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APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
001 1 Liver transplant &/or intestinal transplant 6.1633 22 $626,969
001 2 Liver transplant &/or intestinal transplant 6.1633 22 $626,969
001 3 Liver transplant &/or intestinal transplant 8.3665 22 $626,969
001 4 Liver transplant &/or intestinal transplant 17.5054 22 $626,969
002 1 Heart &/or lung transplant 12.1001 53 $2,562,294
002 2 Heart &/or lung transplant 12.8458 53 $2,562,294
002 3 Heart &/or lung transplant 15.0688 53 $2,562,294
002 4 Heart &/or lung transplant 34.8934 53 $2,562,294
003 1 Bone marrow transplant 6.6256 28 $604,379
003 2 Bone marrow transplant 7.7606 28 $604,379
003 3 Bone marrow transplant 11.8231 28 $604,379
003 4 Bone marrow transplant 22.4103 28 $604,379
004 1 Tracheostomy w MV 96+ hours w extensive procedure or ECMO 7.1886 47 $1,071,974
004 2 Tracheostomy w MV 96+ hours w extensive procedure or ECMO 7.1886 47 $1,071,974
004 3 Tracheostomy w MV 96+ hours w extensive procedure or ECMO 10.0706 47 $1,071,974
004 4 Tracheostomy w MV 96+ hours w extensive procedure or ECMO 18.0721 47 $1,071,974
005 1 Tracheostomy w MV 96+ hours w/o extensive procedure 5.6961 44 $666,101
005 2 Tracheostomy w MV 96+ hours w/o extensive procedure 5.8436 44 $666,101
005 3 Tracheostomy w MV 96+ hours w/o extensive procedure 9.2327 44 $666,101
005 4 Tracheostomy w MV 96+ hours w/o extensive procedure 13.7895 44 $666,101
006 1 Pancreas transplant 5.0554 9 $418,535
006 2 Pancreas transplant 5.0554 9 $418,535
006 3 Pancreas transplant 7.3142 9 $418,535
006 4 Pancreas transplant 7.6389 9 $418,535
020 1 Craniotomy for trauma 1.7856 9 $177,338
020 2 Craniotomy for trauma 2.2554 9 $177,338
020 3 Craniotomy for trauma 3.5424 9 $177,338
020 4 Craniotomy for trauma 6.6900 9 $177,338
021 1 Craniotomy except for trauma 1.8941 8 $211,794
021 2 Craniotomy except for trauma 2.6772 8 $211,794
021 3 Craniotomy except for trauma 4.3319 8 $211,794
021 4 Craniotomy except for trauma 7.2414 8 $211,794
022 1 Ventricular shunt procedures 1.2748 5 $94,385
022 2 Ventricular shunt procedures 1.6300 5 $94,385
022 3 Ventricular shunt procedures 2.6720 5 $94,385
022 4 Ventricular shunt procedures 5.3875 5 $94,385
023 1 Spinal procedures 1.6410 6 $157,615
023 2 Spinal procedures 2.2060 6 $157,615
023 3 Spinal procedures 4.2964 6 $157,615
023 4 Spinal procedures 8.0821 6 $157,615
024 1 Extracranial vascular procedures 1.5017 4 $161,861
024 2 Extracranial vascular procedures 2.1305 4 $161,861
024 3 Extracranial vascular procedures 3.6903 4 $161,861
024 4 Extracranial vascular procedures 6.7936 4 $161,861
026 1 Other nervous system & related procedures 1.2267 5 $109,853
026 2 Other nervous system & related procedures 1.7960 5 $109,853
026 3 Other nervous system & related procedures 2.6684 5 $109,853
026 4 Other nervous system & related procedures 6.2759 5 $109,853
040 1 Spinal disorders & injuries 0.8159 6 $81,664
040 2 Spinal disorders & injuries 1.2843 6 $81,664
040 3 Spinal disorders & injuries 2.2965 6 $81,664
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
1 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
040 4 Spinal disorders & injuries 2.7160 6 $81,664
041 1 Nervous system malignancy 0.7508 6 $86,311
041 2 Nervous system malignancy 0.8664 6 $86,311
041 3 Nervous system malignancy 1.4739 6 $86,311
041 4 Nervous system malignancy 2.7313 6 $86,311
042 1 Degenerative nervous system disorders exc mult sclerosis 0.6372 6 $68,318
042 2 Degenerative nervous system disorders exc mult sclerosis 0.8827 6 $68,318
042 3 Degenerative nervous system disorders exc mult sclerosis 1.8257 6 $68,318
042 4 Degenerative nervous system disorders exc mult sclerosis 1.9434 6 $68,318
043 1 Multiple sclerosis & other demyelinating diseases 0.7839 5 $49,845
043 2 Multiple sclerosis & other demyelinating diseases 1.0748 5 $49,845
043 3 Multiple sclerosis & other demyelinating diseases 2.2581 5 $49,845
043 4 Multiple sclerosis & other demyelinating diseases 5.9177 5 $49,845
044 1 Intracranial hemorrhage 1.0001 7 $129,442
044 2 Intracranial hemorrhage 1.4631 7 $129,442
044 3 Intracranial hemorrhage 2.1155 7 $129,442
044 4 Intracranial hemorrhage 2.7787 7 $129,442
045 1 CVA & precerebral occlusion w infarct 0.7973 5 $70,979
045 2 CVA & precerebral occlusion w infarct 1.1113 5 $70,979
045 3 CVA & precerebral occlusion w infarct 1.7213 5 $70,979
045 4 CVA & precerebral occlusion w infarct 3.4202 5 $70,979
046 1 Nonspecific CVA & precerebral occlusion w/o infarct 0.6315 4 $48,485
046 2 Nonspecific CVA & precerebral occlusion w/o infarct 0.8484 4 $48,485
046 3 Nonspecific CVA & precerebral occlusion w/o infarct 1.1058 4 $48,485
046 4 Nonspecific CVA & precerebral occlusion w/o infarct 1.1555 4 $48,485
047 1 Transient ischemia 0.5134 2 $27,786
047 2 Transient ischemia 0.6329 2 $27,786
047 3 Transient ischemia 0.8756 2 $27,786
047 4 Transient ischemia 0.8965 2 $27,786
048 1 Peripheral, cranial & autonomic nerve disorders 0.5538 4 $40,850
048 2 Peripheral, cranial & autonomic nerve disorders 0.7393 4 $40,850
048 3 Peripheral, cranial & autonomic nerve disorders 1.1061 4 $40,850
048 4 Peripheral, cranial & autonomic nerve disorders 3.4843 4 $40,850
049 1 Bacterial & tuberculous infections of nervous system 1.1648 9 $163,210
049 2 Bacterial & tuberculous infections of nervous system 2.4891 9 $163,210
049 3 Bacterial & tuberculous infections of nervous system 3.2005 9 $163,210
049 4 Bacterial & tuberculous infections of nervous system 5.9675 9 $163,210
050 1 Non‐bacterial infections of nervous system exc viral meningitis 0.7505 7 $114,573
050 2 Non‐bacterial infections of nervous system exc viral meningitis 1.3525 7 $114,573
050 3 Non‐bacterial infections of nervous system exc viral meningitis 2.2046 7 $114,573
050 4 Non‐bacterial infections of nervous system exc viral meningitis 5.3465 7 $114,573
051 1 Viral meningitis 0.6172 4 $35,920
051 2 Viral meningitis 0.7832 4 $35,920
051 3 Viral meningitis 1.5168 4 $35,920
051 4 Viral meningitis 1.7309 4 $35,920
052 1 Nontraumatic stupor & coma 0.5553 4 $42,579
052 2 Nontraumatic stupor & coma 0.7268 4 $42,579
052 3 Nontraumatic stupor & coma 1.0023 4 $42,579
052 4 Nontraumatic stupor & coma 2.2772 4 $42,579
053 1 Seizure 0.4880 3 $36,007
053 2 Seizure 0.5821 3 $36,007
2 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
053 3 Seizure 0.8199 3 $36,007
053 4 Seizure 2.6769 3 $36,007
054 1 Migraine & other headaches 0.4921 2 $29,543
054 2 Migraine & other headaches 0.6122 2 $29,543
054 3 Migraine & other headaches 0.7899 2 $29,543
054 4 Migraine & other headaches 0.8044 2 $29,543
055 1 Head trauma w coma >1 hr or hemorrhage 0.5569 4 $57,297
055 2 Head trauma w coma >1 hr or hemorrhage 0.8775 4 $57,297
055 3 Head trauma w coma >1 hr or hemorrhage 1.5008 4 $57,297
055 4 Head trauma w coma >1 hr or hemorrhage 3.3832 4 $57,297
056 1 Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma 0.5193 4 $51,662
056 2 Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma 0.8016 4 $51,662
056 3 Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma 1.4267 4 $51,662
056 4 Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma 3.8040 4 $51,662
057 1 Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma 0.3969 2 $23,221
057 2 Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma 0.5399 2 $23,221
057 3 Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma 0.9684 2 $23,221
057 4 Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma 2.9538 2 $23,221
058 1 Other disorders of nervous system 0.5385 3 $42,765
058 2 Other disorders of nervous system 0.7829 3 $42,765
058 3 Other disorders of nervous system 1.2643 3 $42,765
058 4 Other disorders of nervous system 3.3883 3 $42,765
070 1 Orbital procedures 0.8042 3 $58,458
070 2 Orbital procedures 1.2338 3 $58,458
070 3 Orbital procedures 2.0389 3 $58,458
070 4 Orbital procedures 2.3207 3 $58,458
073 1 Eye procedures except orbit 0.6590 3 $47,190
073 2 Eye procedures except orbit 0.8460 3 $47,190
073 3 Eye procedures except orbit 2.4648 3 $47,190
073 4 Eye procedures except orbit 2.5766 3 $47,190
080 1 Acute major eye infections 0.5497 4 $39,537
080 2 Acute major eye infections 0.7023 4 $39,537
080 3 Acute major eye infections 1.2112 4 $39,537
080 4 Acute major eye infections 1.3520 4 $39,537
082 1 Eye disorders except major infections 0.4895 3 $33,324
082 2 Eye disorders except major infections 0.5935 3 $33,324
082 3 Eye disorders except major infections 1.0261 3 $33,324
082 4 Eye disorders except major infections 1.0549 3 $33,324
089 1 Major cranial/facial bone procedures 1.3634 5 $142,109
089 2 Major cranial/facial bone procedures 2.1622 5 $142,109
089 3 Major cranial/facial bone procedures 3.8100 5 $142,109
089 4 Major cranial/facial bone procedures 6.8186 5 $142,109
090 1 Major larynx & trachea procedures 0.7586 11 $245,908
090 2 Major larynx & trachea procedures 2.2721 11 $245,908
090 3 Major larynx & trachea procedures 4.0866 11 $245,908
090 4 Major larynx & trachea procedures 11.2304 11 $245,908
091 1 Other major head & neck procedures 1.3346 4 $170,472
091 2 Other major head & neck procedures 2.8490 4 $170,472
091 3 Other major head & neck procedures 3.6846 4 $170,472
091 4 Other major head & neck procedures 4.1427 4 $170,472
092 1 Facial bone procedures except major cranial/facial bone procedures 1.0516 3 $59,798
3 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
092 2 Facial bone procedures except major cranial/facial bone procedures 1.3645 3 $59,798
092 3 Facial bone procedures except major cranial/facial bone procedures 2.1792 3 $59,798
092 4 Facial bone procedures except major cranial/facial bone procedures 7.3534 3 $59,798
093 1 Sinus & mastoid procedures 0.8970 3 $57,671
093 2 Sinus & mastoid procedures 1.2338 3 $57,671
093 3 Sinus & mastoid procedures 2.3681 3 $57,671
093 4 Sinus & mastoid procedures 2.7810 3 $57,671
095 1 Cleft lip & palate repair 0.7169 2 $37,240
095 2 Cleft lip & palate repair 0.9070 2 $37,240
095 3 Cleft lip & palate repair 1.3864 2 $37,240
095 4 Cleft lip & palate repair 2.5435 2 $37,240
097 1 Tonsil & adenoid procedures 0.4842 2 $28,741
097 2 Tonsil & adenoid procedures 0.6906 2 $28,741
097 3 Tonsil & adenoid procedures 1.4791 2 $28,741
097 4 Tonsil & adenoid procedures 3.9742 2 $28,741
098 1 Other ear, nose, mouth & throat procedures 0.6847 3 $43,531
098 2 Other ear, nose, mouth & throat procedures 0.9753 3 $43,531
098 3 Other ear, nose, mouth & throat procedures 1.8633 3 $43,531
098 4 Other ear, nose, mouth & throat procedures 4.1615 3 $43,531
110 1 Ear, nose, mouth, throat, cranial/facial malignancies 0.7172 8 $110,787
110 2 Ear, nose, mouth, throat, cranial/facial malignancies 0.9025 8 $110,787
110 3 Ear, nose, mouth, throat, cranial/facial malignancies 1.7735 8 $110,787
110 4 Ear, nose, mouth, throat, cranial/facial malignancies 3.6277 8 $110,787
111 1 Vertigo & other labyrinth disorders 0.4378 2 $25,410
111 2 Vertigo & other labyrinth disorders 0.5417 2 $25,410
111 3 Vertigo & other labyrinth disorders 0.7626 2 $25,410
111 4 Vertigo & other labyrinth disorders 0.7765 2 $25,410
113 1 Infections of upper respiratory tract 0.3881 2 $26,399
113 2 Infections of upper respiratory tract 0.4974 2 $26,399
113 3 Infections of upper respiratory tract 0.7786 2 $26,399
113 4 Infections of upper respiratory tract 2.0864 2 $26,399
114 1 Dental & oral diseases & injuries 0.4787 3 $36,228
114 2 Dental & oral diseases & injuries 0.6054 3 $36,228
114 3 Dental & oral diseases & injuries 1.1998 3 $36,228
114 4 Dental & oral diseases & injuries 2.4676 3 $36,228
115 1 Other ear, nose, mouth,throat & cranial/facial diagnoses 0.4416 3 $32,482
115 2 Other ear, nose, mouth,throat & cranial/facial diagnoses 0.6014 3 $32,482
115 3 Other ear, nose, mouth,throat & cranial/facial diagnoses 0.9930 3 $32,482
115 4 Other ear, nose, mouth,throat & cranial/facial diagnoses 2.6218 3 $32,482
120 1 Major respiratory & chest procedures 1.7327 8 $108,276
120 2 Major respiratory & chest procedures 2.1111 8 $108,276
120 3 Major respiratory & chest procedures 3.3643 8 $108,276
120 4 Major respiratory & chest procedures 6.0908 8 $108,276
121 1 Other respiratory & chest procedures 1.2087 7 $99,669
121 2 Other respiratory & chest procedures 1.6274 7 $99,669
121 3 Other respiratory & chest procedures 2.8436 7 $99,669
121 4 Other respiratory & chest procedures 6.0571 7 $99,669
130 1 Respiratory system diagnosis w ventilator support 96+ hours 3.4302 16 $267,698
130 2 Respiratory system diagnosis w ventilator support 96+ hours 3.4302 16 $267,698
130 3 Respiratory system diagnosis w ventilator support 96+ hours 4.2794 16 $267,698
130 4 Respiratory system diagnosis w ventilator support 96+ hours 6.0728 16 $267,698
4 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
131 1 Cystic fibrosis ‐ pulmonary disease 1.3800 9 $137,198
131 2 Cystic fibrosis ‐ pulmonary disease 1.7298 9 $137,198
131 3 Cystic fibrosis ‐ pulmonary disease 2.5534 9 $137,198
131 4 Cystic fibrosis ‐ pulmonary disease 2.7335 9 $137,198
132 1 BPD & oth chronic respiratory diseases arising in perinatal period 0.5902 5 $80,418
132 2 BPD & oth chronic respiratory diseases arising in perinatal period 0.7843 5 $80,418
132 3 BPD & oth chronic respiratory diseases arising in perinatal period 1.3177 5 $80,418
132 4 BPD & oth chronic respiratory diseases arising in perinatal period 2.4008 5 $80,418
133 1 Respiratory Failure 0.9215 5 $77,978
133 2 Respiratory Failure 0.9234 5 $77,978
133 3 Respiratory Failure 1.3668 5 $77,978
133 4 Respiratory Failure 2.0171 5 $77,978
134 1 Pulmonary embolism 0.7047 5 $51,936
134 2 Pulmonary embolism 0.9351 5 $51,936
134 3 Pulmonary embolism 1.5094 5 $51,936
134 4 Pulmonary embolism 2.5564 5 $51,936
135 1 Major chest & respiratory trauma 0.5176 3 $39,132
135 2 Major chest & respiratory trauma 0.7209 3 $39,132
135 3 Major chest & respiratory trauma 1.2267 3 $39,132
135 4 Major chest & respiratory trauma 1.8157 3 $39,132
136 1 Respiratory malignancy 0.5690 7 $86,968
136 2 Respiratory malignancy 0.9039 7 $86,968
136 3 Respiratory malignancy 1.5597 7 $86,968
136 4 Respiratory malignancy 2.2936 7 $86,968
137 1 Major respiratory infections & inflammations 0.6958 7 $86,931
137 2 Major respiratory infections & inflammations 1.0308 7 $86,931
137 3 Major respiratory infections & inflammations 1.6768 7 $86,931
137 4 Major respiratory infections & inflammations 2.6121 7 $86,931
138 1 Bronchiolitis & RSV pneumonia 0.4877 3 $38,168
138 2 Bronchiolitis & RSV pneumonia 0.6303 3 $38,168
138 3 Bronchiolitis & RSV pneumonia 1.3648 3 $38,168
138 4 Bronchiolitis & RSV pneumonia 3.0237 3 $38,168
139 1 Other pneumonia 0.5137 4 $40,642
139 2 Other pneumonia 0.6783 4 $40,642
139 3 Other pneumonia 1.1381 4 $40,642
139 4 Other pneumonia 2.1698 4 $40,642
140 1 Chronic obstructive pulmonary disease 0.5751 4 $41,106
140 2 Chronic obstructive pulmonary disease 0.7220 4 $41,106
140 3 Chronic obstructive pulmonary disease 1.0123 4 $41,106
140 4 Chronic obstructive pulmonary disease 1.9704 4 $41,106
141 1 Asthma 0.4736 3 $32,283
141 2 Asthma 0.6173 3 $32,283
141 3 Asthma 0.9377 3 $32,283
141 4 Asthma 1.6519 3 $32,283
142 1 Interstitial & alveolar lung diseases 0.6671 5 $61,580
142 2 Interstitial & alveolar lung diseases 0.8591 5 $61,580
142 3 Interstitial & alveolar lung diseases 1.3308 5 $61,580
142 4 Interstitial & alveolar lung diseases 2.7816 5 $61,580
143 1 Other respiratory diagnoses except signs, symptoms & minor diagnoses 0.5311 4 $49,582
143 2 Other respiratory diagnoses except signs, symptoms & minor diagnoses 0.7590 4 $49,582
143 3 Other respiratory diagnoses except signs, symptoms & minor diagnoses 1.2828 4 $49,582
5 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
143 4 Other respiratory diagnoses except signs, symptoms & minor diagnoses 2.0577 4 $49,582
144 1 Respiratory signs, symptoms & minor diagnoses 0.4527 3 $33,226
144 2 Respiratory signs, symptoms & minor diagnoses 0.5689 3 $33,226
144 3 Respiratory signs, symptoms & minor diagnoses 0.8642 3 $33,226
144 4 Respiratory signs, symptoms & minor diagnoses 1.6989 3 $33,226
160 1 Major cardiothoracic repair of heart anomaly 3.1462 10 $286,279
160 2 Major cardiothoracic repair of heart anomaly 3.3978 10 $286,279
160 3 Major cardiothoracic repair of heart anomaly 4.7801 10 $286,279
160 4 Major cardiothoracic repair of heart anomaly 9.9439 10 $286,279
161 1 Cardiac defibrillator & heart assist implant 4.0143 7 $258,160
161 2 Cardiac defibrillator & heart assist implant 6.1276 7 $258,160
161 3 Cardiac defibrillator & heart assist implant 9.8396 7 $258,160
161 4 Cardiac defibrillator & heart assist implant 23.0808 7 $258,160
162 1 Cardiac valve procedures w AMI or complex PDX 3.4621 13 $288,062
162 2 Cardiac valve procedures w AMI or complex PDX 4.4821 13 $288,062
162 3 Cardiac valve procedures w AMI or complex PDX 5.7367 13 $288,062
162 4 Cardiac valve procedures w AMI or complex PDX 9.3847 13 $288,062
163 1 Cardiac valve procedures w/o AMI or complex PDX 3.0247 8 $173,655
163 2 Cardiac valve procedures w/o AMI or complex PDX 3.7001 8 $173,655
163 3 Cardiac valve procedures w/o AMI or complex PDX 4.5456 8 $173,655
163 4 Cardiac valve procedures w/o AMI or complex PDX 7.0470 8 $173,655
165 1 Coronary bypass w AMI or complex PDX 3.9335 11 $158,010
165 2 Coronary bypass w AMI or complex PDX 3.9470 11 $158,010
165 3 Coronary bypass w AMI or complex PDX 4.8614 11 $158,010
165 4 Coronary bypass w AMI or complex PDX 7.0766 11 $158,010
166 1 Coronary bypass w/o AMI or complex PDX 3.0037 8 $130,867
166 2 Coronary bypass w/o AMI or complex PDX 3.2616 8 $130,867
166 3 Coronary bypass w/o AMI or complex PDX 4.0158 8 $130,867
166 4 Coronary bypass w/o AMI or complex PDX 6.2312 8 $130,867
167 1 Other cardiothoracic & thoracic vascular procedures 2.4257 8 $193,052
167 2 Other cardiothoracic & thoracic vascular procedures 2.8397 8 $193,052
167 3 Other cardiothoracic & thoracic vascular procedures 3.6812 8 $193,052
167 4 Other cardiothoracic & thoracic vascular procedures 6.6312 8 $193,052
169 1 Major abdominal vascular procedures 1.7833 8 $142,648
169 2 Major abdominal vascular procedures 2.2884 8 $142,648
169 3 Major abdominal vascular procedures 3.7154 8 $142,648
169 4 Major abdominal vascular procedures 7.1829 8 $142,648
170 1 Permanent cardiac pacemaker implant w AMI, heart failure or shock 2.7056 10 $174,290
170 2 Permanent cardiac pacemaker implant w AMI, heart failure or shock 2.7354 10 $174,290
170 3 Permanent cardiac pacemaker implant w AMI, heart failure or shock 3.6030 10 $174,290
170 4 Permanent cardiac pacemaker implant w AMI, heart failure or shock 4.8125 10 $174,290
171 1 Perm cardiac pacemaker implant w/o AMI, heart failure or shock 1.7398 4 $94,994
171 2 Perm cardiac pacemaker implant w/o AMI, heart failure or shock 2.1440 4 $94,994
171 3 Perm cardiac pacemaker implant w/o AMI, heart failure or shock 2.9879 4 $94,994
171 4 Perm cardiac pacemaker implant w/o AMI, heart failure or shock 5.9638 4 $94,994
174 1 Percutaneous coronary intervention w AMI 1.7650 3 $81,422
174 2 Percutaneous coronary intervention w AMI 1.9423 3 $81,422
174 3 Percutaneous coronary intervention w AMI 2.5064 3 $81,422
174 4 Percutaneous coronary intervention w AMI 3.8288 3 $81,422
175 1 Percutaneous coronary intervention w/o AMI 1.4754 2 $82,216
175 2 Percutaneous coronary intervention w/o AMI 1.6741 2 $82,216
6 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
175 3 Percutaneous coronary intervention w/o AMI 2.4184 2 $82,216
175 4 Percutaneous coronary intervention w/o AMI 4.9107 2 $82,216
176 1 Cardiac pacemaker & defibrillator device replacement 1.4329 3 $154,191
176 2 Cardiac pacemaker & defibrillator device replacement 2.6404 3 $154,191
176 3 Cardiac pacemaker & defibrillator device replacement 3.3646 3 $154,191
176 4 Cardiac pacemaker & defibrillator device replacement 3.5511 3 $154,191
177 1 Cardiac pacemaker & defibrillator revision except device replacement 1.3942 5 $92,971
177 2 Cardiac pacemaker & defibrillator revision except device replacement 1.7472 5 $92,971
177 3 Cardiac pacemaker & defibrillator revision except device replacement 2.6806 5 $92,971
177 4 Cardiac pacemaker & defibrillator revision except device replacement 6.3346 5 $92,971
180 1 Other circulatory system procedures 1.1390 9 $136,041
180 2 Other circulatory system procedures 1.6462 9 $136,041
180 3 Other circulatory system procedures 2.4195 9 $136,041
180 4 Other circulatory system procedures 4.8191 9 $136,041
181 1 Lower extremity arterial procedures # 1.4350 7 $143,097
181 2 Lower extremity arterial procedures # 2.2777 7 $143,097
181 3 Lower extremity arterial procedures # 4.0903 7 $143,097
181 4 Lower extremity arterial procedures # 6.6165 7 $143,097
182 1 Other peripheral vascular procedures # 1.5004 5 $129,516
182 2 Other peripheral vascular procedures # 2.1180 5 $129,516
182 3 Other peripheral vascular procedures # 3.2240 5 $129,516
182 4 Other peripheral vascular procedures # 6.2720 5 $129,516
190 1 Acute myocardial infarction 0.7357 4 $61,326
190 2 Acute myocardial infarction 0.9583 4 $61,326
190 3 Acute myocardial infarction 1.4508 4 $61,326
190 4 Acute myocardial infarction 2.8132 4 $61,326
191 1 Cardiac catheterization for coronary artery disease 0.7170 2 $39,678
191 2 Cardiac catheterization for coronary artery disease 0.8762 2 $39,678
191 3 Cardiac catheterization for coronary artery disease 1.4267 2 $39,678
191 4 Cardiac catheterization for coronary artery disease 2.6475 2 $39,678
192 1 Cardiac catheterization for other non‐coronary conditions 0.7181 4 $61,559
192 2 Cardiac catheterization for other non‐coronary conditions 1.0194 4 $61,559
192 3 Cardiac catheterization for other non‐coronary conditions 1.8199 4 $61,559
192 4 Cardiac catheterization for other non‐coronary conditions 4.1173 4 $61,559
193 1 Acute & subacute endocarditis 1.0318 11 $121,620
193 2 Acute & subacute endocarditis 1.3781 11 $121,620
193 3 Acute & subacute endocarditis 2.1532 11 $121,620
193 4 Acute & subacute endocarditis 4.4642 11 $121,620
194 1 Heart failure 0.5698 5 $57,181
194 2 Heart failure 0.7912 5 $57,181
194 3 Heart failure 1.2937 5 $57,181
194 4 Heart failure 2.8884 5 $57,181
196 1 Cardiac arrest and shock 0.5857 4 $79,828
196 2 Cardiac arrest and shock 0.6320 4 $79,828
196 3 Cardiac arrest and shock 0.7015 4 $79,828
196 4 Cardiac arrest and shock 2.0908 4 $79,828
197 1 Peripheral & other vascular disorders 0.5860 4 $51,378
197 2 Peripheral & other vascular disorders 0.7923 4 $51,378
197 3 Peripheral & other vascular disorders 1.1809 4 $51,378
197 4 Peripheral & other vascular disorders 2.8639 4 $51,378
198 1 Angina pectoris & coronary atherosclerosis 0.4083 2 $28,629
7 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
198 2 Angina pectoris & coronary atherosclerosis 0.5343 2 $28,629
198 3 Angina pectoris & coronary atherosclerosis 0.8177 2 $28,629
198 4 Angina pectoris & coronary atherosclerosis 2.4207 2 $28,629
199 1 Hypertension 0.4525 2 $30,464
199 2 Hypertension 0.5924 2 $30,464
199 3 Hypertension 0.9319 2 $30,464
199 4 Hypertension 2.4563 2 $30,464
200 1 Cardiac structural & valvular disorders 0.5073 4 $54,268
200 2 Cardiac structural & valvular disorders 0.6960 4 $54,268
200 3 Cardiac structural & valvular disorders 1.2516 4 $54,268
200 4 Cardiac structural & valvular disorders 3.9395 4 $54,268
201 1 Cardiac arrhythmia & conduction disorders 0.4325 3 $31,209
201 2 Cardiac arrhythmia & conduction disorders 0.6247 3 $31,209
201 3 Cardiac arrhythmia & conduction disorders 1.0849 3 $31,209
201 4 Cardiac arrhythmia & conduction disorders 2.5400 3 $31,209
203 1 Chest pain 0.3938 2 $25,743
203 2 Chest pain 0.4913 2 $25,743
203 3 Chest pain 0.7059 2 $25,743
203 4 Chest pain 2.3552 2 $25,743
204 1 Syncope & collapse 0.4603 2 $29,705
204 2 Syncope & collapse 0.5750 2 $29,705
204 3 Syncope & collapse 0.8594 2 $29,705
204 4 Syncope & collapse 2.1207 2 $29,705
205 1 Cardiomyopathy 0.5876 4 $61,031
205 2 Cardiomyopathy 0.7463 4 $61,031
205 3 Cardiomyopathy 1.4534 4 $61,031
205 4 Cardiomyopathy 1.7721 4 $61,031
206 1 Malfunction,reaction,complication of cardiac/vasc device or procedure 0.5498 5 $76,253
206 2 Malfunction,reaction,complication of cardiac/vasc device or procedure 0.7277 5 $76,253
206 3 Malfunction,reaction,complication of cardiac/vasc device or procedure 1.2442 5 $76,253
206 4 Malfunction,reaction,complication of cardiac/vasc device or procedure 3.4045 5 $76,253
207 1 Other circulatory system diagnoses 0.4889 3 $45,387
207 2 Other circulatory system diagnoses 0.7171 3 $45,387
207 3 Other circulatory system diagnoses 1.2029 3 $45,387
207 4 Other circulatory system diagnoses 2.5270 3 $45,387
220 1 Major stomach, esophageal & duodenal procedures 1.1586 8 $127,212
220 2 Major stomach, esophageal & duodenal procedures 1.8452 8 $127,212
220 3 Major stomach, esophageal & duodenal procedures 3.4028 8 $127,212
220 4 Major stomach, esophageal & duodenal procedures 7.0877 8 $127,212
221 1 Major small & large bowel procedures 1.4866 8 $92,208
221 2 Major small & large bowel procedures 1.8827 8 $92,208
221 3 Major small & large bowel procedures 3.1014 8 $92,208
221 4 Major small & large bowel procedures 6.6083 8 $92,208
222 1 Other stomach, esophageal & duodenal procedures 0.8229 3 $47,945
222 2 Other stomach, esophageal & duodenal procedures 1.1339 3 $47,945
222 3 Other stomach, esophageal & duodenal procedures 2.0477 3 $47,945
222 4 Other stomach, esophageal & duodenal procedures 5.5340 3 $47,945
223 1 Other small & large bowel procedures 1.1769 6 $72,889
223 2 Other small & large bowel procedures 1.5746 6 $72,889
223 3 Other small & large bowel procedures 2.6603 6 $72,889
223 4 Other small & large bowel procedures 5.5785 6 $72,889
8 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
224 1 Peritoneal adhesiolysis 1.2018 7 $77,447
224 2 Peritoneal adhesiolysis 1.6013 7 $77,447
224 3 Peritoneal adhesiolysis 2.6538 7 $77,447
224 4 Peritoneal adhesiolysis 5.5686 7 $77,447
225 1 Appendectomy 0.7200 2 $32,173
225 2 Appendectomy 1.1044 2 $32,173
225 3 Appendectomy 2.0288 2 $32,173
225 4 Appendectomy 4.0622 2 $32,173
226 1 Anal procedures 0.6189 3 $32,555
226 2 Anal procedures 0.8830 3 $32,555
226 3 Anal procedures 1.4984 3 $32,555
226 4 Anal procedures 3.6289 3 $32,555
227 1 Hernia procedures except inguinal, femoral & umbilical 1.0394 4 $57,035
227 2 Hernia procedures except inguinal, femoral & umbilical 1.3504 4 $57,035
227 3 Hernia procedures except inguinal, femoral & umbilical 2.3184 4 $57,035
227 4 Hernia procedures except inguinal, femoral & umbilical 5.2737 4 $57,035
228 1 Inguinal, femoral & umbilical hernia procedures 0.6972 2 $35,049
228 2 Inguinal, femoral & umbilical hernia procedures 0.9533 2 $35,049
228 3 Inguinal, femoral & umbilical hernia procedures 1.6136 2 $35,049
228 4 Inguinal, femoral & umbilical hernia procedures 4.4558 2 $35,049
229 1 Other digestive system & abdominal procedures 1.0213 7 $93,599
229 2 Other digestive system & abdominal procedures 1.4802 7 $93,599
229 3 Other digestive system & abdominal procedures 2.6057 7 $93,599
229 4 Other digestive system & abdominal procedures 5.7868 7 $93,599
240 1 Digestive malignancy 0.6998 7 $90,882
240 2 Digestive malignancy 0.9493 7 $90,882
240 3 Digestive malignancy 1.5834 7 $90,882
240 4 Digestive malignancy 2.9739 7 $90,882
241 1 Peptic ulcer & gastritis 0.5405 3 $39,630
241 2 Peptic ulcer & gastritis 0.7757 3 $39,630
241 3 Peptic ulcer & gastritis 1.2427 3 $39,630
241 4 Peptic ulcer & gastritis 3.1297 3 $39,630
242 1 Major esophageal disorders 0.5525 4 $58,199
242 2 Major esophageal disorders 0.7944 4 $58,199
242 3 Major esophageal disorders 1.2483 4 $58,199
242 4 Major esophageal disorders 3.1552 4 $58,199
243 1 Other esophageal disorders 0.4346 3 $34,175
243 2 Other esophageal disorders 0.6290 3 $34,175
243 3 Other esophageal disorders 1.0551 3 $34,175
243 4 Other esophageal disorders 2.2987 3 $34,175
244 1 Diverticulitis & diverticulosis 0.5202 4 $28,240
244 2 Diverticulitis & diverticulosis 0.6935 4 $28,240
244 3 Diverticulitis & diverticulosis 1.1617 4 $28,240
244 4 Diverticulitis & diverticulosis 3.0729 4 $28,240
245 1 Inflammatory bowel disease 0.6247 4 $43,701
245 2 Inflammatory bowel disease 0.7755 4 $43,701
245 3 Inflammatory bowel disease 1.2181 4 $43,701
245 4 Inflammatory bowel disease 2.1554 4 $43,701
246 1 Gastrointestinal vascular insufficiency 0.6231 4 $35,859
246 2 Gastrointestinal vascular insufficiency 0.7846 4 $35,859
246 3 Gastrointestinal vascular insufficiency 1.2927 4 $35,859
9 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
246 4 Gastrointestinal vascular insufficiency 2.8515 4 $35,859
247 1 Intestinal obstruction 0.4905 3 $29,320
247 2 Intestinal obstruction 0.6730 3 $29,320
247 3 Intestinal obstruction 1.2043 3 $29,320
247 4 Intestinal obstruction 2.5557 3 $29,320
248 1 Major gastrointestinal & peritoneal infections 0.5951 5 $48,587
248 2 Major gastrointestinal & peritoneal infections 0.8464 5 $48,587
248 3 Major gastrointestinal & peritoneal infections 1.3189 5 $48,587
248 4 Major gastrointestinal & peritoneal infections 3.2365 5 $48,587
249 1 Other gastroenteritis, nausa & vomiting 0.4251 3 $26,252
249 2 Other gastroenteritis, nausa & vomiting 0.5343 3 $26,252
249 3 Other gastroenteritis, nausa & vomiting 0.8354 3 $26,252
249 4 Other gastroenteritis, nausa & vomiting 2.0227 3 $26,252
251 1 Abdominal pain 0.4283 2 $27,334
251 2 Abdominal pain 0.5669 2 $27,334
251 3 Abdominal pain 0.8474 2 $27,334
251 4 Abdominal pain 1.9363 2 $27,334
252 1 Malfunction, reaction & complication of GI device or procedure 0.6093 5 $52,515
252 2 Malfunction, reaction & complication of GI device or procedure 0.7808 5 $52,515
252 3 Malfunction, reaction & complication of GI device or procedure 1.2420 5 $52,515
252 4 Malfunction, reaction & complication of GI device or procedure 2.8342 5 $52,515
253 1 Other & unspecified gastrointestinal hemorrhage 0.6104 4 $48,514
253 2 Other & unspecified gastrointestinal hemorrhage 0.8153 4 $48,514
253 3 Other & unspecified gastrointestinal hemorrhage 1.3367 4 $48,514
253 4 Other & unspecified gastrointestinal hemorrhage 2.3659 4 $48,514
254 1 Other digestive system diagnoses 0.4994 3 $37,258
254 2 Other digestive system diagnoses 0.7217 3 $37,258
254 3 Other digestive system diagnoses 1.2126 3 $37,258
254 4 Other digestive system diagnoses 2.6081 3 $37,258
260 1 Major pancreas, liver & shunt procedures 1.4598 9 $145,661
260 2 Major pancreas, liver & shunt procedures 1.9923 9 $145,661
260 3 Major pancreas, liver & shunt procedures 3.1452 9 $145,661
260 4 Major pancreas, liver & shunt procedures 7.4265 9 $145,661
261 1 Major biliary tract procedures 1.3983 9 $120,637
261 2 Major biliary tract procedures 2.0020 9 $120,637
261 3 Major biliary tract procedures 3.0883 9 $120,637
261 4 Major biliary tract procedures 6.1406 9 $120,637
262 1 Cholecystectomy except laparoscopic 1.3137 6 $73,048
262 2 Cholecystectomy except laparoscopic 1.6055 6 $73,048
262 3 Cholecystectomy except laparoscopic 2.7370 6 $73,048
262 4 Cholecystectomy except laparoscopic 6.0536 6 $73,048
263 1 Laparoscopic cholecystectomy 0.8846 3 $43,302
263 2 Laparoscopic cholecystectomy 1.1717 3 $43,302
263 3 Laparoscopic cholecystectomy 1.6154 3 $43,302
263 4 Laparoscopic cholecystectomy 3.6697 3 $43,302
264 1 Other hepatobiliary, pancreas & abdominal procedures 1.3339 10 $150,327
264 2 Other hepatobiliary, pancreas & abdominal procedures 1.5121 10 $150,327
264 3 Other hepatobiliary, pancreas & abdominal procedures 2.8565 10 $150,327
264 4 Other hepatobiliary, pancreas & abdominal procedures 6.1546 10 $150,327
279 1 Hepatic coma & other major acute liver disorders 0.5496 7 $89,651
279 2 Hepatic coma & other major acute liver disorders 0.7823 7 $89,651
10 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
279 3 Hepatic coma & other major acute liver disorders 1.3577 7 $89,651
279 4 Hepatic coma & other major acute liver disorders 3.7050 7 $89,651
280 1 Alcoholic liver disease 0.5359 6 $74,043
280 2 Alcoholic liver disease 0.7530 6 $74,043
280 3 Alcoholic liver disease 1.2672 6 $74,043
280 4 Alcoholic liver disease 3.4123 6 $74,043
281 1 Malignancy of hepatobiliary system & pancreas 0.6671 7 $82,597
281 2 Malignancy of hepatobiliary system & pancreas 0.9402 7 $82,597
281 3 Malignancy of hepatobiliary system & pancreas 1.3781 7 $82,597
281 4 Malignancy of hepatobiliary system & pancreas 2.4185 7 $82,597
282 1 Disorders of pancreas except malignancy 0.5520 4 $38,584
282 2 Disorders of pancreas except malignancy 0.7469 4 $38,584
282 3 Disorders of pancreas except malignancy 1.3619 4 $38,584
282 4 Disorders of pancreas except malignancy 3.4568 4 $38,584
283 1 Other disorders of the liver 0.5636 5 $58,520
283 2 Other disorders of the liver 0.7473 5 $58,520
283 3 Other disorders of the liver 1.2045 5 $58,520
283 4 Other disorders of the liver 2.5897 5 $58,520
284 1 Disorders of gallbladder & biliary tract 0.5776 4 $44,778
284 2 Disorders of gallbladder & biliary tract 0.8276 4 $44,778
284 3 Disorders of gallbladder & biliary tract 1.3179 4 $44,778
284 4 Disorders of gallbladder & biliary tract 2.9642 4 $44,778
301 1 Hip joint replacement 1.8454 3 $64,012
301 2 Hip joint replacement 1.9179 3 $64,012
301 3 Hip joint replacement 2.5367 3 $64,012
301 4 Hip joint replacement 6.0537 3 $64,012
302 1 Knee joint replacement 1.7731 3 $67,304
302 2 Knee joint replacement 2.0006 3 $67,304
302 3 Knee joint replacement 2.6936 3 $67,304
302 4 Knee joint replacement 5.4428 3 $67,304
303 1 Dorsal & lumbar fusion proc for curvature of back 4.4198 6 $240,618
303 2 Dorsal & lumbar fusion proc for curvature of back 5.2884 6 $240,618
303 3 Dorsal & lumbar fusion proc for curvature of back 6.9880 6 $240,618
303 4 Dorsal & lumbar fusion proc for curvature of back 10.8945 6 $240,618
304 1 Dorsal & lumbar fusion proc except for curvature of back 3.0661 4 $141,801
304 2 Dorsal & lumbar fusion proc except for curvature of back 3.7348 4 $141,801
304 3 Dorsal & lumbar fusion proc except for curvature of back 5.3276 4 $141,801
304 4 Dorsal & lumbar fusion proc except for curvature of back 9.1822 4 $141,801
305 1 Amputation of lower limb except toes 1.3612 14 $215,520
305 2 Amputation of lower limb except toes 1.9171 14 $215,520
305 3 Amputation of lower limb except toes 3.3819 14 $215,520
305 4 Amputation of lower limb except toes 6.3018 14 $215,520
308 1 Hip and femur fracture repair 1.3356 6 $77,812
308 2 Hip and femur fracture repair 1.8388 6 $77,812
308 3 Hip and femur fracture repair 2.7457 6 $77,812
308 4 Hip and femur fracture repair 5.7688 6 $77,812
309 1 Other significant hip and femur surgery 1.2454 5 $107,151
309 2 Other significant hip and femur surgery 1.8748 5 $107,151
309 3 Other significant hip and femur surgery 3.0219 5 $107,151
309 4 Other significant hip and femur surgery 5.7451 5 $107,151
310 1 Intervertebral disc excision & decompression 0.8619 3 $47,755
11 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
310 2 Intervertebral disc excision & decompression 1.2220 3 $47,755
310 3 Intervertebral disc excision & decompression 2.5450 3 $47,755
310 4 Intervertebral disc excision & decompression 6.8422 3 $47,755
312 1 Skin graft, except hand, for musculoskeletal & connective tissue diagnoses 1.2189 11 $189,566
312 2 Skin graft, except hand, for musculoskeletal & connective tissue diagnoses 2.2533 11 $189,566
312 3 Skin graft, except hand, for musculoskeletal & connective tissue diagnoses 4.5277 11 $189,566
312 4 Skin graft, except hand, for musculoskeletal & connective tissue diagnoses 9.0023 11 $189,566
313 1 Knee & lower leg procedures except foot 1.1963 4 $76,615
313 2 Knee & lower leg procedures except foot 1.7556 4 $76,615
313 3 Knee & lower leg procedures except foot 2.8750 4 $76,615
313 4 Knee & lower leg procedures except foot 6.4713 4 $76,615
314 1 Foot & toe procedures 1.0584 7 $79,504
314 2 Foot & toe procedures 1.3543 7 $79,504
314 3 Foot & toe procedures 2.0326 7 $79,504
314 4 Foot & toe procedures 3.8450 7 $79,504
315 1 Shoulder, upper arm & forearm procedures except joint replacement 0.8087 3 $63,277
315 2 Shoulder, upper arm & forearm procedures except joint replacement 1.3830 3 $63,277
315 3 Shoulder, upper arm & forearm procedures except joint replacement 2.6682 3 $63,277
315 4 Shoulder, upper arm & forearm procedures except joint replacement 5.1334 3 $63,277
316 1 Hand & wrist procedures 0.7165 3 $42,141
316 2 Hand & wrist procedures 1.1806 3 $42,141
316 3 Hand & wrist procedures 2.1331 3 $42,141
316 4 Hand & wrist procedures 2.3874 3 $42,141
317 1 Tendon, muscle & other soft tissue procedures 0.8998 5 $66,392
317 2 Tendon, muscle & other soft tissue procedures 1.4349 5 $66,392
317 3 Tendon, muscle & other soft tissue procedures 2.6078 5 $66,392
317 4 Tendon, muscle & other soft tissue procedures 6.3180 5 $66,392
320 1 Other musculoskeletal system & connective tissue procedures 1.0254 5 $92,749
320 2 Other musculoskeletal system & connective tissue procedures 1.6278 5 $92,749
320 3 Other musculoskeletal system & connective tissue procedures 2.5149 5 $92,749
320 4 Other musculoskeletal system & connective tissue procedures 5.0036 5 $92,749
321 1 Cervical spinal fusion & other back/neck proc exc disc excis/decomp 1.6317 2 $78,165
321 2 Cervical spinal fusion & other back/neck proc exc disc excis/decomp 2.1471 2 $78,165
321 3 Cervical spinal fusion & other back/neck proc exc disc excis/decomp 3.7026 2 $78,165
321 4 Cervical spinal fusion & other back/neck proc exc disc excis/decomp 7.0642 2 $78,165
322 1 Shoulder & elbow joint replacement # 1.5803 2 $54,660
322 2 Shoulder & elbow joint replacement # 1.7456 2 $54,660
322 3 Shoulder & elbow joint replacement # 2.9236 2 $54,660
322 4 Shoulder & elbow joint replacement # 3.4184 2 $54,660
340 1 Fracture of femur 0.5287 5 $49,245
340 2 Fracture of femur 0.7081 5 $49,245
340 3 Fracture of femur 1.7035 5 $49,245
340 4 Fracture of femur 2.3181 5 $49,245
341 1 Fracture of pelvis or dislocation of hip 0.5725 4 $43,651
341 2 Fracture of pelvis or dislocation of hip 0.7138 4 $43,651
341 3 Fracture of pelvis or dislocation of hip 0.9621 4 $43,651
341 4 Fracture of pelvis or dislocation of hip 1.0238 4 $43,651
342 1 Fractures & dislocations except femur, pelvis & back 0.4446 3 $31,060
342 2 Fractures & dislocations except femur, pelvis & back 0.6593 3 $31,060
342 3 Fractures & dislocations except femur, pelvis & back 1.0834 3 $31,060
342 4 Fractures & dislocations except femur, pelvis & back 2.6466 3 $31,060
12 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
343 1 Musculoskeletal malignancy & pathol fracture d/t muscskel malig 0.8297 9 $108,976
343 2 Musculoskeletal malignancy & pathol fracture d/t muscskel malig 0.9976 9 $108,976
343 3 Musculoskeletal malignancy & pathol fracture d/t muscskel malig 2.1466 9 $108,976
343 4 Musculoskeletal malignancy & pathol fracture d/t muscskel malig 3.8518 9 $108,976
344 1 Osteomyelitis, septic arthritis & other musculoskeletal infections 0.8041 7 $74,824
344 2 Osteomyelitis, septic arthritis & other musculoskeletal infections 1.1498 7 $74,824
344 3 Osteomyelitis, septic arthritis & other musculoskeletal infections 1.7834 7 $74,824
344 4 Osteomyelitis, septic arthritis & other musculoskeletal infections 3.4328 7 $74,824
346 1 Connective tissue disorders 0.7315 5 $79,638
346 2 Connective tissue disorders 0.9622 5 $79,638
346 3 Connective tissue disorders 1.6629 5 $79,638
346 4 Connective tissue disorders 4.8745 5 $79,638
347 1 Other back & neck disorders, fractures & injuries 0.5491 3 $38,134
347 2 Other back & neck disorders, fractures & injuries 0.7447 3 $38,134
347 3 Other back & neck disorders, fractures & injuries 1.1237 3 $38,134
347 4 Other back & neck disorders, fractures & injuries 3.1553 3 $38,134
349 1 Malfunction, reaction, complic of orthopedic device or procedure 0.5439 5 $65,403
349 2 Malfunction, reaction, complic of orthopedic device or procedure 0.8792 5 $65,403
349 3 Malfunction, reaction, complic of orthopedic device or procedure 1.5580 5 $65,403
349 4 Malfunction, reaction, complic of orthopedic device or procedure 3.5714 5 $65,403
351 1 Other musculoskeletal system & connective tissue diagnoses 0.4909 3 $38,985
351 2 Other musculoskeletal system & connective tissue diagnoses 0.6388 3 $38,985
351 3 Other musculoskeletal system & connective tissue diagnoses 1.1547 3 $38,985
351 4 Other musculoskeletal system & connective tissue diagnoses 3.0805 3 $38,985
361 1 Skin graft for skin & subcutaneous tissue diagnoses 1.3263 6 $103,983
361 2 Skin graft for skin & subcutaneous tissue diagnoses 1.8779 6 $103,983
361 3 Skin graft for skin & subcutaneous tissue diagnoses 3.3398 6 $103,983
361 4 Skin graft for skin & subcutaneous tissue diagnoses 9.6005 6 $103,983
362 1 Mastectomy procedures 1.3637 2 $86,685
362 2 Mastectomy procedures 1.8053 2 $86,685
362 3 Mastectomy procedures 2.7783 2 $86,685
362 4 Mastectomy procedures 2.9037 2 $86,685
363 1 Breast procedures except mastectomy 0.9053 3 $64,591
363 2 Breast procedures except mastectomy 1.5184 3 $64,591
363 3 Breast procedures except mastectomy 2.2953 3 $64,591
363 4 Breast procedures except mastectomy 2.3603 3 $64,591
364 1 Other skin, subcutaneous tissue & related procedures 0.7695 4 $53,273
364 2 Other skin, subcutaneous tissue & related procedures 1.1098 4 $53,273
364 3 Other skin, subcutaneous tissue & related procedures 2.0231 4 $53,273
364 4 Other skin, subcutaneous tissue & related procedures 5.3093 4 $53,273
380 1 Skin ulcers 0.6865 5 $52,633
380 2 Skin ulcers 0.8343 5 $52,633
380 3 Skin ulcers 1.2978 5 $52,633
380 4 Skin ulcers 2.4923 5 $52,633
381 1 Major skin disorders 0.5945 5 $56,761
381 2 Major skin disorders 0.8806 5 $56,761
381 3 Major skin disorders 1.9271 5 $56,761
381 4 Major skin disorders 5.9028 5 $56,761
382 1 Malignant breast disorders 0.6225 7 $95,202
382 2 Malignant breast disorders 0.8334 7 $95,202
382 3 Malignant breast disorders 1.5061 7 $95,202
13 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
382 4 Malignant breast disorders 2.8937 7 $95,202
383 1 Cellulitis & other skin infections 0.5051 4 $33,117
383 2 Cellulitis & other skin infections 0.6842 4 $33,117
383 3 Cellulitis & other skin infections 1.1819 4 $33,117
383 4 Cellulitis & other skin infections 2.7936 4 $33,117
384 1 Contusion, open wound & other trauma to skin & subcutaneous tissue 0.4128 2 $26,230
384 2 Contusion, open wound & other trauma to skin & subcutaneous tissue 0.5792 2 $26,230
384 3 Contusion, open wound & other trauma to skin & subcutaneous tissue 1.0132 2 $26,230
384 4 Contusion, open wound & other trauma to skin & subcutaneous tissue 1.8397 2 $26,230
385 1 Other skin, subcutaneous tissue & breast disorders 0.4793 3 $33,532
385 2 Other skin, subcutaneous tissue & breast disorders 0.6558 3 $33,532
385 3 Other skin, subcutaneous tissue & breast disorders 1.0830 3 $33,532
385 4 Other skin, subcutaneous tissue & breast disorders 2.8947 3 $33,532
401 1 Pituitary & adrenal procedures 1.2371 4 $90,821
401 2 Pituitary & adrenal procedures 1.6928 4 $90,821
401 3 Pituitary & adrenal procedures 3.0989 4 $90,821
401 4 Pituitary & adrenal procedures 6.9877 4 $90,821
403 1 Procedures for obesity 1.1400 2 $45,995
403 2 Procedures for obesity 1.2816 2 $45,995
403 3 Procedures for obesity 2.1006 2 $45,995
403 4 Procedures for obesity 6.5767 2 $45,995
404 1 Thyroid, parathyroid & thyroglossal procedures 0.6684 1 $28,183
404 2 Thyroid, parathyroid & thyroglossal procedures 0.8682 1 $28,183
404 3 Thyroid, parathyroid & thyroglossal procedures 2.2295 1 $28,183
404 4 Thyroid, parathyroid & thyroglossal procedures 2.6667 1 $28,183
405 1 Other procedures for endocrine, nutritional & metabolic disorders 1.1658 12 $176,231
405 2 Other procedures for endocrine, nutritional & metabolic disorders 1.6936 12 $176,231
405 3 Other procedures for endocrine, nutritional & metabolic disorders 2.9451 12 $176,231
405 4 Other procedures for endocrine, nutritional & metabolic disorders 8.3881 12 $176,231
420 1 Diabetes 0.4556 3 $36,294
420 2 Diabetes 0.6311 3 $36,294
420 3 Diabetes 0.9773 3 $36,294
420 4 Diabetes 2.5400 3 $36,294
421 1 Malnutrition, failure to thrive & other nutritional disorders 0.6250 6 $69,790
421 2 Malnutrition, failure to thrive & other nutritional disorders 0.9133 6 $69,790
421 3 Malnutrition, failure to thrive & other nutritional disorders 1.3876 6 $69,790
421 4 Malnutrition, failure to thrive & other nutritional disorders 3.2013 6 $69,790
422 1 Hypovolemia & related electrolyte disorders 0.3781 3 $31,551
422 2 Hypovolemia & related electrolyte disorders 0.5260 3 $31,551
422 3 Hypovolemia & related electrolyte disorders 0.9020 3 $31,551
422 4 Hypovolemia & related electrolyte disorders 2.2703 3 $31,551
423 1 Inborn errors of metabolism 0.6144 5 $79,546
423 2 Inborn errors of metabolism 1.0113 5 $79,546
423 3 Inborn errors of metabolism 1.5998 5 $79,546
423 4 Inborn errors of metabolism 5.4383 5 $79,546
424 1 Other endocrine disorders 0.4989 4 $43,937
424 2 Other endocrine disorders 0.7594 4 $43,937
424 3 Other endocrine disorders 1.1853 4 $43,937
424 4 Other endocrine disorders 2.7831 4 $43,937
425 1 Electrolyte disorders except hypovolemia related 0.4308 4 $42,453
425 2 Electrolyte disorders except hypovolemia related 0.6008 4 $42,453
14 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
425 3 Electrolyte disorders except hypovolemia related 0.9984 4 $42,453
425 4 Electrolyte disorders except hypovolemia related 2.4910 4 $42,453
440 1 Kidney transplant 3.7060 6 $172,221
440 2 Kidney transplant 4.6454 6 $172,221
440 3 Kidney transplant 5.6724 6 $172,221
440 4 Kidney transplant 10.3841 6 $172,221
441 1 Major bladder procedures 1.2804 8 $133,098
441 2 Major bladder procedures 2.2263 8 $133,098
441 3 Major bladder procedures 3.1477 8 $133,098
441 4 Major bladder procedures 6.7633 8 $133,098
442 1 Kidney & urinary tract procedures for malignancy 1.2940 4 $72,322
442 2 Kidney & urinary tract procedures for malignancy 1.5373 4 $72,322
442 3 Kidney & urinary tract procedures for malignancy 2.8157 4 $72,322
442 4 Kidney & urinary tract procedures for malignancy 6.3759 4 $72,322
443 1 Kidney & urinary tract procedures for nonmalignancy 1.0725 3 $54,404
443 2 Kidney & urinary tract procedures for nonmalignancy 1.1919 3 $54,404
443 3 Kidney & urinary tract procedures for nonmalignancy 2.2718 3 $54,404
443 4 Kidney & urinary tract procedures for nonmalignancy 5.0678 3 $54,404
444 1 Renal dialysis access device procedure only 0.9824 11 $162,162
444 2 Renal dialysis access device procedure only 1.7469 11 $162,162
444 3 Renal dialysis access device procedure only 3.2326 11 $162,162
444 4 Renal dialysis access device procedure only 6.1859 11 $162,162
445 1 Other bladder procedures 0.8214 4 $77,703
445 2 Other bladder procedures 1.2691 4 $77,703
445 3 Other bladder procedures 1.8728 4 $77,703
445 4 Other bladder procedures 2.4496 4 $77,703
446 1 Urethral & transurethral procedures 0.6845 2 $32,763
446 2 Urethral & transurethral procedures 0.7902 2 $32,763
446 3 Urethral & transurethral procedures 1.5078 2 $32,763
446 4 Urethral & transurethral procedures 3.2889 2 $32,763
447 1 Other kidney, urinary tract & related procedures 1.1967 9 $130,935
447 2 Other kidney, urinary tract & related procedures 1.3024 9 $130,935
447 3 Other kidney, urinary tract & related procedures 2.9312 9 $130,935
447 4 Other kidney, urinary tract & related procedures 7.6306 9 $130,935
461 1 Kidney & urinary tract malignancy 0.4546 6 $80,165
461 2 Kidney & urinary tract malignancy 0.8052 6 $80,165
461 3 Kidney & urinary tract malignancy 1.5029 6 $80,165
461 4 Kidney & urinary tract malignancy 2.3281 6 $80,165
462 1 Nephritis & nephrosis 0.5902 4 $55,768
462 2 Nephritis & nephrosis 0.7169 4 $55,768
462 3 Nephritis & nephrosis 1.2648 4 $55,768
462 4 Nephritis & nephrosis 4.0181 4 $55,768
463 1 Kidney & urinary tract infections 0.4969 3 $32,113
463 2 Kidney & urinary tract infections 0.6302 3 $32,113
463 3 Kidney & urinary tract infections 0.9871 3 $32,113
463 4 Kidney & urinary tract infections 2.1810 3 $32,113
465 1 Urinary stones & acquired upper urinary tract obstruction 0.4482 2 $27,577
465 2 Urinary stones & acquired upper urinary tract obstruction 0.5223 2 $27,577
465 3 Urinary stones & acquired upper urinary tract obstruction 0.8706 2 $27,577
465 4 Urinary stones & acquired upper urinary tract obstruction 2.1690 2 $27,577
466 1 Malfunction, reaction, complic of genitourinary device or proc 0.5023 5 $71,542
15 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
466 2 Malfunction, reaction, complic of genitourinary device or proc 0.6979 5 $71,542
466 3 Malfunction, reaction, complic of genitourinary device or proc 1.1635 5 $71,542
466 4 Malfunction, reaction, complic of genitourinary device or proc 2.3277 5 $71,542
468 1 Other kidney & urinary tract diagnoses, signs & symptoms 0.5036 4 $46,839
468 2 Other kidney & urinary tract diagnoses, signs & symptoms 0.7269 4 $46,839
468 3 Other kidney & urinary tract diagnoses, signs & symptoms 1.1894 4 $46,839
468 4 Other kidney & urinary tract diagnoses, signs & symptoms 2.8087 4 $46,839
469 1 Acute Kidney Injury # 0.5265 5 $59,561
469 2 Acute Kidney Injury # 0.7445 5 $59,561
469 3 Acute Kidney Injury # 1.3582 5 $59,561
469 4 Acute Kidney Injury # 3.3013 5 $59,561
470 1 Chronic Kidney Disease # 0.4787 4 $59,531
470 2 Chronic Kidney Disease # 0.6833 4 $59,531
470 3 Chronic Kidney Disease # 1.1921 4 $59,531
470 4 Chronic Kidney Disease # 2.6562 4 $59,531
480 1 Major male pelvic procedures 1.0986 2 $35,336
480 2 Major male pelvic procedures 1.2543 2 $35,336
480 3 Major male pelvic procedures 2.1573 2 $35,336
480 4 Major male pelvic procedures 2.5975 2 $35,336
481 1 Penis procedures 0.7421 2 $47,061
481 2 Penis procedures 1.2195 2 $47,061
481 3 Penis procedures 1.9546 2 $47,061
481 4 Penis procedures 2.0664 2 $47,061
482 1 Transurethral prostatectomy 0.6050 2 $22,904
482 2 Transurethral prostatectomy 0.8478 2 $22,904
482 3 Transurethral prostatectomy 2.3539 2 $22,904
482 4 Transurethral prostatectomy 2.7057 2 $22,904
483 1 Testes & scrotal procedures 0.6317 3 $34,437
483 2 Testes & scrotal procedures 1.2810 3 $34,437
483 3 Testes & scrotal procedures 3.1815 3 $34,437
483 4 Testes & scrotal procedures 4.2780 3 $34,437
484 1 Other male reproductive system & related procedures 0.8784 3 $63,183
484 2 Other male reproductive system & related procedures 1.1766 3 $63,183
484 3 Other male reproductive system & related procedures 1.9720 3 $63,183
484 4 Other male reproductive system & related procedures 2.1479 3 $63,183
500 1 Malignancy, male reproductive system 0.4219 7 $79,798
500 2 Malignancy, male reproductive system 0.9427 7 $79,798
500 3 Malignancy, male reproductive system 1.5797 7 $79,798
500 4 Malignancy, male reproductive system 1.8418 7 $79,798
501 1 Male reproductive system diagnoses except malignancy 0.4834 3 $31,679
501 2 Male reproductive system diagnoses except malignancy 0.6859 3 $31,679
501 3 Male reproductive system diagnoses except malignancy 1.1227 3 $31,679
501 4 Male reproductive system diagnoses except malignancy 2.1326 3 $31,679
510 1 Pelvic evisceration, radical hysterectomy & other radical GYN procs 1.1244 4 $67,002
510 2 Pelvic evisceration, radical hysterectomy & other radical GYN procs 1.4338 4 $67,002
510 3 Pelvic evisceration, radical hysterectomy & other radical GYN procs 2.6313 4 $67,002
510 4 Pelvic evisceration, radical hysterectomy & other radical GYN procs 6.4093 4 $67,002
511 1 Uterine & adnexa procedures for ovarian & adnexal malignancy 1.2809 5 $70,932
511 2 Uterine & adnexa procedures for ovarian & adnexal malignancy 1.5398 5 $70,932
511 3 Uterine & adnexa procedures for ovarian & adnexal malignancy 2.5540 5 $70,932
511 4 Uterine & adnexa procedures for ovarian & adnexal malignancy 6.2264 5 $70,932
16 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
512 1 Uterine & adnexa procedures for non‐ovarian & non‐adnexal malig 1.0951 3 $45,741
512 2 Uterine & adnexa procedures for non‐ovarian & non‐adnexal malig 1.3566 3 $45,741
512 3 Uterine & adnexa procedures for non‐ovarian & non‐adnexal malig 2.3046 3 $45,741
512 4 Uterine & adnexa procedures for non‐ovarian & non‐adnexal malig 7.5034 3 $45,741
513 1 Uterine & adnexa procedures for non‐malignancy except leiomyoma 0.8727 2 $35,086
513 2 Uterine & adnexa procedures for non‐malignancy except leiomyoma 1.0382 2 $35,086
513 3 Uterine & adnexa procedures for non‐malignancy except leiomyoma 1.8502 2 $35,086
513 4 Uterine & adnexa procedures for non‐malignancy except leiomyoma 4.8016 2 $35,086
514 1 Female reproductive system reconstructive procedures 0.9942 1 $38,162
514 2 Female reproductive system reconstructive procedures 0.9942 1 $38,162
514 3 Female reproductive system reconstructive procedures 0.9942 1 $38,162
514 4 Female reproductive system reconstructive procedures 3.1251 1 $38,162
517 1 Dilation & curettage for non‐obstetric diagnoses 0.6677 3 $34,897
517 2 Dilation & curettage for non‐obstetric diagnoses 0.9345 3 $34,897
517 3 Dilation & curettage for non‐obstetric diagnoses 2.0359 3 $34,897
517 4 Dilation & curettage for non‐obstetric diagnoses 2.1499 3 $34,897
518 1 Other female reproductive system & related procedures 0.7559 3 $49,462
518 2 Other female reproductive system & related procedures 1.0825 3 $49,462
518 3 Other female reproductive system & related procedures 2.1188 3 $49,462
518 4 Other female reproductive system & related procedures 5.9779 3 $49,462
519 1 Uterine & adnexa procedures for leiomyoma 0.8588 2 $34,311
519 2 Uterine & adnexa procedures for leiomyoma 1.0751 2 $34,311
519 3 Uterine & adnexa procedures for leiomyoma 1.9793 2 $34,311
519 4 Uterine & adnexa procedures for leiomyoma 6.0488 2 $34,311
530 1 Female reproductive system malignancy 0.6102 6 $73,785
530 2 Female reproductive system malignancy 0.7823 6 $73,785
530 3 Female reproductive system malignancy 1.4519 6 $73,785
530 4 Female reproductive system malignancy 2.5071 6 $73,785
531 1 Female reproductive system infections 0.5400 3 $33,749
531 2 Female reproductive system infections 0.7303 3 $33,749
531 3 Female reproductive system infections 1.1590 3 $33,749
531 4 Female reproductive system infections 1.3019 3 $33,749
532 1 Menstrual & other female reproductive system disorders 0.4037 2 $25,344
532 2 Menstrual & other female reproductive system disorders 0.5587 2 $25,344
532 3 Menstrual & other female reproductive system disorders 0.9707 2 $25,344
532 4 Menstrual & other female reproductive system disorders 1.0288 2 $25,344
540 1 Cesarean delivery 0.8011 4 $34,848
540 2 Cesarean delivery 0.9187 4 $34,848
540 3 Cesarean delivery 1.1764 4 $34,848
540 4 Cesarean delivery 2.7056 4 $34,848
541 1 Vaginal delivery w sterilization &/or D&C 0.7031 3 $29,476
541 2 Vaginal delivery w sterilization &/or D&C 0.7601 3 $29,476
541 3 Vaginal delivery w sterilization &/or D&C 0.9958 3 $29,476
541 4 Vaginal delivery w sterilization &/or D&C 1.0909 3 $29,476
542 1 Vaginal delivery w complicating procedures exc sterilization &/or D&C 0.5951 3 $32,882
542 2 Vaginal delivery w complicating procedures exc sterilization &/or D&C 0.6782 3 $32,882
542 3 Vaginal delivery w complicating procedures exc sterilization &/or D&C 1.2216 3 $32,882
542 4 Vaginal delivery w complicating procedures exc sterilization &/or D&C 1.5409 3 $32,882
544 1 D&C, aspiration curettage or hysterotomy for obstetric diagnoses 0.4799 2 $24,489
544 2 D&C, aspiration curettage or hysterotomy for obstetric diagnoses 0.6189 2 $24,489
544 3 D&C, aspiration curettage or hysterotomy for obstetric diagnoses 1.0994 2 $24,489
17 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
544 4 D&C, aspiration curettage or hysterotomy for obstetric diagnoses 2.8706 2 $24,489
545 1 Ectopic pregnancy procedure 0.6951 2 $26,060
545 2 Ectopic pregnancy procedure 0.7850 2 $26,060
545 3 Ectopic pregnancy procedure 1.1013 2 $26,060
545 4 Ectopic pregnancy procedure 1.1751 2 $26,060
546 1 Other O.R. proc for obstetric diagnoses except delivery diagnoses 0.5754 3 $37,650
546 2 Other O.R. proc for obstetric diagnoses except delivery diagnoses 0.7795 3 $37,650
546 3 Other O.R. proc for obstetric diagnoses except delivery diagnoses 1.6739 3 $37,650
546 4 Other O.R. proc for obstetric diagnoses except delivery diagnoses 4.3077 3 $37,650
560 1 Vaginal delivery 0.5295 2 $23,669
560 2 Vaginal delivery 0.5852 2 $23,669
560 3 Vaginal delivery 0.7264 2 $23,669
560 4 Vaginal delivery 1.6966 2 $23,669
561 1 Postpartum & post abortion diagnoses w/o procedure 0.3790 2 $20,414
561 2 Postpartum & post abortion diagnoses w/o procedure 0.4486 2 $20,414
561 3 Postpartum & post abortion diagnoses w/o procedure 0.6737 2 $20,414
561 4 Postpartum & post abortion diagnoses w/o procedure 1.4578 2 $20,414
563 1 Preterm labor 0.3480 2 $20,960
563 2 Preterm labor 0.4188 2 $20,960
563 3 Preterm labor 0.5946 2 $20,960
563 4 Preterm labor 0.5946 2 $20,960
564 1 Abortion w/o D&C, aspiration curettage or hysterotomy 0.3649 2 $21,483
564 2 Abortion w/o D&C, aspiration curettage or hysterotomy 0.4223 2 $21,483
564 3 Abortion w/o D&C, aspiration curettage or hysterotomy 0.6034 2 $21,483
564 4 Abortion w/o D&C, aspiration curettage or hysterotomy 0.7253 2 $21,483
565 1 False labor 0.2276 1 $9,456
565 2 False labor 0.2824 1 $9,456
565 3 False labor 0.2874 1 $9,456
565 4 False labor 0.2874 1 $9,456
566 1 Other antepartum diagnoses 0.3407 3 $24,107
566 2 Other antepartum diagnoses 0.4459 3 $24,107
566 3 Other antepartum diagnoses 0.6561 3 $24,107
566 4 Other antepartum diagnoses 1.3618 3 $24,107
580 1 Neonate, transferred <5 days old, not born here 0.3049 2 $19,988
580 2 Neonate, transferred <5 days old, not born here 0.3860 2 $19,988
580 3 Neonate, transferred <5 days old, not born here 0.5418 2 $19,988
580 4 Neonate, transferred <5 days old, not born here 1.1132 2 $19,988
581 1 Neonate, transferred < 5 days old, born here 0.1365 1 $10,536
581 2 Neonate, transferred < 5 days old, born here 0.1858 1 $10,536
581 3 Neonate, transferred < 5 days old, born here 0.2740 1 $10,536
581 4 Neonate, transferred < 5 days old, born here 0.4946 1 $10,536
583 1 Neonate w ECMO 14.3195 39 $1,577,388
583 2 Neonate w ECMO 14.3195 39 $1,577,388
583 3 Neonate w ECMO 14.5924 39 $1,577,388
583 4 Neonate w ECMO 25.6857 39 $1,577,388
588 1 Neonate bwt <1500g w major procedure 19.3045 105 $1,567,510
588 2 Neonate bwt <1500g w major procedure 19.3045 105 $1,567,510
588 3 Neonate bwt <1500g w major procedure 25.2342 105 $1,567,510
588 4 Neonate bwt <1500g w major procedure 25.2342 105 $1,567,510
589 1 Neonate bwt <500g or GA <24 weeks 12.1389 8 $12,633
589 2 Neonate bwt <500g or GA <24 weeks 12.1389 8 $12,633
18 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
589 3 Neonate bwt <500g or GA <24 weeks 4.3999 8 $12,633
589 4 Neonate bwt <500g or GA <24 weeks 0.1135 8 $12,633
591 1 Neonate birthwt 500‐749g w/o major procedure 8.8894 76 $1,248,850
591 2 Neonate birthwt 500‐749g w/o major procedure 11.0219 76 $1,248,850
591 3 Neonate birthwt 500‐749g w/o major procedure 11.8148 76 $1,248,850
591 4 Neonate birthwt 500‐749g w/o major procedure 19.3745 76 $1,248,850
593 1 Neonate birthwt 750‐999g w/o major procedure 10.8028 71 $839,104
593 2 Neonate birthwt 750‐999g w/o major procedure 11.1421 71 $839,104
593 3 Neonate birthwt 750‐999g w/o major procedure 13.6180 71 $839,104
593 4 Neonate birthwt 750‐999g w/o major procedure 17.4359 71 $839,104
602 1 Neonate bwt 1000‐1249g w resp dist synd/oth maj resp or maj anom 6.4927 56 $651,756
602 2 Neonate bwt 1000‐1249g w resp dist synd/oth maj resp or maj anom 9.4840 56 $651,756
602 3 Neonate bwt 1000‐1249g w resp dist synd/oth maj resp or maj anom 11.1621 56 $651,756
602 4 Neonate bwt 1000‐1249g w resp dist synd/oth maj resp or maj anom 15.1216 56 $651,756
603 1 Neonate birthwt 1000‐1249g w or w/o other significant condition 5.1742 41 $391,892
603 2 Neonate birthwt 1000‐1249g w or w/o other significant condition 6.8985 41 $391,892
603 3 Neonate birthwt 1000‐1249g w or w/o other significant condition 8.9785 41 $391,892
603 4 Neonate birthwt 1000‐1249g w or w/o other significant condition 13.9298 41 $391,892
607 1 Neonate bwt 1250‐1499g w resp dist synd/oth maj resp or maj anom 6.0412 43 $458,761
607 2 Neonate bwt 1250‐1499g w resp dist synd/oth maj resp or maj anom 7.4784 43 $458,761
607 3 Neonate bwt 1250‐1499g w resp dist synd/oth maj resp or maj anom 9.1491 43 $458,761
607 4 Neonate bwt 1250‐1499g w resp dist synd/oth maj resp or maj anom 12.3456 43 $458,761
608 1 Neonate bwt 1250‐1499g w or w/o other significant condition 4.2444 30 $266,610
608 2 Neonate bwt 1250‐1499g w or w/o other significant condition 5.6860 30 $266,610
608 3 Neonate bwt 1250‐1499g w or w/o other significant condition 6.8236 30 $266,610
608 4 Neonate bwt 1250‐1499g w or w/o other significant condition 7.1824 30 $266,610
609 1 Neonate bwt 1500‐2499g w major procedure 3.5677 50 $889,861
609 2 Neonate bwt 1500‐2499g w major procedure 3.5951 50 $889,861
609 3 Neonate bwt 1500‐2499g w major procedure 7.2831 50 $889,861
609 4 Neonate bwt 1500‐2499g w major procedure 15.9642 50 $889,861
611 1 Neonate birthwt 1500‐1999g w major anomaly 2.5050 26 $307,527
611 2 Neonate birthwt 1500‐1999g w major anomaly 4.0349 26 $307,527
611 3 Neonate birthwt 1500‐1999g w major anomaly 6.2658 26 $307,527
611 4 Neonate birthwt 1500‐1999g w major anomaly 8.2137 26 $307,527
612 1 Neonate bwt 1500‐1999g w resp dist synd/oth maj resp cond 3.5182 27 $294,162
612 2 Neonate bwt 1500‐1999g w resp dist synd/oth maj resp cond 4.5501 27 $294,162
612 3 Neonate bwt 1500‐1999g w resp dist synd/oth maj resp cond 6.3430 27 $294,162
612 4 Neonate bwt 1500‐1999g w resp dist synd/oth maj resp cond 8.4736 27 $294,162
613 1 Neonate birthwt 1500‐1999g w congenital/perinatal infection 2.6641 21 $214,316
613 2 Neonate birthwt 1500‐1999g w congenital/perinatal infection 4.0276 21 $214,316
613 3 Neonate birthwt 1500‐1999g w congenital/perinatal infection 5.0477 21 $214,316
613 4 Neonate birthwt 1500‐1999g w congenital/perinatal infection 5.1781 21 $214,316
614 1 Neonate bwt 1500‐1999g w or w/o other significant condition 1.9946 14 $168,493
614 2 Neonate bwt 1500‐1999g w or w/o other significant condition 3.2983 14 $168,493
614 3 Neonate bwt 1500‐1999g w or w/o other significant condition 5.0361 14 $168,493
614 4 Neonate bwt 1500‐1999g w or w/o other significant condition 5.0361 14 $168,493
621 1 Neonate bwt 2000‐2499g w major anomaly 0.9077 14 $210,917
621 2 Neonate bwt 2000‐2499g w major anomaly 2.0940 14 $210,917
621 3 Neonate bwt 2000‐2499g w major anomaly 3.9783 14 $210,917
621 4 Neonate bwt 2000‐2499g w major anomaly 6.7921 14 $210,917
622 1 Neonate bwt 2000‐2499g w resp dist synd/oth maj resp cond 1.9373 14 $171,243
19 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
622 2 Neonate bwt 2000‐2499g w resp dist synd/oth maj resp cond 2.6304 14 $171,243
622 3 Neonate bwt 2000‐2499g w resp dist synd/oth maj resp cond 3.6058 14 $171,243
622 4 Neonate bwt 2000‐2499g w resp dist synd/oth maj resp cond 5.1690 14 $171,243
623 1 Neonate bwt 2000‐2499g w congenital/perinatal infection 1.4549 11 $112,213
623 2 Neonate bwt 2000‐2499g w congenital/perinatal infection 2.1582 11 $112,213
623 3 Neonate bwt 2000‐2499g w congenital/perinatal infection 3.1251 11 $112,213
623 4 Neonate bwt 2000‐2499g w congenital/perinatal infection 3.1251 11 $112,213
625 1 Neonate bwt 2000‐2499g w other significant condition 1.5998 11 $127,495
625 2 Neonate bwt 2000‐2499g w other significant condition 2.5873 11 $127,495
625 3 Neonate bwt 2000‐2499g w other significant condition 3.2943 11 $127,495
625 4 Neonate bwt 2000‐2499g w other significant condition 3.2943 11 $127,495
626 1 Neonate bwt 2000‐2499g, normal newborn or neonate w other problem 0.2083 4 $27,202
626 2 Neonate bwt 2000‐2499g, normal newborn or neonate w other problem 0.4166 4 $27,202
626 3 Neonate bwt 2000‐2499g, normal newborn or neonate w other problem 1.3379 4 $27,202
626 4 Neonate bwt 2000‐2499g, normal newborn or neonate w other problem 1.3394 4 $27,202
630 1 Neonate birthwt >2499g w major cardiovascular procedure 3.4488 26 $544,273
630 2 Neonate birthwt >2499g w major cardiovascular procedure 3.5867 26 $544,273
630 3 Neonate birthwt >2499g w major cardiovascular procedure 5.9255 26 $544,273
630 4 Neonate birthwt >2499g w major cardiovascular procedure 12.2295 26 $544,273
631 1 Neonate birthwt >2499g w other major procedure 1.6281 25 $357,531
631 2 Neonate birthwt >2499g w other major procedure 2.9340 25 $357,531
631 3 Neonate birthwt >2499g w other major procedure 4.8760 25 $357,531
631 4 Neonate birthwt >2499g w other major procedure 10.5134 25 $357,531
633 1 Neonate birthwt >2499g w major anomaly 0.2818 6 $52,128
633 2 Neonate birthwt >2499g w major anomaly 0.9105 6 $52,128
633 3 Neonate birthwt >2499g w major anomaly 2.3964 6 $52,128
633 4 Neonate birthwt >2499g w major anomaly 5.3539 6 $52,128
634 1 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 0.8041 7 $97,391
634 2 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 1.3331 7 $97,391
634 3 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 2.2522 7 $97,391
634 4 Neonate, birthwt >2499g w resp dist synd/oth maj resp cond 4.0335 7 $97,391
636 1 Neonate birthwt >2499g w congenital/perinatal infection 0.9874 6 $74,783
636 2 Neonate birthwt >2499g w congenital/perinatal infection 1.3400 6 $74,783
636 3 Neonate birthwt >2499g w congenital/perinatal infection 2.0571 6 $74,783
636 4 Neonate birthwt >2499g w congenital/perinatal infection 2.6817 6 $74,783
639 1 Neonate birthwt >2499g w other significant condition 0.5157 5 $46,792
639 2 Neonate birthwt >2499g w other significant condition 1.2966 5 $46,792
639 3 Neonate birthwt >2499g w other significant condition 1.8637 5 $46,792
639 4 Neonate birthwt >2499g w other significant condition 3.8343 5 $46,792
640 1 Neonate birthwt >2499g, normal newborn or neonate w other problem 0.1749 2 $10,159
640 2 Neonate birthwt >2499g, normal newborn or neonate w other problem 0.2430 2 $10,159
640 3 Neonate birthwt >2499g, normal newborn or neonate w other problem 0.5401 2 $10,159
640 4 Neonate birthwt >2499g, normal newborn or neonate w other problem 0.5407 2 $10,159
650 1 Splenectomy 1.2993 6 $80,455
650 2 Splenectomy 1.9844 6 $80,455
650 3 Splenectomy 2.3913 6 $80,455
650 4 Splenectomy 5.7030 6 $80,455
651 1 Other procedures of blood & blood‐forming organs 1.0413 5 $65,617
651 2 Other procedures of blood & blood‐forming organs 1.3809 5 $65,617
651 3 Other procedures of blood & blood‐forming organs 2.6071 5 $65,617
651 4 Other procedures of blood & blood‐forming organs 3.7719 5 $65,617
20 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
660 1 Major hematologic/immunologic diag exc sickle cell crisis & coagul 0.6973 5 $69,367
660 2 Major hematologic/immunologic diag exc sickle cell crisis & coagul 0.8999 5 $69,367
660 3 Major hematologic/immunologic diag exc sickle cell crisis & coagul 1.5217 5 $69,367
660 4 Major hematologic/immunologic diag exc sickle cell crisis & coagul 4.9780 5 $69,367
661 1 Coagulation & platelet disorders 1.0096 4 $80,769
661 2 Coagulation & platelet disorders 1.1858 4 $80,769
661 3 Coagulation & platelet disorders 1.9558 4 $80,769
661 4 Coagulation & platelet disorders 4.5661 4 $80,769
662 1 Sickle cell anemia crisis 0.6688 5 $58,177
662 2 Sickle cell anemia crisis 0.9652 5 $58,177
662 3 Sickle cell anemia crisis 1.5407 5 $58,177
662 4 Sickle cell anemia crisis 3.3123 5 $58,177
663 1 Other anemia & disorders of blood & blood‐forming organs 0.5133 3 $37,235
663 2 Other anemia & disorders of blood & blood‐forming organs 0.7046 3 $37,235
663 3 Other anemia & disorders of blood & blood‐forming organs 1.1104 3 $37,235
663 4 Other anemia & disorders of blood & blood‐forming organs 2.3554 3 $37,235
680 1 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms 1.3840 11 $207,423
680 2 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms 2.1817 11 $207,423
680 3 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms 3.8687 11 $207,423
680 4 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms 8.9463 11 $207,423
681 1 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms 0.9482 9 $170,258
681 2 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms 1.5855 9 $170,258
681 3 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms 3.8193 9 $170,258
681 4 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms 8.9712 9 $170,258
690 1 Acute leukemia 1.3367 21 $524,044
690 2 Acute leukemia 2.7187 21 $524,044
690 3 Acute leukemia 6.0629 21 $524,044
690 4 Acute leukemia 8.7531 21 $524,044
691 1 Lymphoma, myeloma & non‐acute leukemia 1.0227 10 $180,260
691 2 Lymphoma, myeloma & non‐acute leukemia 1.4840 10 $180,260
691 3 Lymphoma, myeloma & non‐acute leukemia 2.5127 10 $180,260
691 4 Lymphoma, myeloma & non‐acute leukemia 6.3328 10 $180,260
692 1 Radiotherapy 0.5959 6 $116,945
692 2 Radiotherapy 1.3009 6 $116,945
692 3 Radiotherapy 2.7838 6 $116,945
692 4 Radiotherapy 3.1237 6 $116,945
694 1 Lymphatic & other malignancies & neoplasms of uncertain behavior 0.6227 7 $101,193
694 2 Lymphatic & other malignancies & neoplasms of uncertain behavior 0.9815 7 $101,193
694 3 Lymphatic & other malignancies & neoplasms of uncertain behavior 1.6209 7 $101,193
694 4 Lymphatic & other malignancies & neoplasms of uncertain behavior 3.3814 7 $101,193
695 1 Chemotherapy for acute leukemia # 0.9049 9 $83,031
695 2 Chemotherapy for acute leukemia # 0.9062 9 $83,031
695 3 Chemotherapy for acute leukemia # 2.4380 9 $83,031
695 4 Chemotherapy for acute leukemia # 7.3868 9 $83,031
696 1 Other Chemotherapy # 0.7469 4 $70,127
696 2 Other Chemotherapy # 1.0044 4 $70,127
696 3 Other Chemotherapy # 1.5150 4 $70,127
696 4 Other Chemotherapy # 4.3944 4 $70,127
710 1 Infectious & parasitic diseases including HIV w O.R. procedure 1.0839 15 $223,074
710 2 Infectious & parasitic diseases including HIV w O.R. procedure 1.6661 15 $223,074
710 3 Infectious & parasitic diseases including HIV w O.R. procedure 2.9756 15 $223,074
21 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
710 4 Infectious & parasitic diseases including HIV w O.R. procedure 6.3204 15 $223,074
711 1 Post‐op, post‐trauma, other device infections w O.R. procedure 1.1583 9 $117,318
711 2 Post‐op, post‐trauma, other device infections w O.R. procedure 1.5845 9 $117,318
711 3 Post‐op, post‐trauma, other device infections w O.R. procedure 2.8749 9 $117,318
711 4 Post‐op, post‐trauma, other device infections w O.R. procedure 6.0359 9 $117,318
720 1 Septicemia & disseminated infections 0.6044 7 $91,619
720 2 Septicemia & disseminated infections 0.8337 7 $91,619
720 3 Septicemia & disseminated infections 1.4880 7 $91,619
720 4 Septicemia & disseminated infections 3.2003 7 $91,619
721 1 Post‐operative, post‐traumatic, other device infections 0.6438 6 $65,973
721 2 Post‐operative, post‐traumatic, other device infections 0.8465 6 $65,973
721 3 Post‐operative, post‐traumatic, other device infections 1.4316 6 $65,973
721 4 Post‐operative, post‐traumatic, other device infections 2.8310 6 $65,973
722 1 Fever 0.5134 3 $30,062
722 2 Fever 0.5849 3 $30,062
722 3 Fever 0.8490 3 $30,062
722 4 Fever 1.7920 3 $30,062
723 1 Viral illness 0.4598 3 $30,606
723 2 Viral illness 0.5554 3 $30,606
723 3 Viral illness 0.8544 3 $30,606
723 4 Viral illness 2.6877 3 $30,606
724 1 Other infectious & parasitic diseases 0.6461 5 $54,014
724 2 Other infectious & parasitic diseases 0.7672 5 $54,014
724 3 Other infectious & parasitic diseases 1.3629 5 $54,014
724 4 Other infectious & parasitic diseases 3.6206 5 $54,014
740 1 Mental illness diagnosis w O.R. procedure 3.0260 14 $45,005
740 2 Mental illness diagnosis w O.R. procedure 3.0260 14 $45,005
740 3 Mental illness diagnosis w O.R. procedure 3.0260 14 $45,005
740 4 Mental illness diagnosis w O.R. procedure 3.0260 14 $45,005
750 1 Schizophrenia 1.4866 12 $102,779
750 2 Schizophrenia 1.7327 12 $102,779
750 3 Schizophrenia 2.1705 12 $102,779
750 4 Schizophrenia 2.9049 12 $102,779
751 1 Major depressive disorders & other/unspecified psychoses 0.8581 7 $58,876
751 2 Major depressive disorders & other/unspecified psychoses 1.0562 7 $58,876
751 3 Major depressive disorders & other/unspecified psychoses 1.7952 7 $58,876
751 4 Major depressive disorders & other/unspecified psychoses 2.3080 7 $58,876
752 1 Disorders of personality & impulse control 0.9482 5 $147,625
752 2 Disorders of personality & impulse control 0.9482 5 $147,625
752 3 Disorders of personality & impulse control 0.9482 5 $147,625
752 4 Disorders of personality & impulse control 0.9482 5 $147,625
753 1 Bipolar disorders 0.8284 6 $64,804
753 2 Bipolar disorders 1.0264 6 $64,804
753 3 Bipolar disorders 1.6490 6 $64,804
753 4 Bipolar disorders 1.7746 6 $64,804
754 1 Depression except major depressive disorder 0.6929 4 $21,794
754 2 Depression except major depressive disorder 0.6929 4 $21,794
754 3 Depression except major depressive disorder 0.8522 4 $21,794
754 4 Depression except major depressive disorder 0.8522 4 $21,794
755 1 Adjustment disorders & neuroses except depressive diagnoses 0.5103 3 $31,892
755 2 Adjustment disorders & neuroses except depressive diagnoses 0.8067 3 $31,892
22 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
755 3 Adjustment disorders & neuroses except depressive diagnoses 0.8067 3 $31,892
755 4 Adjustment disorders & neuroses except depressive diagnoses 0.8067 3 $31,892
756 1 Acute anxiety & delirium states 0.4561 2 $21,824
756 2 Acute anxiety & delirium states 0.5899 2 $21,824
756 3 Acute anxiety & delirium states 0.8952 2 $21,824
756 4 Acute anxiety & delirium states 0.8980 2 $21,824
757 1 Organic mental health disturbances 0.8069 5 $26,352
757 2 Organic mental health disturbances 0.8069 5 $26,352
757 3 Organic mental health disturbances 0.9637 5 $26,352
757 4 Organic mental health disturbances 0.9637 5 $26,352
758 1 Behavioral disorders 0.5380 5 $45,049
758 2 Behavioral disorders 1.1309 5 $45,049
758 3 Behavioral disorders 1.1309 5 $45,049
758 4 Behavioral disorders 1.1309 5 $45,049
759 1 Eating disorders 1.2963 10 $71,296
759 2 Eating disorders 1.2963 10 $71,296
759 3 Eating disorders 2.1156 10 $71,296
759 4 Eating disorders 2.1156 10 $71,296
760 1 Other mental health disorders 0.5519 4 $31,356
760 2 Other mental health disorders 0.8133 4 $31,356
760 3 Other mental health disorders 0.8495 4 $31,356
760 4 Other mental health disorders 0.8495 4 $31,356
770 1 Drug & alcohol abuse or dependence, left against medical advice 0.2990 2 $15,672
770 2 Drug & alcohol abuse or dependence, left against medical advice 0.3790 2 $15,672
770 3 Drug & alcohol abuse or dependence, left against medical advice 0.7868 2 $15,672
770 4 Drug & alcohol abuse or dependence, left against medical advice 0.8937 2 $15,672
772 1 Alcohol & drug dependence w rehab or rehab/detox therapy 0.9901 22 $36,295
772 2 Alcohol & drug dependence w rehab or rehab/detox therapy 0.9901 22 $36,295
772 3 Alcohol & drug dependence w rehab or rehab/detox therapy 0.9901 22 $36,295
772 4 Alcohol & drug dependence w rehab or rehab/detox therapy 1.0904 22 $36,295
773 1 Opioid abuse & dependence 0.3664 4 $36,314
773 2 Opioid abuse & dependence 0.4985 4 $36,314
773 3 Opioid abuse & dependence 1.1327 4 $36,314
773 4 Opioid abuse & dependence 1.3002 4 $36,314
774 1 Cocaine abuse & dependence 0.4956 4 $32,678
774 2 Cocaine abuse & dependence 0.5006 4 $32,678
774 3 Cocaine abuse & dependence 0.8087 4 $32,678
774 4 Cocaine abuse & dependence 1.0099 4 $32,678
775 1 Alcohol abuse & dependence 0.4563 4 $37,220
775 2 Alcohol abuse & dependence 0.6501 4 $37,220
775 3 Alcohol abuse & dependence 1.2324 4 $37,220
775 4 Alcohol abuse & dependence 3.9193 4 $37,220
776 1 Other drug abuse & dependence 0.5230 4 $27,490
776 2 Other drug abuse & dependence 0.5535 4 $27,490
776 3 Other drug abuse & dependence 0.6202 4 $27,490
776 4 Other drug abuse & dependence 0.6202 4 $27,490
791 1 O.R. procedure for other complications of treatment 0.8480 6 $95,102
791 2 O.R. procedure for other complications of treatment 1.4233 6 $95,102
791 3 O.R. procedure for other complications of treatment 2.6741 6 $95,102
791 4 O.R. procedure for other complications of treatment 6.6107 6 $95,102
811 1 Allergic reactions 0.3390 2 $29,304
23 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
811 2 Allergic reactions 0.4720 2 $29,304
811 3 Allergic reactions 1.0474 2 $29,304
811 4 Allergic reactions 2.3612 2 $29,304
812 1 Poisoning of medicinal agents 0.4095 3 $37,611
812 2 Poisoning of medicinal agents 0.5423 3 $37,611
812 3 Poisoning of medicinal agents 0.9200 3 $37,611
812 4 Poisoning of medicinal agents 2.1864 3 $37,611
813 1 Other complications of treatment 0.4975 3 $42,745
813 2 Other complications of treatment 0.6871 3 $42,745
813 3 Other complications of treatment 1.1381 3 $42,745
813 4 Other complications of treatment 2.6136 3 $42,745
815 1 Other injury, poisoning & toxic effect diagnoses 0.3613 3 $40,952
815 2 Other injury, poisoning & toxic effect diagnoses 0.6180 3 $40,952
815 3 Other injury, poisoning & toxic effect diagnoses 1.0546 3 $40,952
815 4 Other injury, poisoning & toxic effect diagnoses 2.7045 3 $40,952
816 1 Toxic effects of non‐medicinal substances 0.4480 3 $46,808
816 2 Toxic effects of non‐medicinal substances 0.5664 3 $46,808
816 3 Toxic effects of non‐medicinal substances 0.8811 3 $46,808
816 4 Toxic effects of non‐medicinal substances 2.0940 3 $46,808
841 1 Extensive 3rd degree burns w skin graft 5.3668 45 $815,677
841 2 Extensive 3rd degree burns w skin graft 7.0819 45 $815,677
841 3 Extensive 3rd degree burns w skin graft 14.6429 45 $815,677
841 4 Extensive 3rd degree burns w skin graft 18.7384 45 $815,677
842 1 Burns with skin graft except extensive 3rd degree burns 2.1552 13 $211,732
842 2 Burns with skin graft except extensive 3rd degree burns 2.8344 13 $211,732
842 3 Burns with skin graft except extensive 3rd degree burns 4.3635 13 $211,732
842 4 Burns with skin graft except extensive 3rd degree burns 8.6377 13 $211,732
843 1 Extensive 3rd degree or full thickness burns w/o skin graft 1.9714 5 $98,430
843 2 Extensive 3rd degree or full thickness burns w/o skin graft 1.9714 5 $98,430
843 3 Extensive 3rd degree or full thickness burns w/o skin graft 1.9714 5 $98,430
843 4 Extensive 3rd degree or full thickness burns w/o skin graft 1.9714 5 $98,430
844 1 Partial thickness burns without skin graft 0.6493 4 $68,509
844 2 Partial thickness burns without skin graft 1.0636 4 $68,509
844 3 Partial thickness burns without skin graft 1.8821 4 $68,509
844 4 Partial thickness burns without skin graft 5.0797 4 $68,509
850 1 Procedure w diag of rehab, aftercare or oth contact w health service 1.1611 5 $117,263
850 2 Procedure w diag of rehab, aftercare or oth contact w health service 1.6578 5 $117,263
850 3 Procedure w diag of rehab, aftercare or oth contact w health service 3.2373 5 $117,263
850 4 Procedure w diag of rehab, aftercare or oth contact w health service 7.6267 5 $117,263
860 1 Rehabilitation 1.5323 16 $64,093
860 2 Rehabilitation 1.7939 16 $64,093
860 3 Rehabilitation 2.3722 16 $64,093
860 4 Rehabilitation 2.3722 16 $64,093
861 1 Signs, symptoms & other factors influencing health status 0.4502 3 $37,846
861 2 Signs, symptoms & other factors influencing health status 0.6303 3 $37,846
861 3 Signs, symptoms & other factors influencing health status 1.0578 3 $37,846
861 4 Signs, symptoms & other factors influencing health status 2.0902 3 $37,846
862 1 Other aftercare & convalescence 0.5121 3 $44,425
862 2 Other aftercare & convalescence 0.7336 3 $44,425
862 3 Other aftercare & convalescence 1.2283 3 $44,425
862 4 Other aftercare & convalescence 2.1425 3 $44,425
24 of 25
APR‐
DRG Severity APR‐DRG Description
Service
Intensity
Weight
Average
Length of
Stay
Cost Outlier
Threshold
July 1, 2018 APR‐DRG Service Intensity Weights, Average Length of Stay and High Cost Outlier Thresholds
863 1 Neonatal aftercare 0.9105 17 $124,563
863 2 Neonatal aftercare 2.1892 17 $124,563
863 3 Neonatal aftercare 4.1515 17 $124,563
863 4 Neonatal aftercare 5.2990 17 $124,563
890 1 HIV w multiple major HIV related conditions 1.1135 13 $186,689
890 2 HIV w multiple major HIV related conditions 1.1151 13 $186,689
890 3 HIV w multiple major HIV related conditions 1.9260 13 $186,689
890 4 HIV w multiple major HIV related conditions 3.7865 13 $186,689
892 1 HIV w major HIV related condition 0.7201 6 $84,219
892 2 HIV w major HIV related condition 0.9331 6 $84,219
892 3 HIV w major HIV related condition 1.3095 6 $84,219
892 4 HIV w major HIV related condition 2.3345 6 $84,219
893 1 HIV w multiple significant HIV related conditions 0.7823 6 $83,022
893 2 HIV w multiple significant HIV related conditions 0.9245 6 $83,022
893 3 HIV w multiple significant HIV related conditions 1.4524 6 $83,022
893 4 HIV w multiple significant HIV related conditions 1.4814 6 $83,022
894 1 HIV w one signif HIV cond or w/o signif related cond 0.6138 4 $53,148
894 2 HIV w one signif HIV cond or w/o signif related cond 0.7620 4 $53,148
894 3 HIV w one signif HIV cond or w/o signif related cond 1.1592 4 $53,148
894 4 HIV w one signif HIV cond or w/o signif related cond 1.1592 4 $53,148
910 1 Craniotomy for multiple significant trauma 3.7594 15 $387,457
910 2 Craniotomy for multiple significant trauma 3.7594 15 $387,457
910 3 Craniotomy for multiple significant trauma 3.8771 15 $387,457
910 4 Craniotomy for multiple significant trauma 7.1825 15 $387,457
911 1 Extensive abdominal/thoracic procedures for mult significant trauma 1.8714 13 $323,703
911 2 Extensive abdominal/thoracic procedures for mult significant trauma 1.8714 13 $323,703
911 3 Extensive abdominal/thoracic procedures for mult significant trauma 2.5631 13 $323,703
911 4 Extensive abdominal/thoracic procedures for mult significant trauma 6.4903 13 $323,703
912 1 Musculoskeletal & other procedures for multiple significant trauma 2.3640 13 $279,636
912 2 Musculoskeletal & other procedures for multiple significant trauma 2.3658 13 $279,636
912 3 Musculoskeletal & other procedures for multiple significant trauma 3.9355 13 $279,636
912 4 Musculoskeletal & other procedures for multiple significant trauma 7.5766 13 $279,636
930 1 Multiple significant trauma w/o O.R. procedure 0.8819 6 $82,077
930 2 Multiple significant trauma w/o O.R. procedure 0.8865 6 $82,077
930 3 Multiple significant trauma w/o O.R. procedure 1.5827 6 $82,077
930 4 Multiple significant trauma w/o O.R. procedure 3.6540 6 $82,077
950 1 Extensive procedure unrelated to principal diagnosis 1.3624 12 $238,391
950 2 Extensive procedure unrelated to principal diagnosis 2.1590 12 $238,391
950 3 Extensive procedure unrelated to principal diagnosis 3.9944 12 $238,391
950 4 Extensive procedure unrelated to principal diagnosis 8.1143 12 $238,391
951 1 Moderately extensive procedure unrelated to principal diagnosis 0.9211 8 $118,349
951 2 Moderately extensive procedure unrelated to principal diagnosis 1.3906 8 $118,349
951 3 Moderately extensive procedure unrelated to principal diagnosis 2.7118 8 $118,349
951 4 Moderately extensive procedure unrelated to principal diagnosis 6.2751 8 $118,349
952 1 Nonextensive procedure unrelated to principal diagnosis 0.7849 6 $88,793
952 2 Nonextensive procedure unrelated to principal diagnosis 1.1962 6 $88,793
952 3 Nonextensive procedure unrelated to principal diagnosis 2.4439 6 $88,793
952 4 Nonextensive procedure unrelated to principal diagnosis 5.9316 6 $88,793
25 of 25
