OFFICE OF MEDICAID POLICY AND PLANNING Relative DRG .
OFFICE OF MEDICAID POLICY AND PLANNINGAPR-DRG Version 36 Implementation Effective 8/1/2020Relative Weights and Average Lengths of -1042-2DescriptionLIVER TRANSPLANT &/OR INTESTINAL TRANSPLANTLIVER TRANSPLANT &/OR INTESTINAL TRANSPLANTLIVER TRANSPLANT &/OR INTESTINAL TRANSPLANTLIVER TRANSPLANT &/OR INTESTINAL TRANSPLANTHEART &/OR LUNG TRANSPLANTHEART &/OR LUNG TRANSPLANTHEART &/OR LUNG TRANSPLANTHEART &/OR LUNG TRANSPLANTTRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURETRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURETRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURETRACHEOSTOMY W MV 96 HOURS W EXTENSIVE PROCEDURETRACHEOSTOMY W MV 96 HOURS W/O EXTENSIVE PROCEDURETRACHEOSTOMY W MV 96 HOURS W/O EXTENSIVE PROCEDURETRACHEOSTOMY W MV 96 HOURS W/O EXTENSIVE PROCEDURETRACHEOSTOMY W MV 96 HOURS W/O EXTENSIVE PROCEDUREPANCREAS TRANSPLANTPANCREAS TRANSPLANTPANCREAS TRANSPLANTPANCREAS TRANSPLANTALLOGENEIC BONE MARROW TRANSPLANTALLOGENEIC BONE MARROW TRANSPLANTALLOGENEIC BONE MARROW TRANSPLANTALLOGENEIC BONE MARROW TRANSPLANTAUTOLOGOUS BONE MARROW TRANSPLANTAUTOLOGOUS BONE MARROW TRANSPLANTAUTOLOGOUS BONE MARROW TRANSPLANTAUTOLOGOUS BONE MARROW TRANSPLANTEXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)HEAD TRAUMA WITH DEEP COMAHEAD TRAUMA WITH DEEP COMAHEAD TRAUMA WITH DEEP COMAHEAD TRAUMA WITH DEEP COMACRANIOTOMY FOR TRAUMACRANIOTOMY FOR TRAUMACRANIOTOMY FOR TRAUMACRANIOTOMY FOR TRAUMACRANIOTOMY EXCEPT FOR TRAUMACRANIOTOMY EXCEPT FOR TRAUMACRANIOTOMY EXCEPT FOR TRAUMACRANIOTOMY EXCEPT FOR TRAUMAVENTRICULAR SHUNT PROCEDURESVENTRICULAR SHUNT PROCEDURESVENTRICULAR SHUNT PROCEDURESVENTRICULAR SHUNT PROCEDURESSPINAL PROCEDURESSPINAL PROCEDURESSPINAL PROCEDURESSPINAL PROCEDURESEXTRACRANIAL VASCULAR PROCEDURESEXTRACRANIAL VASCULAR PROCEDURESEXTRACRANIAL VASCULAR PROCEDURESEXTRACRANIAL VASCULAR PROCEDURESOTHER NERVOUS SYSTEM & RELATED PROCEDURESOTHER NERVOUS SYSTEM & RELATED PROCEDURESOTHER NERVOUS SYSTEM & RELATED PROCEDURESOTHER NERVOUS SYSTEM & RELATED PROCEDURESSPINAL DISORDERS & INJURIESSPINAL DISORDERS & INJURIESSPINAL DISORDERS & INJURIESSPINAL DISORDERS & INJURIESNERVOUS SYSTEM MALIGNANCYNERVOUS SYSTEM MALIGNANCYNERVOUS SYSTEM MALIGNANCYNERVOUS SYSTEM MALIGNANCYDEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSISDEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSISRelative Weights Version Page 1 of 18
E NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSISDEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSISMULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASESMULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASESMULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASESMULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASESINTRACRANIAL HEMORRHAGEINTRACRANIAL HEMORRHAGEINTRACRANIAL HEMORRHAGEINTRACRANIAL HEMORRHAGECVA & PRECEREBRAL OCCLUSION W INFARCTCVA & PRECEREBRAL OCCLUSION W INFARCTCVA & PRECEREBRAL OCCLUSION W INFARCTCVA & PRECEREBRAL OCCLUSION W INFARCTNONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCTNONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCTNONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCTNONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCTTRANSIENT ISCHEMIATRANSIENT ISCHEMIATRANSIENT ISCHEMIATRANSIENT ISCHEMIAPERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERSPERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERSPERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERSPERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERSBACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEMBACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEMBACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEMBACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEMNON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITISNON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITISNON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITISNON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITISVIRAL MENINGITISVIRAL MENINGITISVIRAL MENINGITISVIRAL MENINGITISALTERATION IN CONSCIOUSNESSALTERATION IN CONSCIOUSNESSALTERATION IN CONSCIOUSNESSALTERATION IN CONSCIOUSNESSSEIZURESEIZURESEIZURESEIZUREMIGRAINE & OTHER HEADACHESMIGRAINE & OTHER HEADACHESMIGRAINE & OTHER HEADACHESMIGRAINE & OTHER HEADACHESHEAD TRAUMA W COMA 1 HR OR HEMORRHAGEHEAD TRAUMA W COMA 1 HR OR HEMORRHAGEHEAD TRAUMA W COMA 1 HR OR HEMORRHAGEHEAD TRAUMA W COMA 1 HR OR HEMORRHAGEBRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA 1 HR OR NO COMABRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA 1 HR OR NO COMABRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA 1 HR OR NO COMABRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA 1 HR OR NO COMACONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA 1 HR OR NO COMACONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA 1 HR OR NO COMACONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA 1 HR OR NO COMACONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA 1 HR OR NO COMAOTHER DISORDERS OF NERVOUS SYSTEMOTHER DISORDERS OF NERVOUS SYSTEMOTHER DISORDERS OF NERVOUS SYSTEMOTHER DISORDERS OF NERVOUS SYSTEMANOXIC & OTHER SEVERE BRAIN DAMAGEANOXIC & OTHER SEVERE BRAIN DAMAGEANOXIC & OTHER SEVERE BRAIN DAMAGEANOXIC & OTHER SEVERE BRAIN DAMAGEORBIT AND EYE PROCEDURESORBIT AND EYE PROCEDURESORBIT AND EYE PROCEDURESORBIT AND EYE PROCEDURESEYE INFECTIONS AND OTHER EYE DISORDERSRelative Weights Version .6Page 2 of 18
3-3133-4134-1134-2134-3134-4DescriptionEYE INFECTIONS AND OTHER EYE DISORDERSEYE INFECTIONS AND OTHER EYE DISORDERSEYE INFECTIONS AND OTHER EYE DISORDERSMAJOR CRANIAL/FACIAL BONE PROCEDURESMAJOR CRANIAL/FACIAL BONE PROCEDURESMAJOR CRANIAL/FACIAL BONE PROCEDURESMAJOR CRANIAL/FACIAL BONE PROCEDURESOTHER MAJOR HEAD & NECK PROCEDURESOTHER MAJOR HEAD & NECK PROCEDURESOTHER MAJOR HEAD & NECK PROCEDURESOTHER MAJOR HEAD & NECK PROCEDURESFACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURESFACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURESFACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURESFACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURESCLEFT LIP & PALATE REPAIRCLEFT LIP & PALATE REPAIRCLEFT LIP & PALATE REPAIRCLEFT LIP & PALATE REPAIRTONSIL & ADENOID PROCEDURESTONSIL & ADENOID PROCEDURESTONSIL & ADENOID PROCEDURESTONSIL & ADENOID PROCEDURESOTHER EAR, NOSE, MOUTH & THROAT PROCEDURESOTHER EAR, NOSE, MOUTH & THROAT PROCEDURESOTHER EAR, NOSE, MOUTH & THROAT PROCEDURESOTHER EAR, NOSE, MOUTH & THROAT PROCEDURESEAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIESEAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIESEAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIESEAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIESVERTIGO & OTHER LABYRINTH DISORDERSVERTIGO & OTHER LABYRINTH DISORDERSVERTIGO & OTHER LABYRINTH DISORDERSVERTIGO & OTHER LABYRINTH DISORDERSINFECTIONS OF UPPER RESPIRATORY TRACTINFECTIONS OF UPPER RESPIRATORY TRACTINFECTIONS OF UPPER RESPIRATORY TRACTINFECTIONS OF UPPER RESPIRATORY TRACTDENTAL DISEASES AND DISORDERSDENTAL DISEASES AND DISORDERSDENTAL DISEASES AND DISORDERSDENTAL DISEASES AND DISORDERSOTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSESOTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSESOTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSESOTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSESMAJOR RESPIRATORY & CHEST PROCEDURESMAJOR RESPIRATORY & CHEST PROCEDURESMAJOR RESPIRATORY & CHEST PROCEDURESMAJOR RESPIRATORY & CHEST PROCEDURESOTHER RESPIRATORY & CHEST PROCEDURESOTHER RESPIRATORY & CHEST PROCEDURESOTHER RESPIRATORY & CHEST PROCEDURESOTHER RESPIRATORY & CHEST PROCEDURESRESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURSRESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURSRESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURSRESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURSCYSTIC FIBROSIS - PULMONARY DISEASECYSTIC FIBROSIS - PULMONARY DISEASECYSTIC FIBROSIS - PULMONARY DISEASECYSTIC FIBROSIS - PULMONARY DISEASEBPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIODBPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIODBPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIODBPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIODRESPIRATORY FAILURERESPIRATORY FAILURERESPIRATORY FAILURERESPIRATORY FAILUREPULMONARY EMBOLISMPULMONARY EMBOLISMPULMONARY EMBOLISMPULMONARY EMBOLISMRelative Weights Version .94.05.7Page 3 of 18
7-2167-3167-4169-1169-2169-3DescriptionMAJOR CHEST & RESPIRAZORY TRAUMAMAJOR CHEST & RESPIRATORY TRAUMAMAJOR CHEST & RESPIRATORY TRAUMAMAJOR CHEST & RESPIRATORY TRAUMARESPIRATORY MALIGNANCYRESPIRATORY MALIGNANCYRESPIRATORY MALIGNANCYRESPIRATORY MALIGNANCYMAJOR RESPIRATORY INFECTIONS & INFLAMMATIONSMAJOR RESPIRATORY INFECTIONS & INFLAMMATIONSMAJOR RESPIRATORY INFECTIONS & INFLAMMATIONSMAJOR RESPIRATORY INFECTIONS & INFLAMMATIONSBRONCHIOLITIS & RSV PNEUMONIABRONCHIOLITIS & RSV PNEUMONIABRONCHIOLITIS & RSV PNEUMONIABRONCHIOLITIS & RSV PNEUMONIAOTHER PNEUMONIAOTHER PNEUMONIAOTHER PNEUMONIAOTHER PNEUMONIACHRONIC OBSTRUCTIVE PULMONARY DISEASECHRONIC OBSTRUCTIVE PULMONARY DISEASECHRONIC OBSTRUCTIVE PULMONARY DISEASECHRONIC OBSTRUCTIVE PULMONARY DISEASEASTHMAASTHMAASTHMAASTHMAINTERSTITIAL & ALVEOLAR LUNG DISEASESINTERSTITIAL & ALVEOLAR LUNG DISEASESINTERSTITIAL & ALVEOLAR LUNG DISEASESINTERSTITIAL & ALVEOLAR LUNG DISEASESOTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSESOTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSESOTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSESOTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSESRESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSESRESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSESRESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSESRESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSESACUTE BRONCHITIS AND RELATED SYMPTOMSACUTE BRONCHITIS AND RELATED SYMPTOMSACUTE BRONCHITIS AND RELATED SYMPTOMSACUTE BRONCHITIS AND RELATED SYMPTOMSMAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALYMAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALYMAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALYMAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALYCARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANTCARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANTCARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANTCARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANTCARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDXCARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDXCARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDXCARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDXCARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDXCARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDXCARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDXCARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDXCORONARY BYPASS W AMI OR COMPLEX PDXCORONARY BYPASS W AMI OR COMPLEX PDXCORONARY BYPASS W AMI OR COMPLEX PDXCORONARY BYPASS W AMI OR COMPLEX PDXCORONARY BYPASS W/O AMI OR COMPLEX PDXCORONARY BYPASS W/O AMI OR COMPLEX PDXCORONARY BYPASS W/O AMI OR COMPLEX PDXCORONARY BYPASS W/O AMI OR COMPLEX PDXOTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURESOTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURESOTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURESOTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURESMAJOR ABDOMINAL VASCULAR PROCEDURESMAJOR ABDOMINAL VASCULAR PROCEDURESMAJOR ABDOMINAL VASCULAR PROCEDURESRelative Weights Version 56.3Page 4 of 18
9-1199-2199-3199-4200-1200-2DescriptionMAJOR ABDOMINAL VASCULAR PROCEDURESPERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCKPERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCKPERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCKPERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCKPERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCKPERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCKPERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCKPERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCKPERCUTANEOUS CORONARY INTERVENTION W AMIPERCUTANEOUS CORONARY INTERVENTION W AMIPERCUTANEOUS CORONARY INTERVENTION W AMIPERCUTANEOUS CORONARY INTERVENTION W AMIPERCUTANEOUS CORONARY INTERVENTION W/O AMIPERCUTANEOUS CORONARY INTERVENTION W/O AMIPERCUTANEOUS CORONARY INTERVENTION W/O AMIPERCUTANEOUS CORONARY INTERVENTION W/O AMICARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENTCARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENTCARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENTCARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENTCARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENTCARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENTCARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENTCARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENTOTHER CIRCULATORY SYSTEM PROCEDURESOTHER CIRCULATORY SYSTEM PROCEDURESOTHER CIRCULATORY SYSTEM PROCEDURESOTHER CIRCULATORY SYSTEM PROCEDURESLOWER EXTREMITY ARTERIAL PROCEDURESLOWER EXTREMITY ARTERIAL PROCEDURESLOWER EXTREMITY ARTERIAL PROCEDURESLOWER EXTREMITY ARTERIAL PROCEDURESOTHER PERIPHERAL VASCULAR PROCEDURESOTHER PERIPHERAL VASCULAR PROCEDURESOTHER PERIPHERAL VASCULAR PROCEDURESOTHER PERIPHERAL VASCULAR PROCEDURESACUTE MYOCARDIAL INFARCTIONACUTE MYOCARDIAL INFARCTIONACUTE MYOCARDIAL INFARCTIONACUTE MYOCARDIAL INFARCTIONCARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASECARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASECARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASECARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASECARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONSCARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONSCARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONSCARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONSACUTE & SUBACUTE ENDOCARDITISACUTE & SUBACUTE ENDOCARDITISACUTE & SUBACUTE ENDOCARDITISACUTE & SUBACUTE ENDOCARDITISHEART FAILUREHEART FAILUREHEART FAILUREHEART FAILURECARDIAC ARREST & SHOCKCARDIAC ARREST & SHOCKCARDIAC ARREST & SHOCKCARDIAC ARREST & SHOCKPERIPHERAL & OTHER VASCULAR DISORDERSPERIPHERAL & OTHER VASCULAR DISORDERSPERIPHERAL & OTHER VASCULAR DISORDERSPERIPHERAL & OTHER VASCULAR DISORDERSANGINA PECTORIS & CORONARY ATHEROSCLEROSISANGINA PECTORIS & CORONARY ATHEROSCLEROSISANGINA PECTORIS & CORONARY ATHEROSCLEROSISANGINA PECTORIS & CORONARY NHYPERTENSIONCARDIAC STRUCTURAL & VALVULAR DISORDERSCARDIAC STRUCTURAL & VALVULAR DISORDERSRelative Weights Version e 5 of 18
0-4222-1222-2222-3222-4223-1223-2223-322
007-1 allogeneic bone marrow transplant 11.4151 26.4 007-2 allogeneic bone marrow transplant 11.4151 26.4 . coma 1 hr or no coma 0.7656 2.4 056-4 brain contusion/laceration & complicated skull fx, coma 1 hr or no coma 0.7656 7.0 057-1 concussion, closed skull fx nos,uncomplicated intracranial injury, coma 1 hr or no coma 0.5549 2.3 .
The MAX Medicaid policy issue brief series highlights the essential role MAX data can play in analyzing the Medicaid program. MAX is a set of annual, person-level data files on Medicaid eligibility, service utilization, and payments that are derived from state reporting of Medicaid eligibility and claims data into the Medicaid Statistical Infor-
Name of State Medicaid Agency: Executive Office of Health and Human Services Name of Contact(s) at State Medicaid Agency: Matt Stark E-Mail Address(es) of Contact(s) at State Medicaid Agency: Matt.Stark@ohhs.ri.gov Telephone Number(s) of Contact(s) at State Medicaid Agency: (401) 871-5710 Date of IAPD Submission to CMS: August 17, 2017
COMBATING MEDICAID FRAUD AND ABUSE no way they're going to participate in the Medicaid program," observes Matt Salo, executive director of the National Association of Medicaid Directors.6 Strategies to Combat Fraud and Abuse Fraud and abuse can be committed by both Medicaid providers and patients. But in the project's review of federal
fingerprint-based criminal background checks for high-risk providers in Medicaid, and 2. To describe the remaining challenges to the implementation of criminal background checks in Medicaid. An effective provider enrollment screening process is an important tool for preventing Medicaid fraud. To protect Medicaid against fraudulent and
Managed Care 101 Medicaid, Managed Care, and Children More than 70% of Medicaid beneficiaries are enrolled in private managed care organizations (MCOs) Almost 9 of every 10 children enrolled in Medicaid and CHIP receive health care through a managed care arrangement 39 states rely on MCOs to cover all or some of their Medicaid
The Medicaid card is plastic and has “mihealth” written on it. You will get a regular plastic Medicaid card from the State to use for services you still get through Medicaid. Call Medicaid at (800) 642-3195 if you did not get a plastic Medicaid card or if yo
your level of Medicaid eligibility is, Blue Cross Idaho Medicaid Plus will cover the beneits described in the Medicaid-Covered Beneits section of the Summary of Beneits. If you have questions about your Medicaid eligibility and what beneits you ar
3. In what year did your health plan begin participating in Medicaid programs as a managed care organization (MCO)? 4. How many individuals were enrolled in your Medicaid MCO in all contracts and markets as of December 2020? Please respond to the following items at the parent level. for only the Medicaid product line. 2021 Annual Medicaid MCO .
