V35 Relative Weights and ALOS...0010 1 HEAD TRAUMA WITH DEEP COMA 1.6059 3.27 30,000 80% 30,000 20% 0010 2 HEAD TRAUMA WITH DEEP COMA 2.1848 4.45 30,000 80% 30,000 20% Relative Weight
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0010 1 HEAD TRAUMA WITH DEEP COMA 1.6059 3.27 30,000 80% 30,000 20%
0010 2 HEAD TRAUMA WITH DEEP COMA 2.1848 4.45 30,000 80% 30,000 20%
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0010 3 HEAD TRAUMA WITH DEEP COMA 3.1693 6.45 30,000 80% 30,000 20%
0010 4 HEAD TRAUMA WITH DEEP COMA 11.0459 25.54 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0042 1 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 0.6616 3.12 30,000 80% 30,000 20%
0042 2 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 0.8142 5.80 30,000 80% 30,000 20%
0042 3 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 1.2816 5.80 30,000 80% 30,000 20%
0042 4 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 3.4351 9.98 30,000 80% 30,000 20%
0049 1 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 1.0432 4.26 30,000 80% 30,000 20%
0049 2 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 2.1802 5.41 30,000 80% 30,000 20%
0049 3 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 2.7074 8.31 30,000 80% 30,000 20%
0049 4 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 5.0543 13.73 30,000 80% 30,000 20%
0050 1 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 0.7022 2.95 30,000 80% 30,000 20%
0050 2 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 1.3247 4.37 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
HR OR NO COMA
HR OR NO COMA
HR OR NO COMA
HR OR NO COMA
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0050 3 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 2.1808 7.19 30,000 80% 30,000 20%
0050 4 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 4.4829 12.80 30,000 80% 30,000 20%
0055 1 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 0.7248 1.80 30,000 80% 30,000 20%
0055 2 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 0.9702 2.70 30,000 80% 30,000 20%
0055 3 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 1.5543 4.44 30,000 80% 30,000 20%
0055 4 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 3.6061 9.44 30,000 80% 30,000 20%
0056 1 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA 0.7267 1.74 30,000 80% 30,000 20%
0056 2 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA 0.9867 2.57 30,000 80% 30,000 20%
0056 3 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA 1.6326 4.52 30,000 80% 30,000 20%
0056 4 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA 3.3190 10.26 30,000 80% 30,000 20%
0057 1 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 0.7206 1.31 30,000 80% 30,000 20%
0057 2 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 0.9134 1.82 30,000 80% 30,000 20%
0057 3 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 1.2791 2.97 30,000 80% 30,000 20%
0057 4 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 3.1977 6.69 30,000 80% 30,000 20%
0058 1 OTHER DISORDERS OF NERVOUS SYSTEM 0.6915 1.97 30,000 80% 30,000 20%
0058 2 OTHER DISORDERS OF NERVOUS SYSTEM 0.8523 2.76 30,000 80% 30,000 20%
0058 3 OTHER DISORDERS OF NERVOUS SYSTEM 1.1742 3.92 30,000 80% 30,000 20%
0058 4 OTHER DISORDERS OF NERVOUS SYSTEM 2.7323 7.88 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0059 1 ANOXIC & OTHER SEVERE BRAIN DAMAGE 0.6844 2.45 30,000 80% 30,000 20%
0059 2 ANOXIC & OTHER SEVERE BRAIN DAMAGE 0.7926 2.71 30,000 80% 30,000 20%
0059 3 ANOXIC & OTHER SEVERE BRAIN DAMAGE 1.0232 3.81 30,000 80% 30,000 20%
0059 4 ANOXIC & OTHER SEVERE BRAIN DAMAGE 2.5621 4.94 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0130 1 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 2.9507 9.58 30,000 80% 30,000 20%
0130 2 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 3.3514 9.92 30,000 80% 30,000 20%
0130 3 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 4.1186 11.79 30,000 80% 30,000 20%
0130 4 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 5.5358 15.30 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0139 1 OTHER PNEUMONIA 0.4661 2.33 30,000 80% 30,000 20%
0139 2 OTHER PNEUMONIA 0.6569 3.11 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0139 3 OTHER PNEUMONIA 1.0382 4.49 30,000 80% 30,000 20%
0139 4 OTHER PNEUMONIA 2.0321 7.28 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0162 1 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 4.6973 6.17 30,000 80% 30,000 20%
0162 2 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 5.2901 7.29 30,000 80% 30,000 20%
0162 3 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 6.8678 11.09 30,000 80% 30,000 20%
0162 4 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 10.7696 18.57 30,000 80% 30,000 20%
0163 1 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 3.9033 5.07 30,000 80% 30,000 20%
0163 2 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 4.4664 6.12 30,000 80% 30,000 20%
0163 3 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 5.7205 8.66 30,000 80% 30,000 20%
0163 4 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 9.2652 15.32 30,000 80% 30,000 20%
0165 1 CORONARY BYPASS W AMI OR COMPLEX PDX 4.0584 6.62 30,000 80% 30,000 20%
0165 2 CORONARY BYPASS W AMI OR COMPLEX PDX 4.3680 7.93 30,000 80% 30,000 20%
0165 3 CORONARY BYPASS W AMI OR COMPLEX PDX 5.5551 10.10 30,000 80% 30,000 20%
0165 4 CORONARY BYPASS W AMI OR COMPLEX PDX 8.2349 15.16 30,000 80% 30,000 20%
0166 1 CORONARY BYPASS W/O AMI OR COMPLEX PDX 3.3554 5.33 30,000 80% 30,000 20%
0166 2 CORONARY BYPASS W/O AMI OR COMPLEX PDX 3.8047 6.31 30,000 80% 30,000 20%
0166 3 CORONARY BYPASS W/O AMI OR COMPLEX PDX 4.7560 8.39 30,000 80% 30,000 20%
0166 4 CORONARY BYPASS W/O AMI OR COMPLEX PDX 7.2381 13.43 30,000 80% 30,000 20%
0174 1 PERCUTANEOUS CORONARY INTERVENTION W AMI 2.0431 2.08 30,000 80% 30,000 20%
0174 2 PERCUTANEOUS CORONARY INTERVENTION W AMI 2.2010 2.53 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0174 3 PERCUTANEOUS CORONARY INTERVENTION W AMI 2.8039 4.20 30,000 80% 30,000 20%
0174 4 PERCUTANEOUS CORONARY INTERVENTION W AMI 4.5701 7.67 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0192 1 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 0.9996 1.70 30,000 80% 30,000 20%
0192 2 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 1.2339 2.62 30,000 80% 30,000 20%
0192 3 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 1.8246 4.98 30,000 80% 30,000 20%
0192 4 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 3.6009 9.42 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0223 1 OTHER SMALL & LARGE BOWEL PROCEDURES 1.1830 3.66 30,000 80% 30,000 20%
0223 2 OTHER SMALL & LARGE BOWEL PROCEDURES 1.5680 5.24 30,000 80% 30,000 20%
0223 3 OTHER SMALL & LARGE BOWEL PROCEDURES 2.5875 8.76 30,000 80% 30,000 20%
0223 4 OTHER SMALL & LARGE BOWEL PROCEDURES 5.3678 15.49 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0233 1 APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 1.1860 2.54 30,000 80% 30,000 20%
0233 2 APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 1.1870 3.50 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0233 3 APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 2.0371 5.64 30,000 80% 30,000 20%
0233 4 APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 3.8775 10.52 30,000 80% 30,000 20%
0234 1 APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS 0.8925 1.38 30,000 80% 30,000 20%
0234 2 APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS 1.1810 1.85 30,000 80% 30,000 20%
0234 3 APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS 1.9959 3.55 30,000 80% 30,000 20%
0234 4 APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS 3.7143 9.33 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0347 1 OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES 0.6565 2.28 30,000 80% 30,000 20%
0347 2 OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES 0.8099 2.98 30,000 80% 30,000 20%
0347 3 OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES 1.1248 3.94 30,000 80% 30,000 20%
0347 4 OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES 2.8705 9.03 30,000 80% 30,000 20%
0349 1 MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE 0.5483 1.75 30,000 80% 30,000 20%
0349 2 MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE 0.7934 3.14 30,000 80% 30,000 20%
0349 3 MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE 1.2105 5.05 30,000 80% 30,000 20%
0349 4 MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE 2.5010 9.30 30,000 80% 30,000 20%
0351 1 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 0.5593 1.97 30,000 80% 30,000 20%
0351 2 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 0.6468 2.71 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0351 3 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 1.0571 4.05 30,000 80% 30,000 20%
0351 4 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 2.4298 8.22 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0384 1 CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE 0.6147 1.52 30,000 80% 30,000 20%
0384 2 CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE 0.7397 2.19 30,000 80% 30,000 20%
0384 3 CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE 1.0789 3.57 30,000 80% 30,000 20%
0384 4 CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE 2.6747 7.19 30,000 80% 30,000 20%
0385 1 OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS 0.4687 1.99 30,000 80% 30,000 20%
0385 2 OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS 0.6261 2.68 30,000 80% 30,000 20%
0385 3 OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS 0.9841 3.92 30,000 80% 30,000 20%
0385 4 OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS 2.1329 6.99 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0484 1 OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 0.9824 2.02 30,000 80% 30,000 20%
0484 2 OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 1.4019 1.59 30,000 80% 30,000 20%
0484 3 OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 1.7954 3.34 30,000 80% 30,000 20%
0484 4 OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 4.5482 14.19 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0500 1 MALIGNANCY, MALE REPRODUCTIVE SYSTEM 0.6079 1.73 30,000 80% 30,000 20%
0500 2 MALIGNANCY, MALE REPRODUCTIVE SYSTEM 0.7954 3.10 30,000 80% 30,000 20%
0500 3 MALIGNANCY, MALE REPRODUCTIVE SYSTEM 1.2561 4.83 30,000 80% 30,000 20%
0500 4 MALIGNANCY, MALE REPRODUCTIVE SYSTEM 2.0061 6.71 30,000 80% 30,000 20%
0501 1 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY 0.4946 2.10 30,000 80% 30,000 20%
0501 2 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY 0.6677 2.86 30,000 80% 30,000 20%
0501 3 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY 1.0264 4.20 30,000 80% 30,000 20%
0501 4 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY 2.5421 8.43 30,000 80% 30,000 20%
0518 1 OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 0.8696 1.79 30,000 80% 30,000 20%
0518 2 OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 1.1974 2.96 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0518 3 OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 2.1796 6.08 30,000 80% 30,000 20%
0518 4 OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 4.9768 13.59 30,000 80% 30,000 20%
0544 1 D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES 0.5854 1.21 30,000 80% 30,000 20%
0544 2 D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES 0.6930 1.53 30,000 80% 30,000 20%
0544 3 D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES 1.1485 2.51 30,000 80% 30,000 20%
0544 4 D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES 3.2321 6.55 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
0580 1 NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE 0.2586 1.28 30,000 100% 30,000 20%
0580 2 NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE 0.3328 1.44 30,000 100% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0580 3 NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE 0.5385 1.56 30,000 100% 30,000 20%
0580 4 NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE 1.0167 1.52 30,000 100% 30,000 20%
0581 1 NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE 0.1030 1.15 30,000 100% 30,000 20%
0581 2 NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE 0.1637 1.17 30,000 100% 30,000 20%
0581 3 NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE 0.2825 1.11 30,000 100% 30,000 20%
0581 4 NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE 0.5671 1.16 30,000 100% 30,000 20%
0602 1 NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 4.1963 21.77 30,000 100% 30,000 20%
0602 2 NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 7.7051 43.39 30,000 100% 30,000 20%
0602 3 NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 10.3755 55.55 30,000 100% 30,000 20%
0602 4 NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 14.0933 68.84 30,000 100% 30,000 20%
0603 1 NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION 2.4505 10.41 30,000 100% 30,000 20%
0603 2 NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION 5.6938 27.48 30,000 100% 30,000 20%
0603 3 NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION 9.4141 42.39 30,000 100% 30,000 20%
0603 4 NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION 14.4291 61.04 30,000 100% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0607 1 NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 3.8254 21.38 30,000 100% 30,000 20%
0607 2 NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 6.0465 35.03 30,000 100% 30,000 20%
0607 3 NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 8.3555 44.62 30,000 100% 30,000 20%
0607 4 NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 11.2710 56.12 30,000 100% 30,000 20%
0608 1 NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION 2.5886 15.69 30,000 100% 30,000 20%
0608 2 NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION 4.8932 28.53 30,000 100% 30,000 20%
0608 3 NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION 7.1964 38.83 30,000 100% 30,000 20%
0608 4 NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION 10.5499 47.02 30,000 100% 30,000 20%
0609 1 NEONATE BWT 1500-2499G W MAJOR PROCEDURE 4.0227 3.16 30,000 100% 30,000 20%
0609 2 NEONATE BWT 1500-2499G W MAJOR PROCEDURE 5.2245 14.31 30,000 100% 30,000 20%
0609 3 NEONATE BWT 1500-2499G W MAJOR PROCEDURE 8.3349 30.74 30,000 100% 30,000 20%
0609 4 NEONATE BWT 1500-2499G W MAJOR PROCEDURE 15.4553 50.51 30,000 100% 30,000 20%
0611 1 NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY 2.2290 12.06 30,000 100% 30,000 20%
0611 2 NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY 3.5611 19.59 30,000 100% 30,000 20%
0611 3 NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY 5.7859 31.71 30,000 100% 30,000 20%
0611 4 NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY 9.1763 38.50 30,000 100% 30,000 20%
0612 1 NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 2.7506 16.33 30,000 100% 30,000 20%
0612 2 NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 4.2126 24.15 30,000 100% 30,000 20%
0612 3 NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 5.6950 31.87 30,000 100% 30,000 20%
0612 4 NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 8.2715 38.95 30,000 100% 30,000 20%
0614 1 NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION 1.4952 9.06 30,000 100% 30,000 20%
0614 2 NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION 2.9683 17.60 30,000 100% 30,000 20%
0614 3 NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION 4.9001 26.35 30,000 100% 30,000 20%
0614 4 NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION 8.6291 28.28 30,000 100% 30,000 20%
0621 1 NEONATE BWT 2000-2499G W MAJOR ANOMALY 1.0613 5.46 30,000 100% 30,000 20%
0621 2 NEONATE BWT 2000-2499G W MAJOR ANOMALY 2.2455 11.73 30,000 100% 30,000 20%
0621 3 NEONATE BWT 2000-2499G W MAJOR ANOMALY 3.9896 18.19 30,000 100% 30,000 20%
0621 4 NEONATE BWT 2000-2499G W MAJOR ANOMALY 7.5107 26.89 30,000 100% 30,000 20%
0622 1 NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND 1.6849 9.91 30,000 100% 30,000 20%
0622 2 NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND 2.5166 13.83 30,000 100% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0622 3 NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND 3.4596 18.35 30,000 100% 30,000 20%
0622 4 NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND 5.6405 21.60 30,000 100% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0639 1 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 0.4390 2.50 30,000 100% 30,000 20%
0639 2 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 0.7148 3.26 30,000 100% 30,000 20%
0639 3 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 1.4480 5.19 30,000 100% 30,000 20%
0639 4 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 3.6937 10.50 30,000 100% 30,000 20%
0640 1 NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM 0.1142 1.92 30,000 100% 30,000 20%
0640 2 NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM 0.1802 2.16 30,000 100% 30,000 20%
0640 3 NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM 0.4134 2.91 30,000 100% 30,000 20%
0640 4 NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM 1.9658 9.62 30,000 100% 30,000 20%
0663 1 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 0.5344 1.83 30,000 80% 30,000 20%
0663 2 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 0.6759 2.35 30,000 80% 30,000 20%
0663 3 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 0.9862 3.33 30,000 80% 30,000 20%
0663 4 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 1.9333 5.59 30,000 80% 30,000 20%
0680 1 MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 1.6246 2.98 30,000 80% 30,000 20%
0680 2 MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 2.2343 4.91 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0680 3 MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 3.8591 9.32 30,000 80% 30,000 20%
0680 4 MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 7.7190 18.72 30,000 80% 30,000 20%
0681 1 OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 1.1837 2.02 30,000 80% 30,000 20%
0681 2 OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 1.6334 3.43 30,000 80% 30,000 20%
0681 3 OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 2.9944 8.36 30,000 80% 30,000 20%
0681 4 OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 7.3034 19.07 30,000 80% 30,000 20%
0696 1 OTHER CHEMOTHERAPY 0.8679 2.31 30,000 80% 30,000 20%
0696 2 OTHER CHEMOTHERAPY 1.0338 2.96 30,000 80% 30,000 20%
0696 3 OTHER CHEMOTHERAPY 1.6256 4.22 30,000 80% 30,000 20%
0696 4 OTHER CHEMOTHERAPY 3.8667 9.34 30,000 80% 30,000 20%
0710 1 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 1.1564 3.38 30,000 80% 30,000 20%
0710 2 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 1.6278 5.13 30,000 80% 30,000 20%
0710 3 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 2.8171 8.90 30,000 80% 30,000 20%
0710 4 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 5.7113 14.85 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0711 1 POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE 1.1103 3.45 30,000 80% 30,000 20%
0711 2 POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE 1.5363 4.80 30,000 80% 30,000 20%
0711 3 POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE 2.8233 8.58 30,000 80% 30,000 20%
0711 4 POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE 5.7239 15.12 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0760 1 OTHER MENTAL HEALTH DISORDERS 0.5638 3.82 30,000 80% 30,000 20%
0760 2 OTHER MENTAL HEALTH DISORDERS 0.7352 4.32 30,000 80% 30,000 20%
0760 3 OTHER MENTAL HEALTH DISORDERS 1.1721 5.16 30,000 80% 30,000 20%
0760 4 OTHER MENTAL HEALTH DISORDERS 2.2596 11.16 30,000 80% 30,000 20%
0770 1 DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE 0.2524 1.68 30,000 80% 30,000 20%
0770 2 DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE 0.3319 1.81 30,000 80% 30,000 20%
0770 3 DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE 0.6934 2.19 30,000 80% 30,000 20%
0770 4 DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE 2.0412 4.96 30,000 80% 30,000 20%
0772 1 ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY 0.0000 0.00 0 0% 0 0%
0772 2 ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY 0.0000 0.00 0 0% 0 0%
0772 3 ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY 0.0000 0.00 0 0% 0 0%
0772 4 ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY 0.0000 0.00 0 0% 0 0%
0776 1 OTHER DRUG ABUSE & DEPENDENCE 0.3494 2.58 30,000 80% 30,000 20%
0776 2 OTHER DRUG ABUSE & DEPENDENCE 0.4899 2.86 30,000 80% 30,000 20%
0776 3 OTHER DRUG ABUSE & DEPENDENCE 0.8536 3.52 30,000 80% 30,000 20%
0776 4 OTHER DRUG ABUSE & DEPENDENCE 2.3578 6.11 30,000 80% 30,000 20%
0792 1 EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.0842 2.57 30,000 80% 30,000 20%
0792 2 EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.5941 3.31 30,000 80% 30,000 20%
0792 3 EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 2.5709 6.56 30,000 80% 30,000 20%
0792 4 EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 5.8179 12.71 30,000 80% 30,000 20%
0793 1 MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.0487 1.97 30,000 80% 30,000 20%
0793 2 MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.5290 3.06 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0793 3 MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 2.4646 5.09 30,000 80% 30,000 20%
0793 4 MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 5.2183 12.97 30,000 80% 30,000 20%
0794 1 NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.0001 2.04 30,000 80% 30,000 20%
0794 2 NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.4504 2.83 30,000 80% 30,000 20%
0794 3 NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 2.3739 4.44 30,000 80% 30,000 20%
0794 4 NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 4.4642 11.09 30,000 80% 30,000 20%
0810 1 HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION 0.5746 1.88 30,000 80% 30,000 20%
0810 2 HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION 0.7459 2.42 30,000 80% 30,000 20%
0810 3 HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION 1.1505 3.91 30,000 80% 30,000 20%
0810 4 HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION 2.6762 8.69 30,000 80% 30,000 20%
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Effective October 1, 2017 based on date of discharge
Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance
Threshold Percentage Threshold Percentage
Relative
Weight
APR-
DRG
Severity
of Illness
(SOI) APR-DRG Description
Low-Cost Outlier Average
Length
of Stay
High-Cost Outlier
0950 1 EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 1.5442 2.47 30,000 80% 30,000 20%
0950 2 EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 2.1673 4.39 30,000 80% 30,000 20%
0950 3 EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 3.5372 8.95 30,000 80% 30,000 20%
0950 4 EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 6.8068 17.27 30,000 80% 30,000 20%
0951 1 MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 1.1334 2.27 30,000 80% 30,000 20%
0951 2 MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 1.6582 3.69 30,000 80% 30,000 20%
0951 3 MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 2.6775 7.26 30,000 80% 30,000 20%
0951 4 MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 5.2083 13.46 30,000 80% 30,000 20%
0952 1 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 0.9389 2.05 30,000 80% 30,000 20%
0952 2 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 1.3682 3.50 30,000 80% 30,000 20%
0952 3 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 2.3131 7.03 30,000 80% 30,000 20%
0952 4 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 4.4204 13.12 30,000 80% 30,000 20%
0955 0 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS 0.0000 0.00 0 0% 0 0%
0956 0 UNGROUPABLE 0.0000 0.00 0 0% 0 0%
Effective October 1, 2017 based on date of discharge