Inpatient Hospital Payment
SFY 25-26 Inpatient Base Rate rebasing Documents effective 7/1/2025
2nd 30 Day review for CMS Data/CMS Data/Other Data Inputs for FY25-26 IP Rates
SFY 2025 Inpatient Base Rates effective 7/1/2024, CMS approval received 8/27/2024
Prior Years Inpatient Hospital Rates
SFY 2024 Inpatient Hospital Rates Inpatient Base Rate Rebasing Documents (CMS Approval Received 2/9/2024)
- Inpatient Hospital Base Rates FY23-24
- Inpatient Hospital Rate Model FY23-24 HIPAA Stakeholder version 1.
- GME/IME for Non-PPS/IPPS IMPACT File FY23-24
SFY 2023 Inpatient Hospital Rates
All Patient Refined Diagnosis Related Groups (APR-DRG)
The relative weight tables below are used by the Department to reimburse hospitals for inpatient services.
Please see this link for 3M's document on Design and Application of HSRV Log Weights
Documentation for historical weight and base rate information is available upon request. Please email HCPF_Hospitalregulatory@state.co.us
Effective October 1, 2024: APR-DRG version 40 Weight Table and Hospital Payment Differentials
- October 1, 2024 APR-DRG Version 40 Use column G:V40_WT_SCALED to calculate hospital payment
- Hospital Payment Differentials between APR-DRG Versions 33 and 40 Using Calendar Year 2022 Hospital Claim Dataset (Excel Version)
APR-DRG Versions/Adjustments and related weight tables through the years
| APR-DRG Version | APR-DRG Version Effective Dates: Discharge Date Range this version was active | Reason for Version Change/Adjustment | Download APR-DRG Weight Table Excel Documents |
|---|---|---|---|
| Version 33 | 7/1/2016 - 12/31/2019 | Version Update | July 1,2016 - APR-DRG Version 33 (Excel Version) |
| Version 33 | 1/1/2020 - 6/30/2020 | Version 33 weights adjusted for Immediate Postpartum (IPP) Long Acting Reversible Contraceptives (LARCs) carve out to allow for separate payment for IPP-LARC devices. DRG's 540, 542 & 560 weights were reduced by .004 to allow for this separate payment starting 1/1/2020. | January 1, 2020 - APR-DRG Version 33 (Excel Version) |
| Version 33 | 7/1/2020 - 9/30/2024 | The Department separated the well-baby (neonates) from delivery claims on 7/1/2020 after three years of stakeholder discussion and involvement. The resulting change in Weights, Average Length of Stay (ALOS) and TrimPoint to Delivery and Neonate DRGs using the National HSRV file Ver 33 from 3M and multiplied by a factor of 1.2699 to achieve a budget neutral change in payment for hospitals. Reductions for IPP-LARCs devices were instituted after the budget neutral changes. DRG's 540, 542 & 560 weights were reduced by .004 to allow for a separate payment for IPP-LARCs devices. | July 1, 2020 - APR-DRG Version 33 (Excel Version) |
| Version 40 | 10/1/2024 - present day | Version Update Only. Department Policy Adjustments can be seen in weight table. Colorado Medicaid's APR-DRG Grouper Settings are also contained in the weight table document for download. | October 1, 2024 APR-DRG Version 40 (use column G: V40_WT_SCALED to calculate hospital payment) |
Update Schedule (based on effective date) for both sides of the Inpatient (IP) Hospital Payment Calculation
| 7/1/2024 | 7/1/2025 | 7/1/2026 | 7/1/2027 |
|---|---|---|---|
| Even Year APR-DRG Version Update. (extended to 10/1/24) | No update to APR-DRG Version. | Even Year APR-DRG Version Update. | No update to APR-DRG Version. |
| IP Base Rate updated with State Budget Action only (Graduate Medical Education (GME) unchanged) | Odd Year IP Base Rate rebasing (GME updated). | IP Base Rate updated with State Budget Action only (GME unchanged) | Odd Year IP Base Rate rebasing (GME updated). |