Skip to main content
POST
Calculate Medi-Cal APR-DRG payment

Authorizations

X-API-Key
string
header
required

Body

application/json

Calculate SFY 2025-26 Medi-Cal APR-DRG payment for a known DRG+SOI.

apr_drg
string
required

APR-DRG code, optionally with SOI (e.g. 194 or 194-1)

length_of_stay
number
required
Required range: x >= 0
oshpd_id
string
required

OSHPD hospital ID from the DHCS workbook

Example:

"106010735"

patient_age
number
required
Required range: x >= 0
soi
integer
required

Severity of illness 1-4

Required range: 1 <= x <= 4
total_charges
number
required
Required range: x >= 0
cost_to_charge_ratio
number | null

Override hospital CCR

Required range: x >= 0
designated_nicu
boolean | null

Override hospital NICU designation

discharge_date
string | null
discharge_status_30
boolean
default:false
drg_base_rate
number | null

Override wage-adjusted DRG base rate

Required range: x >= 0
other_health_coverage
number
default:0
Required range: x >= 0
patient_discharge_status_transfer
boolean
default:false
patient_share_of_cost
number
default:0
Required range: x >= 0

Response

SFY 2025-26 DHCS APR-DRG estimate for a known DRG+SOI

allowed_amount
number
required
calculation
MediCalAprDrgCalculationOut · object
required
drg
MediCalAprDrgOut · object
required
fiscal_year
string
required
hospital
MediCalHospitalOut · object
required
payer
string
required
payment_amount
number
required
policy
MediCalAprDrgPolicyOut · object
required
reliability
ReliabilityMetadata · object
required

User-visible reliability metadata attached to API responses.

total_base_payment
number
required
caveats
string[]
discharge_date
string | null