PA v37 DRG SOI DRG Description Weight Stay - Threshold ...

Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 37

Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance

High-Cost Outlier

Low-Cost Outlier

PA v37 Average

Relative Length of

DRG SOI

DRG Description

Weight Stay - Threshold Percentage - Threshold Percentage

001 1 LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

8.9716

6.19

30,000

100%

30,000

20%

001 2 LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

9.6766

7.44

30,000

100%

30,000

20%

001 3 LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

10.1021 10.35

30,000

100%

30,000

20%

001 4 LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

18.5218 21.48

30,000

100%

30,000

20%

002 1 HEART &/OR LUNG TRANSPLANT

10.5866

9.27

30,000

100%

30,000

20%

002 2 HEART &/OR LUNG TRANSPLANT

13.6402 13.02

30,000

100%

30,000

20%

002 3 HEART &/OR LUNG TRANSPLANT

17.7208 16.88

30,000

100%

30,000

20%

002 4 HEART &/OR LUNG TRANSPLANT

24.8663 29.83

30,000

100%

30,000

20%

004 1 TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

7.3623

8.21

30,000

80%

30,000

20%

004 2 TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

9.2021 15.82

30,000

80%

30,000

20%

004 3 TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

11.9984 22.05

30,000

80%

30,000

20%

004 4 TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

16.6139 31.76

30,000

80%

30,000

20%

005 1 TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

6.2270 16.12

30,000

80%

30,000

20%

005 2 TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

6.9190 15.35

30,000

80%

30,000

20%

005 3 TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

8.7041 19.28

30,000

80%

30,000

20%

005 4 TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

11.1643 25.74

30,000

80%

30,000

20%

006 1 PANCREAS TRANSPLANT

9.5796

6.55

30,000

100%

30,000

20%

006 2 PANCREAS TRANSPLANT

9.8249

6.74

30,000

100%

30,000

20%

006 3 PANCREAS TRANSPLANT

10.8382

9.44

30,000

100%

30,000

20%

006 4 PANCREAS TRANSPLANT

15.5592 20.69

30,000

100%

30,000

20%

007 1 ALLOGENEIC BONE MARROW TRANSPLANT

10.1446

1.93

30,000

100%

30,000

20%

007 2 ALLOGENEIC BONE MARROW TRANSPLANT

11.0516 19.65

30,000

100%

30,000

20%

007 3 ALLOGENEIC BONE MARROW TRANSPLANT

15.2355 24.72

30,000

100%

30,000

20%

007 4 ALLOGENEIC BONE MARROW TRANSPLANT

23.6809 34.44

30,000

100%

30,000

20%

008 1 AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY 5.1248

8.58

30,000

100%

30,000

20%

008 2 AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY 6.0815 14.68

30,000

100%

30,000

20%

008 3 AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY 7.9719 17.87

30,000

100%

30,000

20%

008 4 AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY 12.6616 21.81

30,000

100%

30,000

20%

009 1 EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

6.4669

7.00

30,000

80%

30,000

20%

009 2 EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

7.1854

6.71

30,000

80%

30,000

20%

009 3 EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

10.1498 13.95

30,000

80%

30,000

20%

009 4 EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

17.9093 29.91

30,000

80%

30,000

20%

020 1 OPEN CRANIOTOMY FOR TRAUMA

2.5337

4.46

30,000

80%

30,000

20%

020 2 OPEN CRANIOTOMY FOR TRAUMA

3.1084

5.04

30,000

80%

30,000

20%

020 3 OPEN CRANIOTOMY FOR TRAUMA

4.0116

8.30

30,000

80%

30,000

20%

020 4 OPEN CRANIOTOMY FOR TRAUMA

6.6962 15.98

30,000

80%

30,000

20%

021 1 OPEN CRANIOTOMY EXCEPT TRAUMA

2.3626

2.89

30,000

80%

30,000

20%

021 2 OPEN CRANIOTOMY EXCEPT TRAUMA

3.2449

4.29

30,000

80%

30,000

20%

021 3 OPEN CRANIOTOMY EXCEPT TRAUMA

4.7276

8.05

30,000

80%

30,000

20%

021 4 OPEN CRANIOTOMY EXCEPT TRAUMA

7.8816 15.49

30,000

80%

30,000

20%

022 1 VENTRICULAR SHUNT PROCEDURES

1.4668

1.97

30,000

80%

30,000

20%

022 2 VENTRICULAR SHUNT PROCEDURES

1.8003

2.84

30,000

80%

30,000

20%

022 3 VENTRICULAR SHUNT PROCEDURES

2.7800

5.66

30,000

80%

30,000

20%

022 4 VENTRICULAR SHUNT PROCEDURES

7.1251 14.19

30,000

80%

30,000

20%

023 1 SPINAL PROCEDURES

1.7334

2.36

30,000

80%

30,000

20%

023 2 SPINAL PROCEDURES

2.3207

4.21

30,000

80%

30,000

20%

023 3 SPINAL PROCEDURES

4.0465

7.83

30,000

80%

30,000

20%

023 4 SPINAL PROCEDURES

7.1514 16.12

30,000

80%

30,000

20%

024 1 OPEN EXTRACRANIAL VASCULAR PROCEDURES

1.1030

1.27

30,000

80%

30,000

20%

024 2 OPEN EXTRACRANIAL VASCULAR PROCEDURES

1.4294

1.92

30,000

80%

30,000

20%

024 3 OPEN EXTRACRANIAL VASCULAR PROCEDURES

2.5748

5.43

30,000

80%

30,000

20%

024 4 OPEN EXTRACRANIAL VASCULAR PROCEDURES

4.7310 12.39

30,000

80%

30,000

20%

026 1 OTHER NERVOUS SYSTEM & RELATED PROCEDURES

1.6416

1.90

30,000

80%

30,000

20%

026 2 OTHER NERVOUS SYSTEM & RELATED PROCEDURES

2.1760

3.03

30,000

80%

30,000

20%

026 3 OTHER NERVOUS SYSTEM & RELATED PROCEDURES

2.9227

6.04

30,000

80%

30,000

20%

026 4 OTHER NERVOUS SYSTEM & RELATED PROCEDURES

5.5839 13.31

30,000

80%

30,000

20%

027 1 OTHER OPEN CRANIOTOMY

1.8540

2.20

30,000

80%

30,000

20%

027 2 OTHER OPEN CRANIOTOMY

2.3276

3.12

30,000

80%

30,000

20%

027 3 OTHER OPEN CRANIOTOMY

3.2824

5.04

30,000

80%

30,000

20%

027 4 OTHER OPEN CRANIOTOMY

6.9069 11.44

30,000

80%

30,000

20%

029 1 OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

2.0735

1.81

30,000

80%

30,000

20%

029 2 OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

2.3039

3.77

30,000

80%

30,000

20%

029 3 OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

3.1458

6.19

30,000

80%

30,000

20%

Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 37

Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance

High-Cost Outlier

Low-Cost Outlier

PA v37 Average

Relative Length of

DRG SOI

DRG Description

Weight Stay - Threshold Percentage - Threshold Percentage

029 4 OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES

5.4984 10.25

30,000

80%

30,000

20%

030 1 PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

2.1581

1.27

30,000

80%

30,000

20%

030 2 PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

3.0090

2.57

30,000

80%

30,000

20%

030 3 PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

4.5228

5.53

30,000

80%

30,000

20%

030 4 PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES

6.1599

7.62

30,000

80%

30,000

20%

040 1 SPINAL DISORDERS & INJURIES

1.2067

2.66

30,000

80%

30,000

20%

040 2 SPINAL DISORDERS & INJURIES

1.4149

3.48

30,000

80%

30,000

20%

040 3 SPINAL DISORDERS & INJURIES

2.2619

5.43

30,000

80%

30,000

20%

040 4 SPINAL DISORDERS & INJURIES

4.0301 11.33

30,000

80%

30,000

20%

041 1 NERVOUS SYSTEM MALIGNANCY

0.9434

2.16

30,000

80%

30,000

20%

041 2 NERVOUS SYSTEM MALIGNANCY

1.0385

2.80

30,000

80%

30,000

20%

041 3 NERVOUS SYSTEM MALIGNANCY

1.3800

4.19

30,000

80%

30,000

20%

041 4 NERVOUS SYSTEM MALIGNANCY

2.2565

6.19

30,000

80%

30,000

20%

042 1 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

0.7548

3.12

30,000

80%

30,000

20%

042 2 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

0.9140

5.80

30,000

80%

30,000

20%

042 3 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

1.3838

5.80

30,000

80%

30,000

20%

042 4 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS

3.3332

9.98

30,000

80%

30,000

20%

043 1 MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

0.9261

3.00

30,000

80%

30,000

20%

043 2 MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

1.2213

3.84

30,000

80%

30,000

20%

043 3 MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

1.9493

5.43

30,000

80%

30,000

20%

043 4 MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

3.6984 12.14

30,000

80%

30,000

20%

044 1 INTRACRANIAL HEMORRHAGE

0.9164

2.82

30,000

80%

30,000

20%

044 2 INTRACRANIAL HEMORRHAGE

1.1541

3.78

30,000

80%

30,000

20%

044 3 INTRACRANIAL HEMORRHAGE

1.5838

4.95

30,000

80%

30,000

20%

044 4 INTRACRANIAL HEMORRHAGE

2.3659

9.12

30,000

80%

30,000

20%

045 1 CVA & PRECEREBRAL OCCLUSION W INFARCT

0.8270

2.21

30,000

80%

30,000

20%

045 2 CVA & PRECEREBRAL OCCLUSION W INFARCT

1.0478

3.06

30,000

80%

30,000

20%

045 3 CVA & PRECEREBRAL OCCLUSION W INFARCT

1.5273

4.77

30,000

80%

30,000

20%

045 4 CVA & PRECEREBRAL OCCLUSION W INFARCT

2.7081

9.17

30,000

80%

30,000

20%

046 1 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

0.8604

1.87

30,000

80%

30,000

20%

046 2 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

1.0136

2.46

30,000

80%

30,000

20%

046 3 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

1.2899

3.63

30,000

80%

30,000

20%

046 4 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT

2.7487

9.26

30,000

80%

30,000

20%

047 1 TRANSIENT ISCHEMIA

0.7489

1.57

30,000

80%

30,000

20%

047 2 TRANSIENT ISCHEMIA

0.8340

1.97

30,000

80%

30,000

20%

047 3 TRANSIENT ISCHEMIA

1.0808

2.82

30,000

80%

30,000

20%

047 4 TRANSIENT ISCHEMIA

1.9143

5.68

30,000

80%

30,000

20%

048 1 PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

0.7589

2.12

30,000

80%

30,000

20%

048 2 PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

0.8368

2.90

30,000

80%

30,000

20%

048 3 PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

1.1590

3.94

30,000

80%

30,000

20%

048 4 PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS

2.7240

9.31

30,000

80%

30,000

20%

049 1 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

1.3484

4.26

30,000

80%

30,000

20%

049 2 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

2.2179

5.41

30,000

80%

30,000

20%

049 3 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

2.5902

8.31

30,000

80%

30,000

20%

049 4 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

5.0194 13.73

30,000

80%

30,000

20%

050 1 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 0.7690

2.95

30,000

80%

30,000

20%

050 2 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 1.5963

4.37

30,000

80%

30,000

20%

050 3 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 2.6137

7.19

30,000

80%

30,000

20%

050 4 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 5.4386 12.80

30,000

80%

30,000

20%

051 1 VIRAL MENINGITIS

0.4732

2.33

30,000

80%

30,000

20%

051 2 VIRAL MENINGITIS

0.7988

3.20

30,000

80%

30,000

20%

051 3 VIRAL MENINGITIS

1.5663

5.05

30,000

80%

30,000

20%

051 4 VIRAL MENINGITIS

3.2967

9.06

30,000

80%

30,000

20%

052 1 ALTERATION IN CONSCIOUSNESS

0.7049

1.69

30,000

80%

30,000

20%

052 2 ALTERATION IN CONSCIOUSNESS

0.8013

2.43

30,000

80%

30,000

20%

052 3 ALTERATION IN CONSCIOUSNESS

1.0517

3.64

30,000

80%

30,000

20%

052 4 ALTERATION IN CONSCIOUSNESS

2.4265

7.88

30,000

80%

30,000

20%

053 1 SEIZURE

0.6219

1.89

30,000

80%

30,000

20%

053 2 SEIZURE

0.7812

2.25

30,000

80%

30,000

20%

053 3 SEIZURE

1.0551

3.18

30,000

80%

30,000

20%

053 4 SEIZURE

2.7525

6.65

30,000

80%

30,000

20%

054 1 MIGRAINE & OTHER HEADACHES

0.6183

1.95

30,000

80%

30,000

20%

054 2 MIGRAINE & OTHER HEADACHES

0.7510

2.24

30,000

80%

30,000

20%

Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 37

Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance

High-Cost Outlier

Low-Cost Outlier

PA v37 Average

Relative Length of

DRG SOI

DRG Description

Weight Stay - Threshold Percentage - Threshold Percentage

054 3 MIGRAINE & OTHER HEADACHES

0.9826

2.86

30,000

80%

30,000

20%

054 4 MIGRAINE & OTHER HEADACHES

2.1513

4.52

30,000

80%

30,000

20%

055 1 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

0.8110

1.80

30,000

80%

30,000

20%

055 2 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

1.1118

2.70

30,000

80%

30,000

20%

055 3 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

1.6422

4.44

30,000

80%

30,000

20%

055 4 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE

3.3751

9.44

30,000

80%

30,000

20%

056 1 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR N0.O77C9O1MA 1.74

30,000

80%

30,000

20%

056 2 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR N1.O06C5O7MA 2.57

30,000

80%

30,000

20%

056 3 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR N1.O57C6O9MA 4.52

30,000

80%

30,000

20%

056 4 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR N3.O09C0O3MA 10.26

30,000

80%

30,000

20%

057 1 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY,0C.6O3M85A < 1 HR1O.3R1 NO COM30A,000

80%

30,000

20%

057 2 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY,0C.9O6M10A < 1 HR1O.8R2 NO COM30A,000

80%

30,000

20%

057 3 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY,1C.3O8M48A < 1 HR2O.9R7 NO COM30A,000

80%

30,000

20%

057 4 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY,2C.5O1M40A < 1 HR6O.6R9 NO COM30A,000

80%

30,000

20%

058 1 OTHER DISORDERS OF NERVOUS SYSTEM

0.7733

1.97

30,000

80%

30,000

20%

058 2 OTHER DISORDERS OF NERVOUS SYSTEM

0.9543

2.76

30,000

80%

30,000

20%

058 3 OTHER DISORDERS OF NERVOUS SYSTEM

1.3648

3.92

30,000

80%

30,000

20%

058 4 OTHER DISORDERS OF NERVOUS SYSTEM

2.7936

7.88

30,000

80%

30,000

20%

059 1 ANOXIC & OTHER SEVERE BRAIN DAMAGE

0.8042

2.45

30,000

80%

30,000

20%

059 2 ANOXIC & OTHER SEVERE BRAIN DAMAGE

1.0604

2.71

30,000

80%

30,000

20%

059 3 ANOXIC & OTHER SEVERE BRAIN DAMAGE

1.5972

3.81

30,000

80%

30,000

20%

059 4 ANOXIC & OTHER SEVERE BRAIN DAMAGE

2.6069

4.94

30,000

80%

30,000

20%

073 1 ORBIT & EYE PROCEDURES

1.1259

1.75

30,000

80%

30,000

20%

073 2 ORBIT & EYE PROCEDURES

1.5128

2.25

30,000

80%

30,000

20%

073 3 ORBIT & EYE PROCEDURES

2.4966

4.03

30,000

80%

30,000

20%

073 4 ORBIT & EYE PROCEDURES

5.5558 10.13

30,000

80%

30,000

20%

082 1 EYE INFECTIONS & OTHER EYE DISORDERS

0.6201

1.78

30,000

80%

30,000

20%

082 2 EYE INFECTIONS & OTHER EYE DISORDERS

0.8094

2.13

30,000

80%

30,000

20%

082 3 EYE INFECTIONS & OTHER EYE DISORDERS

1.2508

3.15

30,000

80%

30,000

20%

082 4 EYE INFECTIONS & OTHER EYE DISORDERS

3.3803

5.60

30,000

80%

30,000

20%

089 1 MAJOR CRANIAL/FACIAL BONE PROCEDURES

2.0589

1.76

30,000

80%

30,000

20%

089 2 MAJOR CRANIAL/FACIAL BONE PROCEDURES

2.7422

2.92

30,000

80%

30,000

20%

089 3 MAJOR CRANIAL/FACIAL BONE PROCEDURES

4.4057

6.26

30,000

80%

30,000

20%

089 4 MAJOR CRANIAL/FACIAL BONE PROCEDURES

7.6506 12.34

30,000

80%

30,000

20%

091 1 OTHER MAJOR HEAD & NECK PROCEDURES

1.5343

2.26

30,000

80%

30,000

20%

091 2 OTHER MAJOR HEAD & NECK PROCEDURES

2.4781

3.39

30,000

80%

30,000

20%

091 3 OTHER MAJOR HEAD & NECK PROCEDURES

4.3213

7.09

30,000

80%

30,000

20%

091 4 OTHER MAJOR HEAD & NECK PROCEDURES

8.2216 12.78

30,000

80%

30,000

20%

092 1 FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURE1S.3976

1.63

30,000

80%

30,000

20%

092 2 FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURE1S.9906

2.22

30,000

80%

30,000

20%

092 3 FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURE3S.4064

3.97

30,000

80%

30,000

20%

092 4 FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURE7S.5237 10.94

30,000

80%

30,000

20%

095 1 CLEFT LIP & PALATE REPAIR

0.9696

1.33

30,000

80%

30,000

20%

095 2 CLEFT LIP & PALATE REPAIR

1.1367

1.65

30,000

80%

30,000

20%

095 3 CLEFT LIP & PALATE REPAIR

1.8820

2.53

30,000

80%

30,000

20%

095 4 CLEFT LIP & PALATE REPAIR

4.2161

5.71

30,000

80%

30,000

20%

097 1 TONSIL & ADENOID PROCEDURES

0.6684

1.39

30,000

80%

30,000

20%

097 2 TONSIL & ADENOID PROCEDURES

0.9580

2.04

30,000

80%

30,000

20%

097 3 TONSIL & ADENOID PROCEDURES

1.6735

3.22

30,000

80%

30,000

20%

097 4 TONSIL & ADENOID PROCEDURES

4.0790

9.76

30,000

80%

30,000

20%

098 1 OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

1.1401

1.68

30,000

80%

30,000

20%

098 2 OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

1.5310

2.33

30,000

80%

30,000

20%

098 3 OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

2.6526

4.54

30,000

80%

30,000

20%

098 4 OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES

5.0020 10.37

30,000

80%

30,000

20%

110 1 EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

0.9990

1.88

30,000

80%

30,000

20%

110 2 EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

1.1373

2.95

30,000

80%

30,000

20%

110 3 EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

1.6219

5.08

30,000

80%

30,000

20%

110 4 EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES

2.7540

9.21

30,000

80%

30,000

20%

111 1 VERTIGO & OTHER LABYRINTH DISORDERS

0.6851

1.65

30,000

80%

30,000

20%

111 2 VERTIGO & OTHER LABYRINTH DISORDERS

0.7462

1.99

30,000

80%

30,000

20%

111 3 VERTIGO & OTHER LABYRINTH DISORDERS

0.9505

2.67

30,000

80%

30,000

20%

111 4 VERTIGO & OTHER LABYRINTH DISORDERS

1.5294

5.88

30,000

80%

30,000

20%

113 1 INFECTIONS OF UPPER RESPIRATORY TRACT

0.4046

1.61

30,000

80%

30,000

20%

Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 37

Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance

High-Cost Outlier

Low-Cost Outlier

PA v37 Average

Relative Length of

DRG SOI

DRG Description

Weight Stay - Threshold Percentage - Threshold Percentage

113 2 INFECTIONS OF UPPER RESPIRATORY TRACT

0.5921

2.14

30,000

80%

30,000

20%

113 3 INFECTIONS OF UPPER RESPIRATORY TRACT

0.9532

3.10

30,000

80%

30,000

20%

113 4 INFECTIONS OF UPPER RESPIRATORY TRACT

1.9923

4.77

30,000

80%

30,000

20%

114 1 DENTAL DISEASES & DISORDERS

0.5119

1.82

30,000

80%

30,000

20%

114 2 DENTAL DISEASES & DISORDERS

0.7215

2.31

30,000

80%

30,000

20%

114 3 DENTAL DISEASES & DISORDERS

1.2426

4.14

30,000

80%

30,000

20%

114 4 DENTAL DISEASES & DISORDERS

2.9015

8.02

30,000

80%

30,000

20%

115 1 OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

0.5863

1.81

30,000

80%

30,000

20%

115 2 OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

0.8128

2.22

30,000

80%

30,000

20%

115 3 OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

1.3034

3.46

30,000

80%

30,000

20%

115 4 OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES

2.6677

6.29

30,000

80%

30,000

20%

120 1 MAJOR RESPIRATORY & CHEST PROCEDURES

2.0818

4.00

30,000

80%

30,000

20%

120 2 MAJOR RESPIRATORY & CHEST PROCEDURES

2.5481

5.70

30,000

80%

30,000

20%

120 3 MAJOR RESPIRATORY & CHEST PROCEDURES

3.8838

9.39

30,000

80%

30,000

20%

120 4 MAJOR RESPIRATORY & CHEST PROCEDURES

7.2780 15.71

30,000

80%

30,000

20%

121 1 OTHER RESPIRATORY & CHEST PROCEDURES

1.5554

2.50

30,000

80%

30,000

20%

121 2 OTHER RESPIRATORY & CHEST PROCEDURES

1.9860

4.06

30,000

80%

30,000

20%

121 3 OTHER RESPIRATORY & CHEST PROCEDURES

3.1538

7.46

30,000

80%

30,000

20%

121 4 OTHER RESPIRATORY & CHEST PROCEDURES

5.8018 14.12

30,000

80%

30,000

20%

130 1 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

3.6651

9.58

30,000

80%

30,000

20%

130 2 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

4.0784

9.92

30,000

80%

30,000

20%

130 3 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

4.9768 11.79

30,000

80%

30,000

20%

130 4 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS

6.5737 15.30

30,000

80%

30,000

20%

131 1 CYSTIC FIBROSIS - PULMONARY DISEASE

1.5443

5.12

30,000

80%

30,000

20%

131 2 CYSTIC FIBROSIS - PULMONARY DISEASE

2.2847

6.43

30,000

80%

30,000

20%

131 3 CYSTIC FIBROSIS - PULMONARY DISEASE

3.0683

8.26

30,000

80%

30,000

20%

131 4 CYSTIC FIBROSIS - PULMONARY DISEASE

4.5306 10.56

30,000

80%

30,000

20%

132 1 BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD 0.5578

2.49

30,000

80%

30,000

20%

132 2 BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD 0.7937

2.77

30,000

80%

30,000

20%

132 3 BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD 1.4288

3.54

30,000

80%

30,000

20%

132 4 BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD 2.3791

4.15

30,000

80%

30,000

20%

133 1 RESPIRATORY FAILURE

0.5253

1.72

30,000

80%

30,000

20%

133 2 RESPIRATORY FAILURE

0.8748

3.21

30,000

80%

30,000

20%

133 3 RESPIRATORY FAILURE

1.2937

4.36

30,000

80%

30,000

20%

133 4 RESPIRATORY FAILURE

2.1809

6.20

30,000

80%

30,000

20%

134 1 PULMONARY EMBOLISM

0.7101

2.77

30,000

80%

30,000

20%

134 2 PULMONARY EMBOLISM

0.9388

3.53

30,000

80%

30,000

20%

134 3 PULMONARY EMBOLISM

1.3376

5.04

30,000

80%

30,000

20%

134 4 PULMONARY EMBOLISM

2.0009

7.84

30,000

80%

30,000

20%

135 1 MAJOR CHEST & RESPIRATORY TRAUMA

0.8774

2.25

30,000

80%

30,000

20%

135 2 MAJOR CHEST & RESPIRATORY TRAUMA

0.9440

2.86

30,000

80%

30,000

20%

135 3 MAJOR CHEST & RESPIRATORY TRAUMA

1.4109

4.46

30,000

80%

30,000

20%

135 4 MAJOR CHEST & RESPIRATORY TRAUMA

2.4555

7.03

30,000

80%

30,000

20%

136 1 RESPIRATORY MALIGNANCY

1.0261

2.46

30,000

80%

30,000

20%

136 2 RESPIRATORY MALIGNANCY

1.1274

3.23

30,000

80%

30,000

20%

136 3 RESPIRATORY MALIGNANCY

1.5416

4.98

30,000

80%

30,000

20%

136 4 RESPIRATORY MALIGNANCY

2.2480

7.74

30,000

80%

30,000

20%

137 1 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

0.7589

3.19

30,000

80%

30,000

20%

137 2 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

0.9700

4.13

30,000

80%

30,000

20%

137 3 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

1.3912

5.59

30,000

80%

30,000

20%

137 4 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS

2.0416

8.06

30,000

80%

30,000

20%

138 1 BRONCHIOLITIS & RSV PNEUMONIA

0.4235

1.80

30,000

80%

30,000

20%

138 2 BRONCHIOLITIS & RSV PNEUMONIA

0.6243

2.35

30,000

80%

30,000

20%

138 3 BRONCHIOLITIS & RSV PNEUMONIA

1.1362

3.92

30,000

80%

30,000

20%

138 4 BRONCHIOLITIS & RSV PNEUMONIA

2.4581

7.05

30,000

80%

30,000

20%

139 1 OTHER PNEUMONIA

0.5291

2.33

30,000

80%

30,000

20%

139 2 OTHER PNEUMONIA

0.7323

3.11

30,000

80%

30,000

20%

139 3 OTHER PNEUMONIA

1.0872

4.49

30,000

80%

30,000

20%

139 4 OTHER PNEUMONIA

1.7280

7.28

30,000

80%

30,000

20%

140 1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

0.6148

2.50

30,000

80%

30,000

20%

140 2 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

0.7724

3.04

30,000

80%

30,000

20%

140 3 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

0.9635

3.99

30,000

80%

30,000

20%

140 4 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

1.4966

6.61

30,000

80%

30,000

20%

Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 37

Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance

High-Cost Outlier

Low-Cost Outlier

PA v37 Average

Relative Length of

DRG SOI

DRG Description

Weight Stay - Threshold Percentage - Threshold Percentage

141 1 ASTHMA

0.4732

1.79

30,000

80%

30,000

20%

141 2 ASTHMA

0.6818

2.42

30,000

80%

30,000

20%

141 3 ASTHMA

0.9720

3.29

30,000

80%

30,000

20%

141 4 ASTHMA

1.6976

4.26

30,000

80%

30,000

20%

142 1 INTERSTITIAL & ALVEOLAR LUNG DISEASES

0.7310

2.60

30,000

80%

30,000

20%

142 2 INTERSTITIAL & ALVEOLAR LUNG DISEASES

0.8963

3.28

30,000

80%

30,000

20%

142 3 INTERSTITIAL & ALVEOLAR LUNG DISEASES

1.2475

4.83

30,000

80%

30,000

20%

142 4 INTERSTITIAL & ALVEOLAR LUNG DISEASES

1.9303

8.07

30,000

80%

30,000

20%

143 1 OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNO0.S5E9S36

2.24

30,000

80%

30,000

20%

143 2 OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNO0.S8E4S61

2.74

30,000

80%

30,000

20%

143 3 OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNO1.S2E8S39

4.00

30,000

80%

30,000

20%

143 4 OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNO2.S0E1S49

5.81

30,000

80%

30,000

20%

144 1 RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

0.6234

1.79

30,000

80%

30,000

20%

144 2 RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

0.8149

2.33

30,000

80%

30,000

20%

144 3 RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

1.1870

3.21

30,000

80%

30,000

20%

144 4 RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES

1.9476

4.68

30,000

80%

30,000

20%

145 1 ACUTE BRONCHITIS & RELATED SYMPTOMS

0.5903

1.76

30,000

80%

30,000

20%

145 2 ACUTE BRONCHITIS & RELATED SYMPTOMS

0.7118

2.16

30,000

80%

30,000

20%

145 3 ACUTE BRONCHITIS & RELATED SYMPTOMS

0.9896

2.73

30,000

80%

30,000

20%

145 4 ACUTE BRONCHITIS & RELATED SYMPTOMS

1.7392

3.76

30,000

80%

30,000

20%

160 1 MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

4.2400

3.67

30,000

80%

30,000

20%

160 2 MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

4.9158

4.50

30,000

80%

30,000

20%

160 3 MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

7.0209

7.93

30,000

80%

30,000

20%

160 4 MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

13.8007 15.87

30,000

80%

30,000

20%

161 1 IMPLANTABLE HEART ASSIST SYSTEMS

14.2776

2.29

30,000

80%

30,000

20%

161 2 IMPLANTABLE HEART ASSIST SYSTEMS

14.8278

6.03

30,000

80%

30,000

20%

161 3 IMPLANTABLE HEART ASSIST SYSTEMS

20.5424 12.83

30,000

80%

30,000

20%

161 4 IMPLANTABLE HEART ASSIST SYSTEMS

25.7141 27.95

30,000

80%

30,000

20%

162 1 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

5.3544

6.17

30,000

80%

30,000

20%

162 2 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

5.9046

7.29

30,000

80%

30,000

20%

162 3 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

7.9184 11.09

30,000

80%

30,000

20%

162 4 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX

11.9635 18.57

30,000

80%

30,000

20%

163 1 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

4.3546

5.07

30,000

80%

30,000

20%

163 2 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

4.8182

6.12

30,000

80%

30,000

20%

163 3 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

6.3003

8.66

30,000

80%

30,000

20%

163 4 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX

10.0670 15.32

30,000

80%

30,000

20%

165 1 CORONARY BYPASS W AMI OR COMPLEX PDX

4.0595

6.62

30,000

80%

30,000

20%

165 2 CORONARY BYPASS W AMI OR COMPLEX PDX

4.7003

7.93

30,000

80%

30,000

20%

165 3 CORONARY BYPASS W AMI OR COMPLEX PDX

6.0747 10.10

30,000

80%

30,000

20%

165 4 CORONARY BYPASS W AMI OR COMPLEX PDX

8.8209 15.16

30,000

80%

30,000

20%

166 1 CORONARY BYPASS W/O AMI OR COMPLEX PDX

3.6288

5.33

30,000

80%

30,000

20%

166 2 CORONARY BYPASS W/O AMI OR COMPLEX PDX

4.0109

6.31

30,000

80%

30,000

20%

166 3 CORONARY BYPASS W/O AMI OR COMPLEX PDX

5.0245

8.39

30,000

80%

30,000

20%

166 4 CORONARY BYPASS W/O AMI OR COMPLEX PDX

8.0191 13.43

30,000

80%

30,000

20%

167 1 OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

3.5522

3.60

30,000

80%

30,000

20%

167 2 OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

4.0124

5.00

30,000

80%

30,000

20%

167 3 OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

5.0456

7.29

30,000

80%

30,000

20%

167 4 OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES

9.7509 14.02

30,000

80%

30,000

20%

169 1 MAJOR ABDOMINAL VASCULAR PROCEDURES

2.2316

3.17

30,000

80%

30,000

20%

169 2 MAJOR ABDOMINAL VASCULAR PROCEDURES

2.9335

4.42

30,000

80%

30,000

20%

169 3 MAJOR ABDOMINAL VASCULAR PROCEDURES

4.6508

7.98

30,000

80%

30,000

20%

169 4 MAJOR ABDOMINAL VASCULAR PROCEDURES

7.8875 14.71

30,000

80%

30,000

20%

170 1 PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOC2K.3832

3.16

30,000

80%

30,000

20%

170 2 PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOC2K.6054

3.83

30,000

80%

30,000

20%

170 3 PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOC3K.3616

7.58

30,000

80%

30,000

20%

170 4 PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOC4K.8035 12.45

30,000

80%

30,000

20%

171 1 PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK 1.8540

2.18

30,000

80%

30,000

20%

171 2 PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK 2.1319

3.07

30,000

80%

30,000

20%

171 3 PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK 2.6815

4.95

30,000

80%

30,000

20%

171 4 PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK 4.3355

9.01

30,000

80%

30,000

20%

174 1 PERCUTANEOUS CARDIAC INTERVENTION W AMI

2.1435

2.08

30,000

80%

30,000

20%

174 2 PERCUTANEOUS CARDIAC INTERVENTION W AMI

2.4125

2.53

30,000

80%

30,000

20%

174 3 PERCUTANEOUS CARDIAC INTERVENTION W AMI

3.1082

4.20

30,000

80%

30,000

20%

 ................
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