coma >1 Hr 1.2253 3,370.75
0553 Head Trauma w Coma >1 Hr 2.0790 5,719.25
0554 Head Trauma w Coma >1 Hr 4.9570 13,636.51
0561 Complic Skull Fx, Coma <1 Hr 0.9294 2,556.74
0562 Complic Skull Fx, Coma <1 Hr 1.3335 3,668.41
0563 Complic Skull Fx, Coma <1 Hr 2.1986 6,048.26
0564 Complic Skull Fx, Coma <1 Hr 5.6468 15,534.12
0571 Uncomplic Head Trauma 0.8819 2,426.07
0572 Uncomplic Head Trauma 1.1431 3,144.62
0573 Uncomplic Head Trauma 1.7266 4,749.81
0574 Uncomplic Head Trauma 4.3987 12,100.65
0581 Oth Dis of Nervous Sys 0.8399 2,310.53
0582 Oth Dis of Nervous Sys 1.0465 2,878.88
0583 Oth Dis of Nervous Sys 1.4734 4,053.26
0584 Oth Dis of Nervous Sys 3.6836 10,133.44
0701 Orbital Procs 1.1360 3,125.09
0702 Orbital Procs 1.6840 4,632.62
0703 Orbital Procs 2.7834 7,657.02
0704 Orbital Procs 5.6187 15,456.82
0731 Eye Procs Exc Orbit 0.9949 2,736.93
0732 Eye Procs Exc Orbit 1.2693 3,491.79
0733 Eye Procs Exc Orbit 2.3578 6,486.21
0734 Eye Procs Exc Orbit 6.5423 17,997.61
0801 Acute Maj Eye Inf 0.5265 1,448.38
0802 Acute Maj Eye Inf 0.7702 2,118.79
0803 Acute Maj Eye Inf 1.3064 3,593.85
0804 Acute Maj Eye Inf 3.2211 8,861.12
0821 Eye Dis Exc Maj Inf 0.6476 1,781.52
0822 Eye Dis Exc Maj Inf 0.8360 2,299.80
0823 Eye Dis Exc Maj Inf 1.1486 3,159.75
0824 Eye Dis Exc Maj Inf 3.8413 10,567.26
0891 Maj Cranial/Facial Bone Procs 2.0098 5,528.88
0892 Maj Cranial/Facial Bone Procs 2.6544 7,302.15
0893 Maj Cranial/Facial Bone Procs 4.7983 13,199.93
0894 Maj Cranial/Facial Bone Procs 11.0594 30,423.97
0901 Maj Larynx & Trachea Procs 1.1001 3,026.33
0902 Maj Larynx & Trachea Procs 3.0983 8,523.30
0903 Maj Larynx & Trachea Procs 5.0227 13,817.25
0904 Maj Larynx & Trachea Procs 10.7444 29,557.41
0911 Oth Maj Head & Neck Procs 1.8581 5,111.56
0912 Oth Maj Head & Neck Procs 2.8660 7,884.25
0913 Oth Maj Head & Neck Procs 5.0771 13,966.90
0914 Oth Maj Head & Neck Procs 8.6326 23,747.94
0921 Facial Bone Procs Exc Major 1.4161 3,895.63
0922 Facial Bone Procs Exc Major 2.0007 5,503.85
0923 Facial Bone Procs Exc Major 3.3303 9,161.52
0924 Facial Bone Procs Exc Major 7.1956 19,794.81
0931 Sinus & Mastoid Procs 1.3458 3,702.24
0932 Sinus & Mastoid Procs 1.8109 4,981.71
0933 Sinus & Mastoid Procs 3.0998 8,527.43
0934 Sinus & Mastoid Procs 4.3593 11,992.26
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
0951 Cleft Lip & Palate Repair 0.8470 2,330.06
0952 Cleft Lip & Palate Repair 1.0491 2,886.03
0953 Cleft Lip & Palate Repair 1.5063 4,143.77
0954 Cleft Lip & Palate Repair 2.8882 7,945.32
0971 Tonsil & Adenoid Procs 0.5721 1,573.82
0972 Tonsil & Adenoid Procs 0.9302 2,558.94
0973 Tonsil & Adenoid Procs 2.0662 5,684.03
0974 Tonsil & Adenoid Procs 6.4659 17,787.43
0981 Oth Ear, Nose Throat Procs 0.9915 2,727.58
0982 Oth Ear, Nose Throat Procs 1.3520 3,719.30
0983 Oth Ear, Nose Throat Procs 2.3830 6,555.54
0984 Oth Ear, Nose Throat Procs 5.0653 13,934.44
1101 Ear, Nose, Throat, Facial Malig 0.8809 2,423.32
1102 Ear, Nose, Throat, Facial Malig 1.1064 3,043.66
1103 Ear, Nose, Throat, Facial Malig 1.7408 4,788.87
1104 Ear, Nose, Throat, Facial Malig 3.5681 9,815.70
1111 Vertigo & Oth Labyrinth Dis 0.6848 1,883.86
1112 Vertigo & Oth Labyrinth Dis 0.7548 2,076.42
1113 Vertigo & Oth Labyrinth Dis 0.9428 2,593.61
1114 Vertigo & Oth Labyrinth Dis 1.9818 5,451.85
1131 Inf of Upper Resp Tract 0.3802 1,045.91
1132 Inf of Upper Resp Tract 0.5683 1,563.37
1133 Inf of Upper Resp Tract 1.0099 2,778.19
1134 Inf of Upper Resp Tract 2.4917 6,854.57
1141 Dental & Oral Conditions 0.5941 1,634.35
1142 Dental & Oral Conditions 0.8364 2,300.90
1143 Dental & Oral Conditions 1.4618 4,021.35
1144 Dental & Oral Conditions 3.5475 9,759.03
1151 Oth Ear, Nose, Throat Diags 0.6077 1,671.76
1152 Oth Ear, Nose, Throat Diags 0.8697 2,392.51
1153 Oth Ear, Nose, Throat Diags 1.2653 3,480.79
1154 Oth Ear, Nose, Throat Diags 2.9695 8,168.98
1201 Maj Resp & Chest Procs 2.2200 6,107.13
1202 Maj Resp & Chest Procs 2.7743 7,631.99
1203 Maj Resp & Chest Procs 4.2993 11,827.20
1204 Maj Resp & Chest Procs 8.0058 22,023.64
1211 Oth Resp & Chest Procs 1.5058 4,142.40
1212 Oth Resp & Chest Procs 2.0349 5,597.93
1213 Oth Resp & Chest Procs 3.5147 9,668.80
1214 Oth Resp & Chest Procs 7.5224 20,693.82
1301 Resp Sys Diag w MV 96+ Hrs 3.7633 10,352.69
1302 Resp Sys Diag w MV 96+ Hrs 4.1727 11,478.93
1303 Resp Sys Diag w MV 96+ Hrs 5.2221 14,365.79
1304 Resp Sys Diag w MV 96+ Hrs 7.4061 20,373.88
1311 Cystic Fibrosis - Pulmon Dis 1.7861 4,913.49
1312 Cystic Fibrosis - Pulmon Dis 2.3204 6,383.33
1313 Cystic Fibrosis - Pulmon Dis 3.0187 8,304.32
1314 Cystic Fibrosis - Pulmon Dis 3.9470 10,858.04
1321 Chronic Resp Dis Fm Perinatal 0.6194 1,703.94
1322 Chronic Resp Dis Fm Perinatal 0.8038 2,211.22
1323 Chronic Resp Dis Fm Perinatal 1.2959 3,564.97
1324 Chronic Resp Dis Fm Perinatal 2.5275 6,953.05
1331 Pulmon Edema & Resp Failure 0.7308 2,010.40
1332 Pulmon Edema & Resp Failure 1.0154 2,793.32
1333 Pulmon Edema & Resp Failure 1.5559 4,280.22
1334 Pulmon Edema & Resp Failure 2.7694 7,618.51
1341 Pulmonary Embolism 0.9149 2,516.85
1342 Pulmonary Embolism 1.1852 3,260.44
1343 Pulmonary Embolism 1.7497 4,813.35
1344 Pulmonary Embolism 3.1853 8,762.63
1351 Maj Chest & Resp Trauma 0.8869 2,439.83
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
1352 Maj Chest & Resp Trauma 1.1252 3,095.38
1353 Maj Chest & Resp Trauma 1.6884 4,644.72
1354 Maj Chest & Resp Trauma 3.2165 8,848.46
1361 Resp Malig 0.8653 2,380.41
1362 Resp Malig 1.1554 3,178.46
1363 Resp Malig 1.8237 5,016.93
1364 Resp Malig 2.9466 8,105.98
1371 Maj Resp Inf & Inflammations 0.8528 2,346.02
1372 Maj Resp Inf & Inflammations 1.1466 3,154.25
1373 Maj Resp Inf & Inflammations 1.7391 4,784.19
1374 Maj Resp Inf & Inflammations 3.0122 8,286.44
1381 Bronchiolitis & RSV Pneumonia 0.3984 1,095.98
1382 Bronchiolitis & RSV Pneumonia 0.5478 1,506.98
1383 Bronchiolitis & RSV Pneumonia 1.2345 3,396.06
1384 Bronchiolitis & RSV Pneumonia 2.8234 7,767.06
1391 Oth Pneumonia 0.5363 1,475.34
1392 Oth Pneumonia 0.7855 2,160.88
1393 Oth Pneumonia 1.3251 3,645.30
1394 Oth Pneumonia 2.6285 7,230.90
1401 COPD 0.6618 1,820.59
1402 COPD 0.8452 2,325.11
1403 COPD 1.1952 3,287.95
1404 COPD 2.4852 6,836.69
1411 Asthma 0.4869 1,339.44
1412 Asthma 0.7010 1,928.42
1413 Asthma 1.0863 2,988.37
1414 Asthma 2.0635 5,676.61
1421 Interstitial & Alveolar Lung Dis 0.8368 2,302.00
1422 Interstitial & Alveolar Lung Dis 1.0381 2,855.77
1423 Interstitial & Alveolar Lung Dis 1.5467 4,254.91
1424 Interstitial & Alveolar Lung Dis 2.9925 8,232.25
1431 Oth Resp Diags Exc Minor 0.5948 1,636.27
1432 Oth Resp Diags Exc Minor 0.9403 2,586.73
1433 Oth Resp Diags Exc Minor 1.5221 4,187.24
1434 Oth Resp Diags Exc Minor 2.5966 7,143.14
1441 Resp Symptoms & Minor Diags 0.5930 1,631.32
1442 Resp Symptoms & Minor Diags 0.7372 2,028.01
1443 Resp Symptoms & Minor Diags 1.0924 3,005.15
1444 Resp Symptoms & Minor Diags 2.3200 6,382.23
1601 Maj Repair of Heart Anomaly 3.9871 10,968.35
1602 Maj Repair of Heart Anomaly 5.0134 13,791.66
1603 Maj Repair of Heart Anomaly 6.8439 18,827.30
1604 Maj Repair of Heart Anomaly 15.4878 42,606.32
1611 Defib & Heart Assist Implant 5.5540 15,278.83
1612 Defib & Heart Assist Implant 7.4442 20,478.70
1613 Defib & Heart Assist Implant 11.8116 32,493.24
1614 Defib & Heart Assist Implant 29.0890 80,022.68
1621 Cardiac Valve Procs w Cath 5.7272 15,755.30
1622 Cardiac Valve Procs w Cath 6.5548 18,031.99
1623 Cardiac Valve Procs w Cath 8.7462 24,060.45
1624 Cardiac Valve Procs w Cath 13.7473 37,818.27
1631 Cardiac Valve Procs w/o Cath 4.7577 13,088.24
1632 Cardiac Valve Procs w/o Cath 5.3102 14,608.15
1633 Cardiac Valve Procs w/o Cath 7.1219 19,592.06
1634 Cardiac Valve Procs w/o Cath 12.5866 34,625.23
1651 Coronary Bypass w Cath 4.5507 12,518.79
1652 Coronary Bypass w Cath 5.2682 14,492.61
1653 Coronary Bypass w Cath 6.6274 18,231.71
1654 Coronary Bypass w Cath 10.7249 29,503.77
1661 Coronary Bypass w/o Cath 3.5663 9,810.75
1662 Coronary Bypass w/o Cath 4.0491 11,138.91
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
1663 Coronary Bypass w/o Cath 5.3687 14,769.08
1664 Coronary Bypass w/o Cath 9.3845 25,816.38
1671 Oth Cardiothoracic Procs 3.6113 9,934.54
1672 Oth Cardiothoracic Procs 4.2930 11,809.87
1673 Oth Cardiothoracic Procs 5.9016 16,235.07
1674 Oth Cardiothoracic Procs 10.8471 29,839.94
1691 Maj Vascular Procs 2.1667 5,960.51
1692 Maj Vascular Procs 2.9902 8,225.92
1693 Maj Vascular Procs 4.8785 13,420.56
1694 Maj Vascular Procs 9.5230 26,197.39
1701 Pacemaker Impl w AMI or Shock 2.9206 8,034.45
1702 Pacemaker Impl w AMI or Shock 3.1968 8,794.27
1703 Pacemaker Impl w AMI or Shock 3.9872 10,968.63
1704 Pacemaker Impl w AMI or Shock 6.9470 19,110.92
1711 Pacemaker Impl w/o AMI or Shock 2.0614 5,670.83
1712 Pacemaker Impl w/o AMI or Shock 2.4295 6,683.46
1713 Pacemaker Impl w/o AMI or Shock 3.1967 8,793.99
1714 Pacemaker Impl w/o AMI or Shock 5.6999 15,680.20
1731 Oth Vascular Procs 2.2870 6,291.45
1732 Oth Vascular Procs 2.7705 7,621.53
1733 Oth Vascular Procs 3.9432 10,847.59
1734 Oth Vascular Procs 7.7609 21,349.93
1741 Percut CV Procs w AMI 2.5844 7,109.58
1742 Percut CV Procs w AMI 2.7786 7,643.82
1743 Percut CV Procs w AMI 3.6035 9,913.08
1744 Percut CV Procs w AMI 5.7836 15,910.45
1751 Percut CV Procs w/o AMI 2.3090 6,351.97
1752 Percut CV Procs w/o AMI 2.6025 7,159.37
1753 Percut CV Procs w/o AMI 3.3991 9,350.79
1754 Percut CV Procs w/o AMI 5.8534 16,102.47
1761 Pacemaker & Defib Replacement 1.8698 5,143.75
1762 Pacemaker & Defib Replacement 3.9016 10,733.15
1763 Pacemaker & Defib Replacement 4.1389 11,385.95
1764 Pacemaker & Defib Replacement 6.9747 19,187.12
1771 Pacemaker & Defib Revision 1.4592 4,014.20
1772 Pacemaker & Defib Revision 2.0489 5,636.44
1773 Pacemaker & Defib Revision 3.0434 8,372.27
1774 Pacemaker & Defib Revision 6.1050 16,794.61
1801 Oth Circulatory Sys Procs 1.4726 4,051.06
1802 Oth Circulatory Sys Procs 2.0676 5,687.88
1803 Oth Circulatory Sys Procs 3.2394 8,911.46
1804 Oth Circulatory Sys Procs 6.1842 17,012.49
1901 Acute Myocardial Infarction 1.0780 2,965.53
1902 Acute Myocardial Infarction 1.2068 3,319.86
1903 Acute Myocardial Infarction 1.6692 4,591.90
1904 Acute Myocardial Infarction 3.1445 8,650.39
1911 Cardiac Cath Exc Ischem Disease 1.3176 3,624.66
1912 Cardiac Cath Exc Ischem Disease 1.6062 4,418.59
1913 Cardiac Cath Exc Ischem Disease 2.1147 5,817.46
1914 Cardiac Cath Exc Ischem Disease 4.6907 12,903.93
1921 Cardiac Cath for Ischem Disease 1.1496 3,162.50
1922 Cardiac Cath for Ischem Disease 1.3293 3,656.85
1923 Cardiac Cath for Ischem Disease 1.8256 5,022.15
1924 Cardiac Cath for Ischem Disease 3.9036 10,738.65
1931 Acute & Subacute Endocarditis 1.2477 3,432.37
1932 Acute & Subacute Endocarditis 1.6714 4,597.95
1933 Acute & Subacute Endocarditis 2.5090 6,902.16
1934 Acute & Subacute Endocarditis 4.3580 11,988.68
1941 Heart Failure 0.6698 1,842.59
1942 Heart Failure 0.8649 2,379.31
1943 Heart Failure 1.3503 3,714.62
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
1944 Heart Failure 2.7256 7,498.02
1961 Cardiac Arrest 0.6073 1,670.66
1962 Cardiac Arrest 0.6797 1,869.83
1963 Cardiac Arrest 1.5222 4,187.51
1964 Cardiac Arrest 3.5581 9,788.19
1971 Peripheral & Oth Vascular Dis 0.6375 1,753.74
1972 Peripheral & Oth Vascular Dis 0.8935 2,457.98
1973 Peripheral & Oth Vascular Dis 1.3922 3,829.89
1974 Peripheral & Oth Vascular Dis 3.0512 8,393.73
1981 Angina Pect & Atherosclerosis 0.5816 1,599.96
1982 Angina Pect & Atherosclerosis 0.6870 1,889.91
1983 Angina Pect & Atherosclerosis 0.9826 2,703.09
1984 Angina Pect & Atherosclerosis 2.3761 6,536.56
1991 Hypertension 0.6086 1,674.23
1992 Hypertension 0.7287 2,004.62
1993 Hypertension 1.0917 3,003.22
1994 Hypertension 2.4697 6,794.05
2001 Cardiac Structural Dis 0.7002 1,926.22
2002 Cardiac Structural Dis 0.8499 2,338.04
2003 Cardiac Structural Dis 1.3185 3,627.14
2004 Cardiac Structural Dis 3.2119 8,835.81
2011 Cardiac Arrhythmias 0.5754 1,582.90
2012 Cardiac Arrhythmias 0.7545 2,075.60
2013 Cardiac Arrhythmias 1.1618 3,196.07
2014 Cardiac Arrhythmias 2.6859 7,388.80
2031 Chest Pain 0.6044 1,662.68
2032 Chest Pain 0.7112 1,956.48
2033 Chest Pain 0.9832 2,704.74
2034 Chest Pain 2.2840 6,283.19
2041 Syncope & Collapse 0.6937 1,908.34
2042 Syncope & Collapse 0.7962 2,190.31
2043 Syncope & Collapse 1.0477 2,882.18
2044 Syncope & Collapse 2.4419 6,717.57
2051 Cardiomyopathy 0.6711 1,846.17
2052 Cardiomyopathy 0.8121 2,234.05
2053 Cardiomyopathy 1.2526 3,445.85
2054 Cardiomyopathy 3.4234 9,417.64
2061 Complic of CV Device or Proc 0.7451 2,049.74
2062 Complic of CV Device or Proc 0.9228 2,538.59
2063 Complic of CV Device or Proc 1.5577 4,285.17
2064 Complic of CV Device or Proc 3.3555 9,230.85
2071 Oth Circulatory Sys Diags 0.6541 1,799.40
2072 Oth Circulatory Sys Diags 0.9143 2,515.20
2073 Oth Circulatory Sys Diags 1.3406 3,687.94
2074 Oth Circulatory Sys Diags 2.7538 7,575.59
2201 Maj Stomach & Esophag Procs 1.6949 4,662.60
2202 Maj Stomach & Esophag Procs 2.7689 7,617.13
2203 Maj Stomach & Esophag Procs 4.4851 12,338.33
2204 Maj Stomach & Esophag Procs 9.1375 25,136.90
2211 Maj Small & Large Bowel Procs 1.7307 4,761.09
2212 Maj Small & Large Bowel Procs 2.3052 6,341.51
2213 Maj Small & Large Bowel Procs 3.8824 10,680.33
2214 Maj Small & Large Bowel Procs 8.1615 22,451.96
2221 Oth Stomach & Esophag Procs 1.0713 2,947.10
2222 Oth Stomach & Esophag Procs 1.6114 4,432.90
2223 Oth Stomach & Esophag Procs 2.9789 8,194.83
2224 Oth Stomach & Esophag Procs 7.7743 21,386.79
2231 Oth Small & Large Bowel Procs 1.3914 3,827.69
2232 Oth Small & Large Bowel Procs 1.8945 5,211.69
2233 Oth Small & Large Bowel Procs 3.3110 9,108.43
2234 Oth Small & Large Bowel Procs 7.4449 20,480.62
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
2241 Peritoneal Adhesiolysis 1.5295 4,207.59
2242 Peritoneal Adhesiolysis 2.1122 5,810.58
2243 Peritoneal Adhesiolysis 3.3244 9,145.29
2244 Peritoneal Adhesiolysis 6.5800 18,101.32
2251 Appendectomy 1.0256 2,821.38
2252 Appendectomy 1.4179 3,900.59
2253 Appendectomy 2.5278 6,953.88
2254 Appendectomy 5.2212 14,363.31
2261 Anal Procs 0.8202 2,256.34
2262 Anal Procs 1.1677 3,212.30
2263 Anal Procs 2.0174 5,549.79
2264 Anal Procs 4.6238 12,719.89
2271 Oth Hernia Procs 1.2648 3,479.41
2272 Oth Hernia Procs 1.6437 4,521.75
2273 Oth Hernia Procs 2.8664 7,885.35
2274 Oth Hernia Procs 6.4975 17,874.36
2281 Inguin, Fem & Umbil Hernia Procs 0.9518 2,618.36
2282 Inguin, Fem & Umbil Hernia Procs 1.2715 3,497.85
2283 Inguin, Fem & Umbil Hernia Procs 2.1255 5,847.17
2284 Inguin, Fem & Umbil Hernia Procs 4.6212 12,712.74
2291 Oth Digestive & Abdo Procs 1.3809 3,798.80
2292 Oth Digestive & Abdo Procs 2.0016 5,506.32
2293 Oth Digestive & Abdo Procs 3.2616 8,972.53
2294 Oth Digestive & Abdo Procs 6.9520 19,124.67
2401 Digestive Malig 0.9288 2,555.09
2402 Digestive Malig 1.1189 3,078.05
2403 Digestive Malig 1.7307 4,761.09
2404 Digestive Malig 3.4080 9,375.27
2411 Peptic Ulcer & Gastritis 0.7314 2,012.05
2412 Peptic Ulcer & Gastritis 0.9298 2,557.84
2413 Peptic Ulcer & Gastritis 1.4099 3,878.58
2414 Peptic Ulcer & Gastritis 3.5394 9,736.75
2421 Maj Esophageal Dis 0.6891 1,895.69
2422 Maj Esophageal Dis 0.9480 2,607.91
2423 Maj Esophageal Dis 1.3828 3,804.03
2424 Maj Esophageal Dis 3.4521 9,496.59
2431 Oth Esophageal Dis 0.6294 1,731.45
2432 Oth Esophageal Dis 0.8079 2,222.50
2433 Oth Esophageal Dis 1.2396 3,410.09
2434 Oth Esophageal Dis 3.0432 8,371.72
2441 Diverticulitis & Diverticulosis 0.6814 1,874.50
2442 Diverticulitis & Diverticulosis 0.8655 2,380.96
2443 Diverticulitis & Diverticulosis 1.3388 3,682.99
2444 Diverticulitis & Diverticulosis 3.0459 8,379.15
2451 Inflammatory Bowel Disease 0.7883 2,168.58
2452 Inflammatory Bowel Disease 0.9531 2,621.94
2453 Inflammatory Bowel Disease 1.4596 4,015.30
2454 Inflammatory Bowel Disease 2.9358 8,076.27
2461 Gastroint Vasc Insufficiency 0.8248 2,268.99
2462 Gastroint Vasc Insufficiency 1.0386 2,857.15
2463 Gastroint Vasc Insufficiency 1.5494 4,262.34
2464 Gastroint Vasc Insufficiency 3.6171 9,950.50
2471 Intestinal Obstruction 0.6441 1,771.89
2472 Intestinal Obstruction 0.8273 2,275.87
2473 Intestinal Obstruction 1.3441 3,697.57
2474 Intestinal Obstruction 3.2660 8,984.64
2481 Maj Gastroint & Peritoneal Inf 0.6735 1,852.77
2482 Maj Gastroint & Peritoneal Inf 1.0017 2,755.64
2483 Maj Gastroint & Peritoneal Inf 1.5623 4,297.82
2484 Maj Gastroint & Peritoneal Inf 3.3544 9,227.82
2491 Non-Bact Gastroenteritis, N & V 0.4903 1,348.80
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
2492 Non-Bact Gastroenteritis, N & V 0.6538 1,798.58
2493 Non-Bact Gastroenteritis, N & V 0.9768 2,687.14
2494 Non-Bact Gastroenteritis, N & V 2.6051 7,166.53
2511 Abdominal Pain 0.6390 1,757.86
2512 Abdominal Pain 0.7917 2,177.94
2513 Abdominal Pain 1.1245 3,093.45
2514 Abdominal Pain 2.2672 6,236.98
2521 Complic of Gi Device or Proc 0.6755 1,858.27
2522 Complic of Gi Device or Proc 0.9302 2,558.94
2523 Complic of Gi Device or Proc 1.5401 4,236.75
2524 Complic of Gi Device or Proc 3.5342 9,722.44
2531 Oth & Unspec Gi Hemorrhage 0.6948 1,911.37
2532 Oth & Unspec Gi Hemorrhage 0.9143 2,515.20
2533 Oth & Unspec Gi Hemorrhage 1.4114 3,882.70
2534 Oth & Unspec Gi Hemorrhage 3.0252 8,322.20
2541 Oth Digestive Sys Diags 0.6447 1,773.54
2542 Oth Digestive Sys Diags 0.8730 2,401.59
2543 Oth Digestive Sys Diags 1.3223 3,637.59
2544 Oth Digestive Sys Diags 3.0621 8,423.71
2601 Maj Pancreas & Liver Procs 2.1672 5,961.88
2602 Maj Pancreas & Liver Procs 2.8050 7,716.44
2603 Maj Pancreas & Liver Procs 4.6270 12,728.69
2604 Maj Pancreas & Liver Procs 10.2279 28,136.54
2611 Maj Biliary Tract Procs 1.6793 4,619.69
2612 Maj Biliary Tract Procs 2.4675 6,787.99
2613 Maj Biliary Tract Procs 3.6643 10,080.34
2614 Maj Biliary Tract Procs 7.0637 19,431.96
2621 Cholecystectomy Exc Laparo 1.4801 4,071.70
2622 Cholecystectomy Exc Laparo 1.9570 5,383.63
2623 Cholecystectomy Exc Laparo 3.1367 8,628.94
2624 Cholecystectomy Exc Laparo 6.5817 18,105.99
2631 Laparoscopic Cholecystectomy 1.2132 3,337.46
2632 Laparoscopic Cholecystectomy 1.5729 4,326.98
2633 Laparoscopic Cholecystectomy 2.2834 6,281.54
2634 Laparoscopic Cholecystectomy 5.0537 13,902.53
2641 Oth Hepatobiliary & Abdo Procs 1.8342 5,045.81
2642 Oth Hepatobiliary & Abdo Procs 2.0178 5,550.89
2643 Oth Hepatobiliary & Abdo Procs 3.5371 9,730.42
2644 Oth Hepatobiliary & Abdo Procs 8.8869 24,447.51
2791 Hepatic Coma & Oth Maj Liver Dis 0.6700 1,843.14
2792 Hepatic Coma & Oth Maj Liver Dis 0.9107 2,505.30
2793 Hepatic Coma & Oth Maj Liver Dis 1.5522 4,270.04
2794 Hepatic Coma & Oth Maj Liver Dis 4.1178 11,327.90
2801 Alcoholic Liver Disease 0.6743 1,854.97
2802 Alcoholic Liver Disease 0.8791 2,418.37
2803 Alcoholic Liver Disease 1.4210 3,909.11
2804 Alcoholic Liver Disease 3.3312 9,164.00
2811 Malig of Hepatobiliary Sys 1.0132 2,787.27
2812 Malig of Hepatobiliary Sys 1.2102 3,329.21
2813 Malig of Hepatobiliary Sys 1.7030 4,684.88
2814 Malig of Hepatobiliary Sys 3.0757 8,461.13
2821 Dis of Pancreas Exc Malig 0.7391 2,033.23
2822 Dis of Pancreas Exc Malig 0.9412 2,589.20
2823 Dis of Pancreas Exc Malig 1.6340 4,495.07
2824 Dis of Pancreas Exc Malig 4.8094 13,230.47
2831 Oth Dis of the Liver 0.7120 1,958.68
2832 Oth Dis of the Liver 0.9217 2,535.56
2833 Oth Dis of the Liver 1.3599 3,741.03
2834 Oth Dis of the Liver 2.9680 8,164.85
2841 Dis of Gallbladder 0.7657 2,106.41
2842 Dis of Gallbladder 1.0490 2,885.76
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
2843 Dis of Gallbladder 1.5928 4,381.73
2844 Dis of Gallbladder 3.4783 9,568.66
3011 Hip Joint Replacement 2.0807 5,723.92
3012 Hip Joint Replacement 2.3094 6,353.07
3013 Hip Joint Replacement 3.1365 8,628.39
3014 Hip Joint Replacement 5.4666 15,038.40
3021 Knee Joint Replacement 1.9688 5,416.09
3022 Knee Joint Replacement 2.2224 6,113.73
3023 Knee Joint Replacement 2.8799 7,922.49
3024 Knee Joint Replacement 5.9973 16,498.33
3031 Lumb Fusion for Back Curvature 6.2229 17,118.95
3032 Lumb Fusion for Back Curvature 7.4174 20,404.97
3033 Lumb Fusion for Back Curvature 10.9148 30,026.18
3034 Lumb Fusion for Back Curvature 14.2986 39,334.88
3041 Lumb Fusion Exc Back Curvature 3.7802 10,399.18
3042 Lumb Fusion Exc Back Curvature 4.5023 12,385.65
3043 Lumb Fusion Exc Back Curvature 6.7125 18,465.82
3044 Lumb Fusion Exc Back Curvature 11.5490 31,770.84
3051 Amput of Lower Limb Exc Toes 1.3544 3,725.90
3052 Amput of Lower Limb Exc Toes 1.8736 5,154.20
3053 Amput of Lower Limb Exc Toes 3.0320 8,340.91
3054 Amput of Lower Limb Exc Toes 6.6390 18,263.62
3081 Hip & Femur Procs for Trauma 1.5387 4,232.90
3082 Hip & Femur Procs for Trauma 1.9021 5,232.60
3083 Hip & Femur Procs for Trauma 2.7233 7,491.69
3084 Hip & Femur Procs for Trauma 5.3928 14,835.38
3091 Hip & Femur Procs Non-Trauma 1.5448 4,249.68
3092 Hip & Femur Procs Non-Trauma 2.1544 5,926.67
3093 Hip & Femur Procs Non-Trauma 3.2021 8,808.85
3094 Hip & Femur Procs Non-Trauma 6.9114 19,012.98
3101 Disc Excision & Decompress 1.1228 3,088.78
3102 Disc Excision & Decompress 1.5111 4,156.98
3103 Disc Excision & Decompress 2.2514 6,193.51
3104 Disc Excision & Decompress 5.8651 16,134.66
3121 Skin Graft for Connect Tis Diags 2.0318 5,589.40
3122 Skin Graft for Connect Tis Diags 2.9913 8,228.95
3123 Skin Graft for Connect Tis Diags 5.7861 15,917.33
3124 Skin Graft for Connect Tis Diags 12.7005 34,938.57
3131 Knee & Lower Leg Procs Exc Foot 1.3686 3,764.96
3132 Knee & Lower Leg Procs Exc Foot 1.9779 5,441.12
3133 Knee & Lower Leg Procs Exc Foot 3.1430 8,646.27
3134 Knee & Lower Leg Procs Exc Foot 6.7375 18,534.59
3141 Foot & Toe Procs 1.2286 3,379.83
3142 Foot & Toe Procs 1.4585 4,012.28
3143 Foot & Toe Procs 2.2229 6,115.11
3144 Foot & Toe Procs 4.8664 13,387.27
3151 Shoulder And Arm Procs 1.1258 3,097.03
3152 Shoulder And Arm Procs 1.9473 5,356.94
3153 Shoulder And Arm Procs 3.0199 8,307.62
3154 Shoulder And Arm Procs 6.2422 17,172.04
3161 Hand & Wrist Procs 0.9881 2,718.22
3162 Hand & Wrist Procs 1.5028 4,134.14
3163 Hand & Wrist Procs 2.5026 6,884.55
3164 Hand & Wrist Procs 5.0461 13,881.62
3171 Soft Tissue Procs 1.0700 2,943.53
3172 Soft Tissue Procs 1.6429 4,519.55
3173 Soft Tissue Procs 2.9981 8,247.65
3174 Soft Tissue Procs 6.9666 19,164.84
3201 Oth Muscskl & Connect Tis Procs 1.2446 3,423.84
3202 Oth Muscskl & Connect Tis Procs 1.8603 5,117.61
3203 Oth Muscskl & Connect Tis Procs 2.9282 8,055.36
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
3204 Oth Muscskl & Connect Tis Procs 6.1847 17,013.86
3211 Cervical Spinal Fusion 2.1341 5,870.82
3212 Cervical Spinal Fusion 2.8191 7,755.23
3213 Cervical Spinal Fusion 5.0838 13,985.33
3214 Cervical Spinal Fusion 9.5927 26,389.13
3401 Fracture of Femur 0.6047 1,663.51
3402 Fracture of Femur 0.7517 2,067.90
3403 Fracture of Femur 1.2153 3,343.24
3404 Fracture of Femur 2.5791 7,095.00
3411 Fx of Pelvis or Dislocation of Hip 0.6085 1,673.96
3412 Fx of Pelvis or Dislocation of Hip 0.7389 2,032.68
3413 Fx of Pelvis or Dislocation of Hip 1.0597 2,915.19
3414 Fx of Pelvis or Dislocation of Hip 2.8832 7,931.57
3421 Fx & Dislc Exc Femur, Pelvis, Back 0.6076 1,671.48
3422 Fx & Dislc Exc Femur, Pelvis, Back 0.8081 2,223.05
3423 Fx & Dislc Exc Femur, Pelvis, Back 1.2194 3,354.52
3424 Fx & Dislc Exc Femur, Pelvis, Back 3.3329 9,168.67
3431 Muscskl Malig & Pathol Fx 0.9609 2,643.40
3432 Muscskl Malig & Pathol Fx 1.1855 3,261.26
3433 Muscskl Malig & Pathol Fx 1.9454 5,351.72
3434 Muscskl Malig & Pathol Fx 3.6628 10,076.22
3441 Musculoskeletal Inf 0.9164 2,520.98
3442 Musculoskeletal Inf 1.2191 3,353.70
3443 Musculoskeletal Inf 1.9386 5,333.01
3444 Musculoskeletal Inf 3.5197 9,682.55
3461 Connective Tissue Dis 0.7899 2,172.98
3462 Connective Tissue Dis 1.0931 3,007.07
3463 Connective Tissue Dis 1.9111 5,257.36
3464 Connective Tissue Dis 5.3642 14,756.70
3471 Oth Back & Neck Dis, Fx & Injuries 0.7259 1,996.92
3472 Oth Back & Neck Dis, Fx & Injuries 0.9481 2,608.19
3473 Oth Back & Neck Dis, Fx & Injuries 1.4010 3,854.09
3474 Oth Back & Neck Dis, Fx & Injuries 3.4244 9,420.39
3491 Complic of Ortho Device or Proc 0.5816 1,599.96
3492 Complic of Ortho Device or Proc 0.9217 2,535.56
3493 Complic of Ortho Device or Proc 1.5736 4,328.91
3494 Complic of Ortho Device or Proc 3.5328 9,718.59
3511 Oth Muscskl & Connect Tis Diags 0.6086 1,674.23
3512 Oth Muscskl & Connect Tis Diags 0.7764 2,135.85
3513 Oth Muscskl & Connect Tis Diags 1.3246 3,643.92
3514 Oth Muscskl & Connect Tis Diags 3.0512 8,393.73
3611 Skin Graft for Cutaneous Diags 1.7006 4,678.28
3612 Skin Graft for Cutaneous Diags 2.2378 6,156.10
3613 Skin Graft for Cutaneous Diags 3.4500 9,490.81
3614 Skin Graft for Cutaneous Diags 8.1368 22,384.01
3621 Mastectomy Procs 1.3632 3,750.11
3622 Mastectomy Procs 1.8166 4,997.39
3623 Mastectomy Procs 2.6380 7,257.03
3624 Mastectomy Procs 6.3126 17,365.71
3631 Breast Procs Exc Mastectomy 1.2581 3,460.98
3632 Breast Procs Exc Mastectomy 2.1339 5,870.27
3633 Breast Procs Exc Mastectomy 2.6700 7,345.06
3634 Breast Procs Exc Mastectomy 6.1793 16,999.01
3641 Oth Cutaneous & Related Procs 1.0855 2,986.17
3642 Oth Cutaneous & Related Procs 1.4969 4,117.91
3643 Oth Cutaneous & Related Procs 2.4611 6,770.39
3644 Oth Cutaneous & Related Procs 4.9435 13,599.37
3801 Skin Ulcers 0.7325 2,015.08
3802 Skin Ulcers 0.8862 2,437.90
3803 Skin Ulcers 1.3307 3,660.70
3804 Skin Ulcers 2.7057 7,443.27
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
3811 Maj Skin Dis 0.5979 1,644.80
3812 Maj Skin Dis 0.8767 2,411.77
3813 Maj Skin Dis 1.6469 4,530.56
3814 Maj Skin Dis 5.2090 14,329.75
3821 Malignant Breast Dis 0.6294 1,731.45
3822 Malignant Breast Dis 0.9547 2,626.34
3823 Malignant Breast Dis 1.6242 4,468.11
3824 Malignant Breast Dis 2.8484 7,835.83
3831 Cellulitis & Oth Bact Skin Inf 0.5665 1,558.42
3832 Cellulitis & Oth Bact Skin Inf 0.7941 2,184.54
3833 Cellulitis & Oth Bact Skin Inf 1.2782 3,516.28
3834 Cellulitis & Oth Bact Skin Inf 3.1734 8,729.90
3841 Trauma To Cutaneous Tissue 0.7268 1,999.40
3842 Trauma To Cutaneous Tissue 0.8495 2,336.94
3843 Trauma To Cutaneous Tissue 1.2933 3,557.82
3844 Trauma To Cutaneous Tissue 3.7052 10,192.86
3851 Oth Cutaneous Tis & Breast Dis 0.5187 1,426.92
3852 Oth Cutaneous Tis & Breast Dis 0.7364 2,025.81
3853 Oth Cutaneous Tis & Breast Dis 1.2010 3,303.90
3854 Oth Cutaneous Tis & Breast Dis 3.9887 10,972.75
4011 Pituitary & Adrenal Procs 1.8168 4,997.94
4012 Pituitary & Adrenal Procs 2.5206 6,934.07
4013 Pituitary & Adrenal Procs 4.3570 11,985.93
4014 Pituitary & Adrenal Procs 10.2272 28,134.62
4031 Procs for Obesity 1.7833 4,905.79
4032 Procs for Obesity 1.9888 5,471.11
4033 Procs for Obesity 3.1791 8,745.58
4034 Procs for Obesity 9.6689 26,598.76
4041 Thyroid Procs 0.9807 2,697.87
4042 Thyroid Procs 1.3020 3,581.75
4043 Thyroid Procs 2.8358 7,801.17
4044 Thyroid Procs 6.3529 17,476.57
4051 Oth Procs for Metabolic Dis 1.7392 4,784.47
4052 Oth Procs for Metabolic Dis 2.1712 5,972.88
4053 Oth Procs for Metabolic Dis 3.4100 9,380.77
4054 Oth Procs for Metabolic Dis 7.7166 21,228.06
4201 Diabetes 0.5340 1,469.01
4202 Diabetes 0.7016 1,930.07
4203 Diabetes 1.1073 3,046.14
4204 Diabetes 3.1259 8,599.23
4211 Nutritional Dis 0.4890 1,345.22
4212 Nutritional Dis 0.7320 2,013.70
4213 Nutritional Dis 1.1779 3,240.36
4214 Nutritional Dis 3.0530 8,398.68
4221 Hypovolemia 0.3811 1,048.39
4222 Hypovolemia 0.6027 1,658.00
4223 Hypovolemia 0.9333 2,567.47
4224 Hypovolemia 2.4037 6,612.48
4231 Inborn Errors of Metabolism 0.7136 1,963.09
4232 Inborn Errors of Metabolism 0.9506 2,615.06
4233 Inborn Errors of Metabolism 1.5782 4,341.57
4234 Inborn Errors of Metabolism 6.4144 17,645.76
4241 Oth Endocrine Dis 0.6370 1,752.36
4242 Oth Endocrine Dis 0.9458 2,601.86
4243 Oth Endocrine Dis 1.4048 3,864.55
4244 Oth Endocrine Dis 3.3997 9,352.44
4251 Electrolyte Dis Exc Hypovolemia 0.5340 1,469.01
4252 Electrolyte Dis Exc Hypovolemia 0.6991 1,923.20
4253 Electrolyte Dis Exc Hypovolemia 1.0951 3,012.58
4254 Electrolyte Dis Exc Hypovolemia 2.8062 7,719.74
4401 Kidney Transpl 6.1357 16,879.07
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
4402 Kidney Transpl 6.8864 18,944.21
4403 Kidney Transpl 8.4814 23,331.99
4404 Kidney Transpl 14.0706 38,707.66
4411 Maj Bladder Procs 1.8315 5,038.38
4412 Maj Bladder Procs 2.8383 7,808.05
4413 Maj Bladder Procs 3.9135 10,765.88
4414 Maj Bladder Procs 8.3785 23,048.92
4421 Kidney & Urinary Procs for Malig 1.6554 4,553.94
4422 Kidney & Urinary Procs for Malig 1.9893 5,472.48
4423 Kidney & Urinary Procs for Malig 3.2177 8,851.76
4424 Kidney & Urinary Procs for Malig 7.5184 20,682.82
4431 Kidney & Urinary Procs Nonmalig 1.4249 3,919.84
4432 Kidney & Urinary Procs Nonmalig 1.7564 4,831.79
4433 Kidney & Urinary Procs Nonmalig 2.8175 7,750.83
4434 Kidney & Urinary Procs Nonmalig 6.6670 18,340.65
4441 Renal Dialysis Access Proc 1.3883 3,819.16
4442 Renal Dialysis Access Proc 1.9081 5,249.11
4443 Renal Dialysis Access Proc 3.2373 8,905.68
4444 Renal Dialysis Access Proc 6.0364 16,605.89
4451 Oth Bladder Procs 1.0330 2,841.74
4452 Oth Bladder Procs 1.5195 4,180.08
4453 Oth Bladder Procs 2.3539 6,475.48
4454 Oth Bladder Procs 4.5428 12,497.06
4461 Urethral Procs 0.8567 2,356.75
4462 Urethral Procs 1.1283 3,103.91
4463 Urethral Procs 1.9350 5,323.11
4464 Urethral Procs 4.3013 11,832.70
4471 Oth Kidney & Urinary Procs 1.5603 4,292.32
4472 Oth Kidney & Urinary Procs 1.9383 5,332.19
4473 Oth Kidney & Urinary Procs 2.9286 8,056.46
4474 Oth Kidney & Urinary Procs 7.2877 20,048.17
4601 Renal Failure 0.7761 2,135.02
4602 Renal Failure 0.9275 2,551.52
4603 Renal Failure 1.1626 3,198.27
4604 Renal Failure 3.2614 8,971.98
4611 Kidney & Urinary Tract Malig 0.8158 2,244.23
4612 Kidney & Urinary Tract Malig 0.9485 2,609.29
4613 Kidney & Urinary Tract Malig 1.5040 4,137.44
4614 Kidney & Urinary Tract Malig 3.2132 8,839.38
4621 Nephritis & Nephrosis 0.5759 1,584.28
4622 Nephritis & Nephrosis 0.8089 2,225.25
4623 Nephritis & Nephrosis 1.4684 4,039.51
4624 Nephritis & Nephrosis 3.9045 10,741.12
4631 Kidney & Urinary Tract Inf 0.5493 1,511.10
4632 Kidney & Urinary Tract Inf 0.7280 2,002.70
4633 Kidney & Urinary Tract Inf 1.0520 2,894.01
4634 Kidney & Urinary Tract Inf 2.2172 6,099.43
4651 Urinary Stones & Obstruction 0.5834 1,604.91
4652 Urinary Stones & Obstruction 0.7444 2,047.81
4653 Urinary Stones & Obstruction 1.2295 3,382.31
4654 Urinary Stones & Obstruction 2.4052 6,616.61
4661 Complic Genitourin Dev or Proc 0.5163 1,420.32
4662 Complic Genitourin Dev or Proc 0.8633 2,374.90
4663 Complic Genitourin Dev or Proc 1.4472 3,981.19
4664 Complic Genitourin Dev or Proc 2.8207 7,759.63
4681 Oth Kidney & Urinary Diags 0.6281 1,727.88
4682 Oth Kidney & Urinary Diags 0.8412 2,314.11
4683 Oth Kidney & Urinary Diags 1.2674 3,486.57
4684 Oth Kidney & Urinary Diags 2.9289 8,057.29
4801 Maj Male Pelvic Procs 1.5444 4,248.58
4802 Maj Male Pelvic Procs 1.7625 4,848.57
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
4803 Maj Male Pelvic Procs 3.1832 8,756.86
4804 Maj Male Pelvic Procs 7.7134 21,219.25
4811 Penis Procs 0.9798 2,695.39
4812 Penis Procs 1.6847 4,634.54
4813 Penis Procs 2.6552 7,304.35
4814 Penis Procs 6.4370 17,707.93
4821 Transurethral Prostatectomy 0.7440 2,046.71
4822 Transurethral Prostatectomy 0.9730 2,676.68
4823 Transurethral Prostatectomy 2.0480 5,633.97
4824 Transurethral Prostatectomy 4.2598 11,718.54
4831 Testes & Scrotal Procs 0.8324 2,289.90
4832 Testes & Scrotal Procs 1.7935 4,933.85
4833 Testes & Scrotal Procs 3.1846 8,760.71
4834 Testes & Scrotal Procs 7.2601 19,972.24
4841 Oth Male Reproductive Procs 1.1149 3,067.05
4842 Oth Male Reproductive Procs 1.6390 4,508.82
4843 Oth Male Reproductive Procs 2.0997 5,776.19
4844 Oth Male Reproductive Procs 6.4952 17,868.04
5001 Malig, Male Reproductive Sys 0.6886 1,894.31
5002 Malig, Male Reproductive Sys 0.9727 2,675.86
5003 Malig, Male Reproductive Sys 1.4233 3,915.44
5004 Malig, Male Reproductive Sys 2.7907 7,677.10
5011 Male Reproduct Diags Exc Malig 0.5765 1,585.93
5012 Male Reproduct Diags Exc Malig 0.7760 2,134.74
5013 Male Reproduct Diags Exc Malig 1.2192 3,353.97
5014 Male Reproduct Diags Exc Malig 3.0462 8,379.97
5101 Radical Hysterectectomy 1.5538 4,274.44
5102 Radical Hysterectectomy 1.9596 5,390.78
5103 Radical Hysterectectomy 3.7871 10,418.16
5104 Radical Hysterectectomy 8.2719 22,755.67
5111 Procs for Uterine/Adnexa Malig 1.5271 4,200.99
5112 Procs for Uterine/Adnexa Malig 2.0016 5,506.32
5113 Procs for Uterine/Adnexa Malig 3.1431 8,646.54
5114 Procs for Uterine/Adnexa Malig 7.3656 20,262.47
5121 Uterine/Adnexa Procs Oth Malig 1.4224 3,912.97
5122 Uterine/Adnexa Procs Oth Malig 1.6160 4,445.55
5123 Uterine/Adnexa Procs Oth Malig 2.7602 7,593.20
5124 Uterine/Adnexa Procs Oth Malig 6.3469 17,460.07
5131 Uterine/Adnexa Procs Non-Malig 1.0020 2,756.46
5132 Uterine/Adnexa Procs Non-Malig 1.1915 3,277.77
5133 Uterine/Adnexa Procs Non-Malig 2.1143 5,816.35
5134 Uterine/Adnexa Procs Non-Malig 5.7678 15,866.99
5141 Fem Reproduct Reconstr Procs 0.9059 2,492.09
5142 Fem Reproduct Reconstr Procs 1.2209 3,358.65
5143 Fem Reproduct Reconstr Procs 2.1368 5,878.25
5144 Fem Reproduct Reconstr Procs 6.9583 19,142.00
5171 D&C for Non-Obstetric Diags 0.8444 2,322.91
5172 D&C for Non-Obstetric Diags 1.1052 3,040.36
5173 D&C for Non-Obstetric Diags 2.0250 5,570.69
5174 D&C for Non-Obstetric Diags 3.8216 10,513.07
5181 Oth Fem Reproductive Procs 0.9836 2,705.84
5182 Oth Fem Reproductive Procs 1.3791 3,793.85
5183 Oth Fem Reproductive Procs 2.6913 7,403.66
5184 Oth Fem Reproductive Procs 5.6467 15,533.85
5191 Uterine/Adnexa Procs Leiomyoma 1.0515 2,892.63
5192 Uterine/Adnexa Procs Leiomyoma 1.2350 3,397.44
5193 Uterine/Adnexa Procs Leiomyoma 2.3066 6,345.36
5194 Uterine/Adnexa Procs Leiomyoma 5.3215 14,639.23
5301 Female Reproductive Sys Malig 0.7333 2,017.28
5302 Female Reproductive Sys Malig 0.9455 2,601.03
5303 Female Reproductive Sys Malig 1.5991 4,399.06
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
5304 Female Reproductive Sys Malig 3.3639 9,253.95
5311 Female Reproductive Sys Inf 0.6300 1,733.10
5312 Female Reproductive Sys Inf 0.8750 2,407.09
5313 Female Reproductive Sys Inf 1.4928 4,106.63
5314 Female Reproductive Sys Inf 3.0266 8,326.06
5321 Menstrual & Oth Fem Reprod Dis 0.5759 1,584.28
5322 Menstrual & Oth Fem Reprod Dis 0.6993 1,923.75
5323 Menstrual & Oth Fem Reprod Dis 1.1680 3,213.12
5324 Menstrual & Oth Fem Reprod Dis 1.8452 5,076.07
5401 Cesarean Del 0.7060 1,942.18
5402 Cesarean Del 0.8586 2,361.97
5403 Cesarean Del 1.2772 3,513.53
5404 Cesarean Del 3.5686 9,817.08
5411 Vag Del w Ster &/or D&C 0.6570 1,807.38
5412 Vag Del w Ster &/or D&C 0.7309 2,010.68
5413 Vag Del w Ster &/or D&C 1.1748 3,231.83
5414 Vag Del w Ster &/or D&C 4.0564 11,158.99
5421 Vag Del w Proc Exc Ster &/or D&C 0.4456 1,225.83
5422 Vag Del w Proc Exc Ster &/or D&C 0.5591 1,538.06
5423 Vag Del w Proc Exc Ster &/or D&C 1.2062 3,318.21
5424 Vag Del w Proc Exc Ster &/or D&C 5.0425 13,871.72
5441 D&C for Obstetric Diags 0.6897 1,897.34
5442 D&C for Obstetric Diags 0.8192 2,253.59
5443 D&C for Obstetric Diags 1.5978 4,395.48
5444 D&C for Obstetric Diags 4.2728 11,754.30
5451 Ectopic Pregnancy Proc 0.9500 2,613.41
5452 Ectopic Pregnancy Proc 1.0956 3,013.95
5453 Ectopic Pregnancy Proc 1.3491 3,711.32
5454 Ectopic Pregnancy Proc 2.8199 7,757.43
5461 Oth O.R. Proc for Ob Diag Exc Del 0.7456 2,051.12
5462 Oth O.R. Proc for Ob Diag Exc Del 1.0629 2,924.00
5463 Oth O.R. Proc for Ob Diag Exc Del 2.2078 6,073.57
5464 Oth O.R. Proc for Ob Diag Exc Del 6.5042 17,892.79
5601 Vaginal Del 0.4181 1,150.18
5602 Vaginal Del 0.4776 1,313.86
5603 Vaginal Del 0.7063 1,943.00
5604 Vaginal Del 2.1733 5,978.66
5611 Postpartum Diags w/o Proc 0.3759 1,034.09
5612 Postpartum Diags w/o Proc 0.5669 1,559.52
5613 Postpartum Diags w/o Proc 0.8929 2,456.33
5614 Postpartum Diags w/o Proc 2.5257 6,948.10
5631 Threatened Abortion 0.4045 1,112.76
5632 Threatened Abortion 0.5491 1,510.55
5633 Threatened Abortion 1.0334 2,842.84
5634 Threatened Abortion 1.2349 3,397.16
5641 Abortion w/o D&C 0.3932 1,081.68
5642 Abortion w/o D&C 0.4642 1,277.00
5643 Abortion w/o D&C 0.6868 1,889.36
5644 Abortion w/o D&C 3.6549 10,054.48
5651 False Labor 0.2021 555.97
5652 False Labor 0.2926 804.93
5653 False Labor 0.4888 1,344.67
5654 False Labor 0.5377 1,479.19
5661 Oth Antepartum Diags 0.3748 1,031.06
5662 Oth Antepartum Diags 0.4955 1,363.10
5663 Oth Antepartum Diags 0.8085 2,224.15
5664 Oth Antepartum Diags 2.6254 7,222.37
5801 Neo, Tsf<5 Days, Not Born Here 0.3471 954.86
5802 Neo, Tsf<5 Days, Not Born Here 0.5374 1,478.37
5803 Neo, Tsf<5 Days, Not Born Here 0.9484 2,609.01
5804 Neo, Tsf<5 Days, Not Born Here 1.3630 3,749.56
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
5811 Neo, Tsf<5 Days Old, Born Here 0.1500 412.64
5812 Neo, Tsf<5 Days Old, Born Here 0.2188 601.91
5813 Neo, Tsf<5 Days Old, Born Here 0.3854 1,060.22
5814 Neo, Tsf<5 Days Old, Born Here 0.7859 2,161.98
5831 Neo w Ecmo 18.0234 49,581.65
5832 Neo w Ecmo 20.0261 55,091.00
5833 Neo w Ecmo 23.0622 63,443.19
5834 Neo w Ecmo 36.6526 100,829.84
5881 Neo Bwt <1500G w Maj Proc 10.6299 29,242.43
5882 Neo Bwt <1500G w Maj Proc 11.8110 32,491.59
5883 Neo Bwt <1500G w Maj Proc 24.5882 67,641.15
5884 Neo Bwt <1500G w Maj Proc 35.7085 98,232.66
5891 Neo Bwt <500G or <24 Wks 18.3920 50,595.66
5892 Neo Bwt <500G or <24 Wks 16.7201 45,996.33
5893 Neo Bwt <500G or <24 Wks 12.7730 35,138.01
5894 Neo Bwt <500G or <24 Wks 0.4342 1,194.47
5911 Neo Bwt 500-749G w/o Maj Proc 8.8286 24,287.13
5912 Neo Bwt 500-749G w/o Maj Proc 14.4636 39,788.79
5913 Neo Bwt 500-749G w/o Maj Proc 18.2265 50,140.37
5914 Neo Bwt 500-749G w/o Maj Proc 28.4817 78,352.02
5931 Neo Bwt 750-999G w/o Maj Proc 5.6374 15,508.26
5932 Neo Bwt 750-999G w/o Maj Proc 11.9425 32,853.34
5933 Neo Bwt 750-999G w/o Maj Proc 14.9888 41,233.59
5934 Neo Bwt 750-999G w/o Maj Proc 22.4059 61,637.73
6021 Neo Bwt 1000-1249G w Maj Problem 6.1993 17,054.03
6022 Neo Bwt 1000-1249G w Maj Problem 8.8500 24,346.00
6023 Neo Bwt 1000-1249G w Maj Problem 11.9292 32,816.75
6024 Neo Bwt 1000-1249G w Maj Problem 17.5008 48,144.00
6031 Neo Bwt 1000-1249G 4.1739 11,482.23
6032 Neo Bwt 1000-1249G 6.8331 18,797.58
6033 Neo Bwt 1000-1249G 10.6024 29,166.78
6034 Neo Bwt 1000-1249G 17.2557 47,469.74
6071 Neo Bwt 1250-1499G w Maj Problem 4.5701 12,572.16
6072 Neo Bwt 1250-1499G w Maj Problem 7.1008 19,534.02
6073 Neo Bwt 1250-1499G w Maj Problem 8.8139 24,246.69
6074 Neo Bwt 1250-1499G w Maj Problem 13.7483 37,821.02
6081 Neo Bwt 1250-1499G 3.4851 9,587.37
6082 Neo Bwt 1250-1499G 5.5447 15,253.25
6083 Neo Bwt 1250-1499G 8.2934 22,814.81
6084 Neo Bwt 1250-1499G 12.7671 35,121.78
6091 Neo Bwt 1500-2499G w Maj Proc 5.0491 13,889.87
6092 Neo Bwt 1500-2499G w Maj Proc 5.5164 15,175.40
6093 Neo Bwt 1500-2499G w Maj Proc 9.7319 26,772.07
6094 Neo Bwt 1500-2499G w Maj Proc 18.9390 52,100.43
6111 Neo Bwt 1500-1999G w Maj Anomaly 2.4938 6,860.34
6112 Neo Bwt 1500-1999G w Maj Anomaly 3.9784 10,944.42
6113 Neo Bwt 1500-1999G w Maj Anomaly 6.6804 18,377.51
6114 Neo Bwt 1500-1999G w Maj Anomaly 13.1996 36,311.57
6121 Neo Bwt 1500-1999G Maj Resp Cond 3.1196 8,581.89
6122 Neo Bwt 1500-1999G Maj Resp Cond 4.4862 12,341.36
6123 Neo Bwt 1500-1999G Maj Resp Cond 6.5087 17,905.17
6124 Neo Bwt 1500-1999G Maj Resp Cond 10.0110 27,539.86
6131 Neo Bwt 1500-1999G w Inf 2.4130 6,638.07
6132 Neo Bwt 1500-1999G w Inf 3.9893 10,974.40
6133 Neo Bwt 1500-1999G w Inf 5.6199 15,460.12
6134 Neo Bwt 1500-1999G w Inf 9.7889 26,928.87
6141 Neo Bwt 1500-1999G 1.6872 4,641.42
6142 Neo Bwt 1500-1999G 3.5545 9,778.29
6143 Neo Bwt 1500-1999G 5.5072 15,150.09
6144 Neo Bwt 1500-1999G 8.5543 23,532.54
6211 Neo Bwt 2000-2499G w Maj Anomaly 1.3321 3,664.55
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
6212 Neo Bwt 2000-2499G w Maj Anomaly 2.6000 7,152.50
6213 Neo Bwt 2000-2499G w Maj Anomaly 4.4528 12,249.47
6214 Neo Bwt 2000-2499G w Maj Anomaly 8.5706 23,577.38
6221 Neo Bwt 2000-2499G Maj Resp Cond 2.0032 5,510.72
6222 Neo Bwt 2000-2499G Maj Resp Cond 2.8032 7,711.49
6223 Neo Bwt 2000-2499G Maj Resp Cond 4.0211 11,061.89
6224 Neo Bwt 2000-2499G Maj Resp Cond 7.6268 20,981.02
6231 Neo Bwt 2000-2499G w Inf 1.6042 4,413.09
6232 Neo Bwt 2000-2499G w Inf 2.5006 6,879.05
6233 Neo Bwt 2000-2499G w Inf 4.1002 11,279.49
6234 Neo Bwt 2000-2499G w Inf 6.2577 17,214.68
6251 Neo Bwt 2000-2499G w Oth Sig Cond 1.9273 5,301.93
6252 Neo Bwt 2000-2499G w Oth Sig Cond 2.8086 7,726.35
6253 Neo Bwt 2000-2499G w Oth Sig Cond 3.6305 9,987.36
6254 Neo Bwt 2000-2499G w Oth Sig Cond 5.2241 14,371.29
6261 Norm Newborn, Bwt 2000-2499G 0.1870 514.43
6262 Norm Newborn, Bwt 2000-2499G 0.5225 1,437.38
6263 Norm Newborn, Bwt 2000-2499G 1.3018 3,581.20
6264 Norm Newborn, Bwt 2000-2499G 4.1651 11,458.02
6301 Neo Bwt >2499G w Maj CV Proc 2.6255 7,222.65
6302 Neo Bwt >2499G w Maj CV Proc 4.3396 11,938.07
6303 Neo Bwt >2499G w Maj CV Proc 7.8731 21,658.58
6304 Neo Bwt >2499G w Maj CV Proc 16.5786 45,607.07
6311 Neo Bwt >2499G w Oth Maj Proc 1.4241 3,917.64
6312 Neo Bwt >2499G w Oth Maj Proc 2.6351 7,249.05
6313 Neo Bwt >2499G w Oth Maj Proc 5.8886 16,199.30
6314 Neo Bwt >2499G w Oth Maj Proc 16.9789 46,708.27
6331 Neo Bwt >2499G w Maj Anomaly 0.3314 911.67
6332 Neo Bwt >2499G w Maj Anomaly 1.1130 3,061.82
6333 Neo Bwt >2499G w Maj Anomaly 2.5697 7,069.14
6334 Neo Bwt >2499G w Maj Anomaly 8.1569 22,439.31
6341 Neo, Bwt >2499G w Maj Resp Cond 0.7853 2,160.33
6342 Neo, Bwt >2499G w Maj Resp Cond 1.4764 4,061.52
6343 Neo, Bwt >2499G w Maj Resp Cond 2.9788 8,194.56
6344 Neo, Bwt >2499G w Maj Resp Cond 7.6567 21,063.28
6361 Neo Bwt >2499G w Inf 0.9416 2,590.30
6362 Neo Bwt >2499G w Inf 1.4680 4,038.41
6363 Neo Bwt >2499G w Inf 2.6013 7,156.07
6364 Neo Bwt >2499G w Inf 6.4839 17,836.95
6391 Neo Bwt >2499G w Oth Sig Cond 0.5595 1,539.16
6392 Neo Bwt >2499G w Oth Sig Cond 1.1093 3,051.64
6393 Neo Bwt >2499G w Oth Sig Cond 2.0007 5,503.85
6394 Neo Bwt >2499G w Oth Sig Cond 5.0926 14,009.54
6401 Normal Newborn, Bwt >2499G 0.1299 357.35
6402 Normal Newborn, Bwt >2499G 0.1870 514.43
6403 Normal Newborn, Bwt >2499G 0.5046 1,388.13
6404 Normal Newborn, Bwt >2499G 2.4856 6,837.79
6501 Splenectomy 1.6886 4,645.27
6502 Splenectomy 2.2401 6,162.43
6503 Splenectomy 3.6984 10,174.15
6504 Splenectomy 7.4399 20,466.87
6511 Oth Procs of Blood & Rel Organs 1.2814 3,525.08
6512 Oth Procs of Blood & Rel Organs 1.7973 4,944.30
6513 Oth Procs of Blood & Rel Organs 2.9617 8,147.52
6514 Oth Procs of Blood & Rel Organs 9.0285 24,837.04
6601 Maj Hem/Immun Diag 0.8697 2,392.51
6602 Maj Hem/Immun Diag 1.0640 2,927.02
6603 Maj Hem/Immun Diag 1.8156 4,994.64
6604 Maj Hem/Immun Diag 5.0471 13,884.37
6611 Coagulation & Platelet Dis 1.1373 3,128.67
6612 Coagulation & Platelet Dis 1.3642 3,752.86
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
6613 Coagulation & Platelet Dis 2.6319 7,240.25
6614 Coagulation & Platelet Dis 5.7949 15,941.54
6621 Sickle Cell Anemia Crisis 0.7691 2,115.76
6622 Sickle Cell Anemia Crisis 1.0346 2,846.14
6623 Sickle Cell Anemia Crisis 1.6785 4,617.49
6624 Sickle Cell Anemia Crisis 4.1448 11,402.18
6631 Oth Dis of Blood & Rel Organs 0.6174 1,698.44
6632 Oth Dis of Blood & Rel Organs 0.8025 2,207.65
6633 Oth Dis of Blood & Rel Organs 1.1830 3,254.39
6634 Oth Dis of Blood & Rel Organs 2.5522 7,021.00
6801 Maj O.R. Proc Lymphatic Neoplasm 1.8695 5,142.92
6802 Maj O.R. Proc Lymphatic Neoplasm 2.6565 7,307.93
6803 Maj O.R. Proc Lymphatic Neoplasm 4.6950 12,915.76
6804 Maj O.R. Proc Lymphatic Neoplasm 10.6295 29,241.33
6811 Oth O.R. Proc Lymphatic Neoplasm 1.3489 3,710.77
6812 Oth O.R. Proc Lymphatic Neoplasm 1.9328 5,317.06
6813 Oth O.R. Proc Lymphatic Neoplasm 3.8108 10,483.36
6814 Oth O.R. Proc Lymphatic Neoplasm 9.4770 26,070.85
6901 Acute Leukemia 1.6616 4,571.00
6902 Acute Leukemia 2.7068 7,446.30
6903 Acute Leukemia 5.2392 14,412.83
6904 Acute Leukemia 11.3104 31,114.46
6911 Lymphoma, Myeloma & Non-Ac Leuk 1.3181 3,626.04
6912 Lymphoma, Myeloma & Non-Ac Leuk 1.6445 4,523.95
6913 Lymphoma, Myeloma & Non-Ac Leuk 2.5631 7,050.99
6914 Lymphoma, Myeloma & Non-Ac Leuk 5.7577 15,839.20
6921 Radiothapy 1.1132 3,062.37
6922 Radiothapy 1.9659 5,408.11
6923 Radiothapy 2.8381 7,807.50
6924 Radiothapy 5.0596 13,918.76
6931 Chemothapy 1.0045 2,763.34
6932 Chemothapy 1.2578 3,460.16
6933 Chemothapy 2.5195 6,931.04
6934 Chemothapy 8.4289 23,187.57
6941 Lymphatic & Oth Malig & Neoplasms 0.8087 2,224.70
6942 Lymphatic & Oth Malig & Neoplasms 1.0498 2,887.96
6943 Lymphatic & Oth Malig & Neoplasms 1.7245 4,744.03
6944 Lymphatic & Oth Malig & Neoplasms 3.6565 10,058.89
7101 Inf & Parasit Dis Incl HIV w O.R. Proc 1.3430 3,694.54
7102 Inf & Parasit Dis Incl HIV w O.R. Proc 2.2141 6,090.90
7103 Inf & Parasit Dis Incl HIV w O.R. Proc 3.6614 10,072.36
7104 Inf & Parasit Dis Incl HIV w O.R. Proc 7.9852 21,966.97
7111 Post-Op, Device Inf w O.R. Proc 1.3742 3,780.37
7112 Post-Op, Device Inf w O.R. Proc 1.9877 5,468.08
7113 Post-Op, Device Inf w O.R. Proc 3.4772 9,565.64
7114 Post-Op, Device Inf w O.R. Proc 8.3204 22,889.09
7201 Septicemia & Disseminated Inf 0.7109 1,955.66
7202 Septicemia & Disseminated Inf 1.0128 2,786.17
7203 Septicemia & Disseminated Inf 1.7431 4,795.20
7204 Septicemia & Disseminated Inf 4.0057 11,019.52
7211 Post-Op, Post-Trauma, Device Inf 0.7548 2,076.42
7212 Post-Op, Post-Trauma, Device Inf 1.0459 2,877.23
7213 Post-Op, Post-Trauma, Device Inf 1.7593 4,839.76
7214 Post-Op, Post-Trauma, Device Inf 3.4096 9,379.67
7221 Fever 0.4665 1,283.32
7222 Fever 0.7334 2,017.55
7223 Fever 1.1096 3,052.47
7224 Fever 2.1578 5,936.02
7231 Viral Illness 0.4426 1,217.57
7232 Viral Illness 0.6677 1,836.82
7233 Viral Illness 1.1806 3,247.78
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
7234 Viral Illness 4.0378 11,107.83
7241 Oth Inf & Parasit Diseases 0.8042 2,212.32
7242 Oth Inf & Parasit Diseases 1.0101 2,778.74
7243 Oth Inf & Parasit Diseases 1.6772 4,613.91
7244 Oth Inf & Parasit Diseases 4.1111 11,309.47
7401 Mental Illness Diag w O.R. Proc 1.6513 4,542.66
7402 Mental Illness Diag w O.R. Proc 1.9500 5,364.37
7403 Mental Illness Diag w O.R. Proc 3.6128 9,938.67
7404 Mental Illness Diag w O.R. Proc 5.9125 16,265.05
7501 Schizophrenia 0.8257 2,271.47
7502 Schizophrenia 0.9433 2,594.98
7503 Schizophrenia 1.3222 3,637.32
7504 Schizophrenia 2.6976 7,420.99
7511 Maj Depression 0.4640 1,276.45
7512 Maj Depression 0.6646 1,828.29
7513 Maj Depression 1.1156 3,068.97
7514 Maj Depression 2.0748 5,707.69
7521 Dis of Personality 0.4435 1,220.05
7522 Dis of Personality 0.6042 1,662.13
7523 Dis of Personality 1.1243 3,092.90
7524 Dis of Personality 1.2367 3,402.11
7531 Bipolar Dis 0.5180 1,425.00
7532 Bipolar Dis 0.7100 1,953.18
7533 Bipolar Dis 1.0864 2,988.64
7534 Bipolar Dis 1.9919 5,479.64
7541 Depression Exc Maj Dep 0.3940 1,083.88
7542 Depression Exc Maj Dep 0.5348 1,471.21
7543 Depression Exc Maj Dep 0.8410 2,313.56
7544 Depression Exc Maj Dep 1.8352 5,048.56
7551 Adjust Dis & Neuroses Exc Dep 0.3331 916.34
7552 Adjust Dis & Neuroses Exc Dep 0.5327 1,465.44
7553 Adjust Dis & Neuroses Exc Dep 0.7710 2,120.99
7554 Adjust Dis & Neuroses Exc Dep 0.9824 2,702.54
7561 Acute Anxiety & Delirium States 0.5713 1,571.62
7562 Acute Anxiety & Delirium States 0.6947 1,911.09
7563 Acute Anxiety & Delirium States 0.8415 2,314.93
7564 Acute Anxiety & Delirium States 2.2220 6,112.63
7571 Organic Mental Health Disturb 0.7400 2,035.71
7572 Organic Mental Health Disturb 0.8496 2,337.22
7573 Organic Mental Health Disturb 1.1459 3,152.33
7574 Organic Mental Health Disturb 2.2782 6,267.24
7581 Childhood Behavioral Dis 0.5695 1,566.67
7582 Childhood Behavioral Dis 0.7375 2,028.83
7583 Childhood Behavioral Dis 1.0625 2,922.90
7584 Childhood Behavioral Dis 1.1685 3,214.50
7591 Eating Dis 1.2978 3,570.20
7592 Eating Dis 1.7246 4,744.31
7593 Eating Dis 1.8372 5,054.06
7594 Eating Dis 3.4326 9,442.95
7601 Oth Mental Health Dis 0.6399 1,760.34
7602 Oth Mental Health Dis 0.7983 2,196.09
7603 Oth Mental Health Dis 1.0834 2,980.39
7604 Oth Mental Health Dis 1.8034 4,961.08
7701 Drug & Alcohol Abuse, AMA 0.2829 778.25
7702 Drug & Alcohol Abuse, AMA 0.3491 960.36
7703 Drug & Alcohol Abuse, AMA 0.7888 2,169.96
7704 Drug & Alcohol Abuse, AMA 3.1393 8,636.09
7721 Alc & Drug Dep w Rehab or Detox 0.6302 1,733.65
7722 Alc & Drug Dep w Rehab or Detox 0.7867 2,164.18
7723 Alc & Drug Dep w Rehab or Detox 0.9214 2,534.73
7724 Alc & Drug Dep w Rehab or Detox 3.8341 10,547.46
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
7731 Opioid Abuse & Dependence 0.3308 910.02
7732 Opioid Abuse & Dependence 0.4322 1,188.96
7733 Opioid Abuse & Dependence 0.8915 2,452.48
7734 Opioid Abuse & Dependence 2.6200 7,207.52
7741 Cocaine Abuse & Dependence 0.4144 1,140.00
7742 Cocaine Abuse & Dependence 0.4295 1,181.54
7743 Cocaine Abuse & Dependence 0.8902 2,448.90
7744 Cocaine Abuse & Dependence 3.1113 8,559.06
7751 Alcohol Abuse & Dependence 0.4048 1,113.59
7752 Alcohol Abuse & Dependence 0.6235 1,715.22
7753 Alcohol Abuse & Dependence 1.2384 3,406.79
7754 Alcohol Abuse & Dependence 3.8924 10,707.84
7761 Oth Drug Abuse & Dependence 0.4471 1,229.95
7762 Oth Drug Abuse & Dependence 0.6081 1,672.86
7763 Oth Drug Abuse & Dependence 1.0645 2,928.40
7764 Oth Drug Abuse & Dependence 2.3719 6,525.00
7911 O.R. Proc for Complic of Care 1.2095 3,327.29
7912 O.R. Proc for Complic of Care 1.8410 5,064.52
7913 O.R. Proc for Complic of Care 3.1975 8,796.19
7914 O.R. Proc for Complic of Care 7.9046 21,745.24
8111 Allergic Reactions 0.3947 1,085.80
8112 Allergic Reactions 0.5445 1,497.90
8113 Allergic Reactions 1.2035 3,310.78
8114 Allergic Reactions 3.2701 8,995.91
8121 Poisoning of Medicinal Agents 0.4442 1,221.98
8122 Poisoning of Medicinal Agents 0.5700 1,568.05
8123 Poisoning of Medicinal Agents 1.0667 2,934.45
8124 Poisoning of Medicinal Agents 2.6645 7,329.93
8131 Oth Complics of Treatment 0.6367 1,751.54
8132 Oth Complics of Treatment 0.8655 2,380.96
8133 Oth Complics of Treatment 1.4546 4,001.55
8134 Oth Complics of Treatment 3.2404 8,914.21
8151 Oth Inj And Poisoning Diags 0.6571 1,807.66
8152 Oth Inj And Poisoning Diags 0.7065 1,943.55
8153 Oth Inj And Poisoning Diags 1.1822 3,252.18
8154 Oth Inj And Poisoning Diags 3.7838 10,409.08
8161 Toxic Eff of Non-Medicinal Subst 0.7492 2,061.02
8162 Toxic Eff of Non-Medicinal Subst 0.7498 2,062.67
8163 Toxic Eff of Non-Medicinal Subst 1.1956 3,289.05
8164 Toxic Eff of Non-Medicinal Subst 2.9750 8,184.11
8411 Ext 3Rd Deg Burns w Skin Graft 6.9977 19,250.39
8412 Ext 3Rd Deg Burns w Skin Graft 7.7752 21,389.26
8413 Ext 3Rd Deg Burns w Skin Graft 9.0509 24,898.66
8414 Ext 3Rd Deg Burns w Skin Graft 28.2058 77,593.03
8421 Full Thick Burns w Graft 2.2369 6,153.62
8422 Full Thick Burns w Graft 3.3853 9,312.82
8423 Full Thick Burns w Graft 6.1290 16,860.63
8424 Full Thick Burns w Graft 16.8273 46,291.23
8431 Ext Burns w/o Skin Graft 0.8147 2,241.21
8432 Ext Burns w/o Skin Graft 1.0914 3,002.40
8433 Ext Burns w/o Skin Graft 1.9930 5,482.66
8434 Ext Burns w/o Skin Graft 7.9111 21,763.12
8441 Part Thick Burns w or w/o Graft 0.8255 2,270.92
8442 Part Thick Burns w or w/o Graft 1.3015 3,580.37
8443 Part Thick Burns w or w/o Graft 2.5632 7,051.26
8444 Part Thick Burns w or w/o Graft 9.5117 26,166.31
8501 Proc w Diag of Rehab or Other 1.6415 4,515.70
8502 Proc w Diag of Rehab or Other 1.9283 5,304.68
8503 Proc w Diag of Rehab or Other 3.9351 10,825.30
8504 Proc w Diag of Rehab or Other 8.5665 23,566.10
8601 Rehabilitation 0.9659 2,657.15
APR-DRG Description
Relative Weight
Re-centered for
Florida Medicaid
Inpatient Hospital
Reimbursement RateAPR-DRG
8602 Rehabilitation 1.3761 3,785.60
8603 Rehabilitation 2.1072 5,796.82
8604 Rehabilitation 3.0148 8,293.59
8611 Signs, Symptoms & Oth Factors 0.5183 1,425.82
8612 Signs, Symptoms & Oth Factors 0.7182 1,975.74
8613 Signs, Symptoms & Oth Factors 1.0707 2,945.45
8614 Signs, Symptoms & Oth Factors 2.6155 7,195.14
8621 Oth Aftercare & Convalescence 0.4938 1,358.42
8622 Oth Aftercare & Convalescence 0.7946 2,185.91
8623 Oth Aftercare & Convalescence 1.0975 3,019.18
8624 Oth Aftercare & Convalescence 1.7789 4,893.68
8631 Neonatal Aftercare 0.9120 2,508.88
8632 Neonatal Aftercare 3.0703 8,446.27
8633 Neonatal Aftercare 5.2178 14,353.96
8634 Neonatal Aftercare 11.7510 32,326.53
8901 HIV w Mult Maj Related Cond 1.5166 4,172.11
8902 HIV w Mult Maj Related Cond 1.9186 5,277.99
8903 HIV w Mult Maj Related Cond 2.5782 7,092.53
8904 HIV w Mult Maj Related Cond 5.4911 15,105.80
8921 HIV w Maj Related Cond 0.9056 2,491.27
8922 HIV w Maj Related Cond 1.3877 3,817.51
8923 HIV w Maj Related Cond 1.8088 4,975.94
8924 HIV w Maj Related Cond 3.4129 9,388.75
8931 HIV w Mult Sig Related Cond 1.1357 3,124.27
8932 HIV w Mult Sig Related Cond 1.3410 3,689.04
8933 HIV w Mult Sig Related Cond 1.9352 5,323.66
8934 HIV w Mult Sig Related Cond 4.4606 12,270.93
8941 HIV 0.8537 2,348.49
8942 HIV 1.0727 2,950.95
8943 HIV 1.4962 4,115.99
8944 HIV 2.9260 8,049.31
9101 Craniotomy for Mult Sig Trauma 4.1745 11,483.88
9102 Craniotomy for Mult Sig Trauma 4.6384 12,760.05
9103 Craniotomy for Mult Sig Trauma 6.2901 17,303.81
9104 Craniotomy for Mult Sig Trauma 13.8745 38,168.19
9111 Ext Trunk Procs Mult Sig Trauma 2.1466 5,905.21
9112 Ext Trunk Procs Mult Sig Trauma 2.8803 7,923.59
9113 Ext Trunk Procs Mult Sig Trauma 4.0209 11,061.34
9114 Ext Trunk Procs Mult Sig Trauma 10.7803 29,656.17
9121 Muscskl Procs Mult Sig Trauma 2.8614 7,871.60
9122 Muscskl Procs Mult Sig Trauma 3.1476 8,658.92
9123 Muscskl Procs Mult Sig Trauma 5.3731 14,781.18
9124 Muscskl Procs Mult Sig Trauma 11.1538 30,683.66
9301 Mult Sig Trauma w/o O.R. Proc 1.1281 3,103.36
9302 Mult Sig Trauma w/o O.R. Proc 1.4295 3,932.50
9303 Mult Sig Trauma w/o O.R. Proc 2.3729 6,527.75
9304 Mult Sig Trauma w/o O.R. Proc 6.4615 17,775.33
9501 Ext Proc Unrel To Diag 1.9172 5,274.14
9502 Ext Proc Unrel To Diag 3.0325 8,342.29
9503 Ext Proc Unrel To Diag 4.7674 13,114.93
9504 Ext Proc Unrel To Diag 9.5819 26,359.42
9511 Mod Ext Proc Unrel To Diag 1.3528 3,721.50
9512 Mod Ext Proc Unrel To Diag 2.0636 5,676.88
9513 Mod Ext Proc Unrel To Diag 3.5340 9,721.89
9514 Mod Ext Proc Unrel To Diag 6.9646 19,159.34
9521 Nonext Proc Unrel To Diag 1.0276 2,826.89
9522 Nonext Proc Unrel To Diag 1.6731 4,602.63
9523 Nonext Proc Unrel To Diag 2.9630 8,151.09
9524 Nonext Proc Unrel To Diag 6.0581 16,665.59
9550 Principal Diag Invalid -
9560 Ungroupable -