Microdyn Update for Ambulatory Payment Classifications (APC) and Diagnostic Related Groups (DRG) – CRs 133841, 133842, 133900
Effective August 23, 2025, we completed the Centers for Medicare & Medicaid Services’ (CMS) quarterly updates in MIHMS. The following CMS documents provide the details of the APC and DRG updates:
July 2025 Integrated Outpatient Code Editor Specs
July 2025 Update of Hospital Outpatient Prospective Payment System (OPPS)
July 2025 Update for DRGs - Logic update to correctly assign DRG 451 when only 1 single-level fusion procedure code is submitted.
Effective July 1, 2025, you can find the updated DRG Weights in MIHMS.
Claims Adjustment
MIHMS denied some claims in error due to the lag time between when CMS made procedure code updates and we updated them in MIHMS. We will adjust the affected claims, and no provider action is needed.
For questions, please contact Tiffany Norton, Provider Relations Specialist.