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<pre>
 
 

Methodology 2018 19  

Casemix Funding for 
South Australian 
Public Hospitals 

 
 

 



 
For Official Use Only-I2-A2   

Published October 2018 by the South Australian Department for Health and Wellbeing  

Funding Models, Finance and Corporate Services, PO Box 287 Rundle Mall 5000 

South Australia, Australia 

 

 

 

 

 

The National Library of Australia Cataloguing-in-Publication entry: 

 Casemix funding for hospitals: Methodology 2018 19 

 

  ISBN 978-1-76083-043-4  

 1. Hospitals - South Australia - Business management.  2. 

 Hospitals - South Australia - Finance.  3. Diagnosis 

 Related Groups - South Australia.  4. Public health - South 

 Australia.  I. South Australia. Department for Health and Wellbeing. Funding Models. 

  

 362.11099423 

 

 

 

 

 

  Copyright Funding Models, Department for Health and Wellbeing, 2018 

 

The Department for Health and Wellbeing owns the copyright of the contents within this folder 
(including  algorithm diagrams).  The information may be reproduced in whole or in part for study and 
training purposes subject to the inclusion of an acknowledgment of the source and no commercial 
usage or resale.  Under copyright law, reproduction for purposes other than those stated above 
requires the written permission of Funding Models, Finance and Corporate Services, Department for 
Health and Wellbeing, PO Box 287, Rundle Mall, SA, 5000. 

.



 
For Official Use Only-I2-A2   

METHODOLOGY 2018 19 

TABLE OF CONTENTS 

 

1  INTRODUCTION ............................................................................................................................. 1 
1.1  Purpose of the document ........................................................................................................ 1 
1.2  Funding principles ................................................................................................................... 1 
1.3  The National ABF System ....................................................................................................... 3 
1.4  Priorities for SA Health Funding Reform ................................................................................. 4 
1.5  Changes to the South Australian Casemix Funding Model for 2018 19 ................................ 5 
1.6  Future developments .............................................................................................................. 5 
1.7  Contacts .................................................................................................................................. 6 

2  SA s PRICING AND FUNDING FRAMEWORK .............................................................................. 7 
2.1  SA Health Casemix funding governance ................................................................................ 7 
2.2  LHN responsibilities ................................................................................................................ 7 

3  ACTIVITY BASED MANAGEMENT PRINCIPLES .......................................................................... 9 
3.1  What is Activity Based Management? .................................................................................... 9 
3.2  ABF management practices .................................................................................................... 9 
3.3  Implications for LHN analysis and reporting ......................................................................... 11 

4  SPECIFIC FUNDING DETAILS ..................................................................................................... 12 
4.1  Activity Payment .................................................................................................................... 12 

4.1.1   Acute Admitted .............................................................................................................. 12 
4.1.2   Sub-Acute and Non Acute ............................................................................................. 14 
4.1.3  Non Admitted Activity - Outpatients .................................................................................. 15 
4.1.4  Emergency Department / Services ................................................................................... 16 

4.2  Teaching Grant...................................................................................................................... 17 
4.2.1  Nursing .............................................................................................................................. 17 
4.2.2  Medical Officers................................................................................................................. 17 
4.2.3  Other Health Professionals ............................................................................................... 18 

4.3  Special Grants ....................................................................................................................... 18 
4.4  Rural Access Grant ............................................................................................................... 18 

5  Section ........................................................................................................................................... 19 
5.1  Section 1: 2018 19 AR-DRG version 9.0 price weights and adjustments ........................... 19 
5.2  Section 2: ICD-10-AM 10th edition Procedure Codes Eligible for Radiotherapy Adjustments
 57 
5.3  Section 3: ICD-10-AM 10th edition Procedure Codes Eligible for Dialysis Adjustment ........ 59 
5.4  Section 4: 2018 19 AN-SNAP v4.0 price weights ................................................................ 60 



 
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5.5  Section 5: Special Grants ...................................................................................................... 65 
5.6  Section 6: Low Volume / Minimum Budget / Grant Funded Hospitals .................................. 67 
5.7  Section 7: Non-Admitted Patients - Tier 2 Clinic v5.0 ........................................................... 68 
5.8  Section 8: List of hospitals by Emergency Classification type .............................................. 72 
5.9  Section 9: Emergency Department   Urgency Related Groups (URG) v1.4 ........................ 75 
5.10  Section 10: Emergency Department   UDG v1.3 ................................................................. 78 
5.11  Section 11: List of hospitals by Peer Group .......................................................................... 79 

 



 
For Official Use Only-I2-A2  1 

1 INTRODUCTION 
This chapter provides an overview of the funding principles and approaches to funding the public 
health system in South Australia, as well as identifying the priorities and developments at a State 
level, taking into account the work that is happening under the national Activity Based Funding (ABF) 
program.   

The terms Activity Based Funding (ABF) and Casemix Funding, in a health context, are 
interchangeable.  They refer to a method of funding hospital services that is primarily based on the 
level of activity undertaken, at an agreed  price .  The services are broken down into work streams 
(e.g. inpatient, emergency department, outpatient, teaching and training), with each having a specific 
taxonomy (classification) that enables activities to be grouped according to clinical need and relative 
costs.  In this document, the term Casemix Funding will primarily be used.  The term Activity Based 
Funding (or ABF) is only used in the context of the national ABF program. 

 

1.1 Purpose of the document 
Casemix Funding is the resource allocation tool used within SA Health to fund public hospitals.  As a 
consequence, its application, the funding levels it determines and the management data it produces 
are of key concern and use to Local Hospital Networks and the Department. 

This document provides guidance regarding the health funding allocations made to public hospitals in 
South Australia.  It incorporates information on the policy setting in which Casemix Funding is applied, 
the technical allocation methodologies used in the Casemix Funding Model and also describes 
Activity Based Management (ABM) approaches that can assist the health system efficiently manage 
services within an ABF environment. 

 

1.2 Funding principles 
Casemix Funding was first introduced into the South Australian public health system in July 1994.  
The Casemix Funding Model has been progressively adapted and updated over the years to reflect 
the changing service profile and models of care delivered by our metropolitan and country public 
hospitals.   

As the primary resource allocation tool for public hospital services, Casemix Funding represents a 
significant portion of the total funding provided to LHNs, as reported in the Table 1.1 below (by work 
stream): 

Table 1.1: Proportion of casemix funded budget by work stream 

Work stream % of budget funded by Casemix 

Acute admitted  57.8% 

ED  10.3% 

Outpatient  14.5% 

Sub-acute, non-acute (include GEM and Palliative Care) 4.2% 

Teaching, training and research  2.6% 

Site Specifics 9.3% 



 
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The health care system is a dynamic and complex array of services.  With increasing patient demand 
and advancements in technology, increased emphasis has been placed on output-based tools (such 
as Casemix) that improve operational efficiency.  In this context, the utilisation of Casemix aims to: 

? Provide equity in the funding of health units. 
? Enable sound business decisions about resource allocation. 
? Analyse the link between the costs of services and patient care. 
? Provide a basis of comparison for activity between health units. 
? Maintain a high level of care while striving for the most efficient and effective use of resources. 
The key components of a Casemix system are summarised in Figure 1.1 below. 

Figure 1.1: Components of a Casemix System 

Product identification 
and classification  

A system of taxonomies that adequately classifies 
care across different care types and settings and to a 
level that allows for variation in complexity and care 
needs. 

Product counting 
 

A system that supports accurate, electronic counting 
of all patient related services, linking clinical and 
accounting feeder systems. 

Product costing 
 

Product level costing with as close to full cost 
absorption as possible yielding a recognised unit cost 
per product type. 

Data management, 
analysis and 
reporting  

Data management, analysis and reporting is a 
supporting element for counting, costing, 
benchmarking whilst supporting flexible local reporting 
requirements 

Funding 
 

A system of activity based funding based on accepted 
activity based costs and classification of products. 

Governance and 
management  

A model of clinical and corporate governance at a 
jurisdictional and regional / local level.  It includes 
activity based management systems and processes. 

 

The primary benefit of Casemix is that it provides incentives to shift the focus of health service funding 
and management towards the delivery of patient services and health outcomes by better aligning SA 
Health resources to LHNs and to patients. 

Casemix is an important tool for health service management.  Sometimes termed  Activity Based 
Management  (ABM), the utilisation of data produced from Casemix activities for a range of 
undertakings beyond hospital funding (e.g. service planning and performance monitoring) and is 
essential in the current economic environment.  This data allows for a richer and more detailed 
analysis of health service throughput and workload, providing a basis for more meaningful 
comparisons of health service activity levels and efficiency through the classification and weighting of 
different patient groups.  As the activities and costs of the health sector grows, the need for and 
reliance on Casemix data also grows.   



 
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1.3 The National ABF System 
On 2 August 2011, the Commonwealth government, together with all state and territory governments, 
signed the National Health Reform Agreement (NHRA).  Under the NHRA, the Australian Government 
and states and territories have joint responsibility for the funding of public hospital services so that the 
increase in health service demand and costs can be met. 

The reforms focus on increased accountability and transparency.  The funding arrangements and 
performance and accountability requirements are the domain of three independent national bodies: 

? Independent Hospital Pricing Authority (IHPA) 
? National Health Funding Body (NHFB) 
? Australian Commission for Safety and Quality in Health Care (ACSQHC). 
Of these, the IHPA s main function is to determine the National Efficient Price (NEP) for public 
hospital services and the National Efficient Cost (NEC) block-funded services.  The IHPA also 
determines the public hospital services that are eligible for an Australian Government funding 
contribution and formulates the standards and requirements for public hospital activity and cost data 
that is provided by Commonwealth and state and territory governments.   

IHPA deploys a range of classifications for pricing components of its funding model as shown in Table 
1.2 below. 

Table 1.2: Current national ABF work streams 

Work stream  Current classification system 

Acute inpatients  AR-DRG V9.0 

Mental Health inpatients AR-DRG V9.0 

Sub-Acute (Rehabilitation, Palliative Care, GEM) AN-SNAP V4.0 

Non Acute (Maintenance Care) AN-SNAP V4.0 

Emergency Department/ Services  URG V1.4 and UDG V1.3 

Outpatients  Tier 2 Clinics V5.0 

Teaching, training and research  Block funded (NEC)  

Community Non-Admitted Services  Tier 2 Clinics V5.0 

Community service obligations (low volume hospitals) National Efficient Cost (NEC) 

 

Under the terms of the NHRA:   

? The Commonwealth will contribute 45 per cent of  efficient  growth in eligible public hospital 
activity and funding in 2018 19, with a national funding cap of 6.5 per cent. 

? Each state, as the system manager of their respective public hospital system, is responsible for 
determining the total level of funding to LHNs.  States are free to decide which, if any, elements 
of the national ABF model they wish to adopt to determine their own funding of LHNs. 

? The Commonwealth s funding of LHNs is based on the concept of a NEP. 



 
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? The NEP is a single figure, set by IHPA in March each year based on the average cost per 
weighted acute separation in Australian public hospitals.  The NEP has two primary functions: 

o It is multiplied by a number of National Weighted Activity Units (NWAUs), which are derived 
from activity volumes and price relativities, to determine Commonwealth funding allocations.  
A NWAU is a weighted measure of health service activity expressed as a common unit, 
against which the NEP is paid.  It provides a way of comparing and valuing each public 
hospital service (whether it is an admission, emergency department presentation or 
outpatient episode), by weighting it for its clinical complexity and relative resource use. 

o The NEP provides a price signal, or benchmark, for the efficient cost of providing public 
hospital services and is intended to drive improvements in service delivery costs. 

There are a range of benefits for states and territories from the National ABF program, beyond the 
funding elements.  These include: 

? Based on national activity and cost data, and with a continuous development program led by 
IHPA, ABF can provide greater precision in overall hospital funding if jurisdictions adopt 
components of the national model in their own local funding model, particularly as these ABF 
components become more robust and improve over time.  

? Access to de-identified patient level costing data from hospitals across Australia provides 
opportunities for national benchmarking that were previously unachievable.  

? The NEP is a benchmark based on robust national data and is now recognised as a key measure 
of hospital efficiency in Australia against which individual hospitals and LHNs can be compared. 

The National ABF continues to be developed by IHPA, with the key development activities scheduled 
for 2018 19 being: 

? Ongoing development of the Australian Mental Health Care classification. 
? The finalisation of a new patient based emergency care classification system. 
? Continued development of a new patient based classification for non admitted services. 
? Refinement of a classification for Teaching Training and Research activities.   
? Continued development of funding / pricing approach for safety and quality, now focusing on 

avoidable hospital readmissions. 

 

1.4 Priorities for SA Health Funding Reform 
The key over-arching objectives of SA Health s funding approach, which includes a state-based 
Casemix funding methodology and a national ABF system for Commonwealth funding, are: 

? Improved efficiency of health service delivery. 
? Better use of resources, ensuring greater value for money and improved financial sustainability 

within quality and safety standards. 

? Increased utilisation of available data on the cost and performance of LHNs to assist with 
management decision-making processes.  This will be achieved by the further adoption of ABM 
principles and processes. 

One of SA Health s key objectives is to appraise the elements of the National ABF System with a view 
to local implementation, where appropriate.  In addition, the Funding Models Unit is actively working 
to provide LHNs with improved patient level costing data, which is stored in a centrally maintained 
patient costing system, with detailed and customised outputs made available to LHNs. 



 
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Casemix funding in itself will not improve patient care, but patient-level costing data, when coupled 
with outcome data (e.g. readmissions, mortality) can provide a basis for monitoring the effectiveness 
and efficiency of care.  Casemix data can facilitate an understanding of variations in work practices 
and the impact on costs and outcomes for patients with similar morbidity profiles. 

 

1.5 Changes to the South Australian Casemix Funding Model for 2018 19 
The Casemix model in 2018-19 has undergone further refinements in line with the National ABF 
System.  Following the appraisal of the National ABF System, SA Health decided to implement the 
remaining components, except for National Efficient Cost model for low volume hospitals. 

The extensive and ongoing development work that is being undertaken by the IHPA under the 
national ABF program provided the opportunity to refresh and improve SA s Casemix funding model.  
As components of the national ABF model benefit from extensive national activity and cost data and 
significant investment in classification development, they have become superior to their equivalent 
components in the state-based Casemix model.  It is sensible for SA to replace components of its 
own model with the equivalent components from the national ABF model.  This process commenced, 
with the adoption of the acute admitted component of the national model in 2014 15. 

Key changes to the model in 2018 19 are summarised below: 

? The funding rate has been reviewed and based on the 2018 19 NEP. 
? All activity is now measured in NWAUs and applying the national weights published by IHPA. 
? Australian Refined Diagnosis Related Groups (AR-DRG) version 9 has been adopted for the 

acute admitted activity.  ICD-10-AM / ACHI / ACS 10th edition, the system used for recording 
diagnoses and procedures will continue to be used. 

? Site-specific grants have been reviewed to determine if they are still necessary to supplement the 
funding allocation derived from actual activity (based on the national price weights).  Grants that 
are considered unnecessary have been discontinued and where possible funded based on 
activity. 

? Hospital Acquired Complication adjustment (note for 2018-19 this has been set to zero). 
In determining whether the price should be set to be equivalent to the 2018 19 NEP ($5,012), the 
following factors were considered: 

? The total funding for health services needed to  fit within  SA Health s overall 2018 19 budget 
allocation. 

? The resultant savings requirements for each LHN. 
The LHN NEP has been set below the NEP to take account of cost in the NEP that relate to services 
managed centrally (e.g. some ICT, workforce, procurement). 

 

1.6 Future developments 
In future financial years, more changes to the SA Casemix funding model may be made as the 
national ABF model is developed further. 

A national ABF model component will only be adopted if it can be clearly demonstrated that it is a 
significant improvement on the local component.  The evaluation of these components will be 



 
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underpinned by modelling and sensitivity analyses to determine the impact of adopting the 
components on LHN funding. 

 

1.7 Contacts 
This manual has been compiled by the Funding Models Unit.  Any requests, comments or 
suggestions are welcome and can be addressed to: 

 

Funding Models 
Finance and Corporate Services 
Email: Health.ABF@sa.gov.au 
 
 
November 2018 
 
Krystyna Parrott 
 
 
 

 

 

  



 
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2 SA s PRICING AND FUNDING FRAMEWORK 
This chapter provides an overview of the existing governance and policy framework with respect to 
Casemix funding.   

 

2.1 SA Health Casemix funding governance 
The Department for Health and Wellbeing has established Service Level Agreements (SLAs) with 
each LHN which set out the parties  mutual understanding of their respective statutory and other legal 
functions and obligations.  The SLAs stipulate that the Department for Health and Wellbeing Chief 
Executive is responsible for being the system manager and single purchaser of public health services 
and functions. 

As identified earlier, Casemix is the primary resource allocation tool within the South Australian public 
health system.  The Casemix funding calculations are undertaken by the Finance and Corporate 
Services Division, as part of the annual budget setting process, taking into account: 

? Agreed activity allocations for each LHN (including counting changes) as set out in the 2018-19 
Purchasing Principles and Priorities.  

? Agreed activity movements and / or service profile changes in accordance with Purchasing 
priorities.  The Purchasing Principles and Priorities will be updated annually to reflect agreed 
state-wide priorities.  Annual purchasing plans developed for each LHN will reflect local projects 
and priorities. 

? Implementation and monitoring of specified savings measures announced in State Budgets.   
? Other funding streams.  Not all the funding allocation is determined through commissioning.  

There are grants for a range of services, like teaching, training and research and site specifics 
that need to be considered within the total funding allocation. 

Casemix funding principles are endorsed by the Department s Purchasing and Performance 
Committee and discussed with LHN Chief Executives and Chief Finance Officers. 

 

2.2 LHN responsibilities 
LHNs have critical responsibilities in respect to Casemix funding that extend to the need to accurately 
classify, count and cost activities.   

In this respect, LHN must place an emphasis on: 

? Counting and reporting the services provided (timely and accurate coding and classification). 
? The accuracy and timeliness of costing services in accordance with Australian Hospital Patient 

Costing Standards. 

? Understanding the relationship between price and cost, in order to make more informed 
decisions on services within the available funding parameters. 

? Managing within their funding allocations and understanding their required level of savings and 
the role of transition grants as LHNs work to reduce costs down to the level that will enable them 
to operate within the NEP. 



 
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Projections of expected activity levels and service profiles are a key input into the commissioning and 
funding process.  Typically, these projections are based on an analysis of historical activity levels.  
Robust processes and systems to accurately count, code and report activity are required by LHN s to 
ensure system-wide activity and resources are appropriately managed. 

Service agreements require LHNs to  ensure appropriate systems and processes are in place to 
enable accurate recording of activity, and provision of data requirements to enable monitoring of 
outcome measures and KPIs and to support the implementation of Activity Based Funding (ABF).  

In practice, this requires LHNs to count activity accurately and promptly, which includes the consistent 
application of data collection definitions and standards.  If activity is not coded accurately and in a 
timely manner, inappropriate decisions may be made about the complexity and service profile, and by 
extension, the appropriate cost and funding profile expected of the site. 

Delays in coding of inpatient encounters and errors in allocating patients to the right classification 
group are largely related to incomplete medical record documentation.  An appropriate level of coding 
resources to optimise coding accuracy and timeliness is an important enabler to good quality Casemix 
data and to ensure funding is commensurate with the level of patient activity. 

Cost data for a patient encounter is made up of a number of components, such as nursing, medical, 
drugs, theatres and allied health costs.  The data is dependent on a number of factors, such as 
coding and financial information as well as being able to link a service to a patient.  The costing 
process needs to be validated and monitored for accuracy and timeliness to ensure the information 
used in the funding process is reliable and consistent with the Australian Hospital Patient Costing 
Standards. 

Good costing provides information for benchmarking against other facilities.  It helps managers 
(clinical and administrative) understand the difference in cost for each service provided, highlighting 
not only potential inefficiencies but also areas of costing inaccuracies or changes in service profile.  
Variations in clinical models of care and treatment protocols can then be assessed in the context of 
cost variations for patients with similar morbidity profiles.  

 

 

  



 
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3 ACTIVITY BASED MANAGEMENT PRINCIPLES 
This document describes the methodology underpinning SA Health s 2018 19 public hospital funding 
model, which is based on Casemix funding principles.  However, it is important to note that Casemix 
is actually a specialised application of Activity Based Management (ABM), tailored to the specific 
needs of hospital funding.  ABM is a broad management and funding methodology which has 
applications across many industries.  This chapter provides an overview of ABM principles, noting its 
particular applications to public hospital funding.   

 

3.1 What is Activity Based Management? 
ABM involves using available information generated as part of the funding process to understand the 
costs and costs drivers in service delivery and to make management decisions to change and 
improve these factors.  ABM is just one hospital management tool that can be integrated into an 
organisation at both a strategic and operational level. 

 

3.2 ABF management practices 
The process of managing under a Casemix funding model requires a high level of understanding of 
activity and costs.  The adoption of ABM principles and processes are becoming more widespread in 
Australia due to the national ABF program and the greater focus it brings on Casemix activities. 

Adopting ABM approaches requires regional executives, managers, directors and executive directors, 
both clinical and corporate, to work collaboratively to understand the LHN s operations. 

The key outputs of an ABM system can be categorised into four key components namely: 

? The activities and associated costs for the range of patient services that are delivered. 
? The cost of non-patient related activities. 
? Activity-based performance measures. 
? The key cost drivers associated with service delivery and models of care. 
An ABM model is depicted in Figure 3.1 below that illustrates the interrelationship between costing 
and the performance management that supports continuous quality improvement  

  



 
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Figure 3.1: The ABM model 

 

LHNs already have systems in place to support planning, organising, resourcing, leading, monitoring 
and improving health services and making best use of limited funds.  However, a fully implemented 
ABM program can provide new opportunities in the management of health services.  These data can 
be used to support a number of management processes: 

? Facilitating a better understanding of costs and cost drivers. 
? Benchmarking. 
? Managing budgets and activity. 
? Comparing costs of services to activity. 
? Developing budgets. 
? Negotiating for funds. 
In this environment, standard practice at LHNs is expected to include: 

? Capturing consistent and detailed information on inpatients, sub-acute, ED, outpatients, mental 
health and community services accurately (at the patient level). 

? Accurately measuring the costs of delivery at the patient level for hospitals to support service 
improvement. 

? Understanding the relationship between funds allocated and services provided. 
? Strengthening health management s focus on outputs, outcomes and quality. 
? Encouraging clinicians and managers to identify drivers for the variations in costs and practices 

so these can be managed at a local level in the context of improving efficiency and effectiveness. 

 



 
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3.3 Implications for LHN analysis and reporting 
It is expected that LHNs will embark on a suite of analysis and reporting to better understand cost and 
activity.  This reporting should be cascaded through the LHN to ensure all managers develop an 
improved understanding of LHN activity and cost performance. 

The patient costing system will provide patient level costing data for all metropolitan public hospitals 
and the larger country public hospitals.  While processing is being undertaken centrally, LHNs are 
responsible for ensuring the resource data required for the system (feeder systems) are as extensive 
as possible and the costing allocation processes are optimised in consultation with the central patient 
costing team. 

Detailed cost analyses can be conducted by specifically trained LHN staff through direct access to SA 
Health s patient costing system, SA Health s LHN Analytics and Reporting System (LARS) or IHPA s 
National Benchmarking Portal (based on the National Health Costing Data Collection).  The analysis 
can be conducted at the patient level and can include the number, type and cost of diagnostic service 
provided, of theatre procedures performed and of drugs supplied and the level of clinical staff costs 
attributed, as well as other goods and services and overhead costs. 

Benchmarking and similar comparative performance analysis, produced from these data will have 
significant relevance for clinicians in terms of:  

? Developing and evaluating models of care and clinical pathways. 
? Monitoring performance indicators. 
? Understanding the drivers of cost associated with multiple modes of service delivery including 

inpatient, sub-acute, emergency, mental health and community health services. 

? Understanding the costs of daily service delivery. 
A wide range of leadership and performance committees established by LHNs would also benefit from 
activity and cost data being presented at monthly forums.  Indicative types of analysis that would 
provide the biggest impact on decision making could include: 

? Cost profile analysis and benchmarking of DRG cost outcomes to peer hospitals and services. 
? Trend analysis of costs overtime. 
? Comparative analysis at a summary and DRG level of costs and funding to identify activities 

where there are discrepancies between funding levels and cost of service delivery. 

 

  



 
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4 SPECIFIC FUNDING DETAILS 
4.1 Activity Payment  
For 2018 19, activity payments will be funded based on the SA LHN NEP is $4,503 per NWAU.  This 
price is based on the 2018 19 NEP of $5,012 and is adjusted to account for the impact of some 
centrally managed services (e.g. some ICT, WorkCover levy, Procurement Services, etc).  

The classification systems, price weights and adjustments used are specified below. These are 
published by IHPA as part of the 2018 19 National Efficient Price (NEP) Determination. 

4.1.1  Acute Admitted 

For 2018 19, SA Health will use Australian Refined Diagnosis Related Groups Version 9.0 (AR-DRG 
v9.0)  

This applies to inpatient admitted acute and mental health activity performed in all hospitals. 

The 2018 19 NEP Determination also includes a number of price weight adjustments that have been 
incorporated into the 2018 19 funding model, as summarised in the following table. 

Name of Adjustment Description Amount Applied 

ICU Adjustment Applies to patients that spend time in 
ICU (WCH, RAH, TQEH, FMC and 
LMH only) and are assigned to a 
DRG where ICU costs are not 
bundled (see Section 5.1). 

0.0439 NWAU per ICU 
Hour 

Indigenous Adjustment Applies to Aboriginal and / or Torres 
Strait Islander patients. 

4 per cent 

Outer Regional 
Adjustment 

Applies to patients with a residential 
address classified as  Outer 
Regional  

8 per cent 

Remote Area Adjustment Applies to patients with a residential 
address classified as  Remote  

25 per cent 

Very Remote Area 
Adjustment 

Applies to patients with a residential 
address classified as  Very Remote  

29 per cent 

Private Patient 
Accommodation 
Adjustment 

Applies to all private patients to 
account for accommodation costs 
borne by the patient. 

0.0516 NWAU (same-day) 
0.0711 NWAU per day 
(overnight) 

Private Patient Service 
Adjustment 

Applies to all private patients to 
account for medical service costs 
borne by the patient. 

Varies by DRG. See 
Appendix 5.1. 

Paediatric Adjustment Applies to patients aged 17 or less 
and treated at a specialised 
paediatric hospital (i.e. WCH only). 

Varies by DRG. See 
Appendix 5.1. 



 
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Name of Adjustment Description Amount Applied 

Specialist Psychiatric Age 
Adjustment (&lt;= 17 years 
AND in MDC 19 or 20) 

Applies to patients aged 17 years or 
less that have one or more 
Psychiatric Days recorded and are 
assigned to an AR-DRG in MCD 19 
or 20. 

41 per cent 
(or 15 per cent at WCH) 

Specialist Psychiatric Age 
Adjustment (&lt;= 17 years 
AND NOT in MDC 19 or 20) 

Applies to patients aged 17 years or 
less that have one or more 
Psychiatric Days recorded and are 
not assigned to an AR-DRG in MCD 
19 or 20. 

71 per cent 
(or 58 per cent at WCH) 

Specialist Psychiatric Age 
Adjustment (&gt;17 years and 
NOT in MDC 19 or 20) 

Applies to patients aged 17 years or 
over that have one or more 
Psychiatric Days recorded and are 
not assigned to an AR-DRG in MCD 
19 or 20. 

30 per cent 

Radiotherapy Adjustment Applies to patients with a specified 
ICD-10-AM 10th Edition radiotherapy 
procedure code recorded (see 
Section 5.2). 

32 per cent 

Dialysis Adjustment Applies to patients with a specified 
ICD-10-AM 10th Edition renal dialysis 
procedure code recorded (see 
Section 5.3) where the patient is 
NOT coded to an AR-DRG of L61Z 
or L68Z. 

27 per cent 

 

Section 5.1 also contains a table that outlines the price weights and associated parameters that apply 
to each DRG, including: 

? The price weights that apply to each DRG, including inlier, short-stay outlier and long-stay outlier 
weights. 

? The short-stay and long-stay outlier trim points. 
? Private patient service adjustment 
? Paediatric adjustment 
Note that admitted mental health patients will be funded as acute patients according to the price 
weights and loadings associated with the DRG to which the patient is assigned.  Further work will be 
undertaken over the medium to longer term to develop appropriate methodologies for the funding of 
mental health services. 

  



 
For Official Use Only-I2-A2  14 

4.1.2  Sub-Acute and Non Acute 

For 2018 19, the SA Health will use Australian National Subacute and Non-Acute Patient (AN-SNAP) 
classification version 4.0. See Section 5.4 

Sub-Acute and Non Acute includes the following episodes of care: 

? Palliative Care  
? Rehabilitation 
? Psychogeriatric Care 
? Geriatric Evaluation and Management (GEM)  
? Maintenance Care 
For Rehabilitation [Refer Technical Bulletin 16 for further information] the Australian Institute of Health 
and Welfare (AIHW) defines it as follows: 

? Rehabilitation care is care in which the primary clinical purpose or treatment goal is improvement 
in the functioning of a patient with an impairment, activity limitation or participation restriction due 
to a health condition. The patient will be capable of actively participating. 

Rehabilitation care is always: 

o delivered under the management of or informed by a clinician with specialised expertise in 
rehabilitation, and 

o evidenced by an individualised multidisciplinary management plan, which is documented in 
the patient s medical record, that includes negotiated goals within specified time frames and 
formal assessment of functional ability. 

For sub-acute and non- acute activity that cannot be classified using AN-SNAP or for rehabilitation 
performed in another hospital (not listed above) will be funded as acute patients according to the price 
weights and loadings associated with the DRG to which the patient is assigned 

The 2018 19 NEP Determination also includes a number of price weight adjustments for sub-acute 
and non-acute activity that have been incorporated into the 2018 19 funding model, as summarised 
in the following table. 

Name of Adjustment Description Amount Applied 

Indigenous Adjustment Applies to Aboriginal and / or 
Torres Strait Islander patients. 

4 per cent 

Outer Regional 
Adjustment 

Applies to patients with a residential 
address classified as  Outer 
Regional  

8 per cent 

Remote Area Adjustment Applies to patients with a residential 
address classified as  Remote  

25 per cent 

Very Remote Area 
Adjustment 

Applies to patients with a residential 
address classified as  Very Remote  

29 per cent 

Private Patient 
Accommodation 
Adjustment 

Applies to all private patients to 
account for accommodation costs 
borne by the patient. 

0.0516 NWAU (same-day) 
0.0711 NWAU per day 
(overnight) 



 
For Official Use Only-I2-A2  15 

Name of Adjustment Description Amount Applied 

Private Patient Service 
Adjustment 

Applies to all private patients to 
account for medical service costs 
borne by the patient. 

Palliative Care 3.9% 
Rehabilitation 4.0% 
Psychogeriatric Care 3.7% 
GEM 3.3% 
Maintenance Care 1.5% 

 

Section 5.4 contains a table that outlines the price weights and associated parameters that apply to 
each AN-SNAP, including: 

? The price weights that apply to each AN-SNAP including inlier, short-stay outlier and long-stay 
outlier weights. 

? The short-stay and long-stay outlier trim points. 
For WCH paediatric palliative care patients the following per diem rate is applied that is applied to the 
length of stay to determine the number of NWAUs. 

Care Type Same Day Overnight 

Palliative Care 0.6014 0.6014 

 

Maintenance care will also apply to those patients who cannot be formally classified as maintenance 
care patients due to the Commonwealth 35 day rule but have been assessed by ACAT teams as 
requiring such services and are admitted to a public acute hospital. 

Where an acute episode occurs during a maintenance care episode the classification can be changed 
to an acute episode and the relevant AR-DRG payment will apply. 

4.1.3 Non Admitted Activity - Outpatients 

 [Refer Technical Bulletin 23 for further information] 

For 2018 19, the SA Health will use Tier 2 Non-Admitted Service Classification v5.0 to fund all non-
admitted activity performed in by all hospitals.  See Section 5.7 

The 2018 19 NEP Determination also includes the following price weight adjustment that has been 
incorporated into the 2018 19 funding model, as summarised below. 

Name of Adjustment Description Amount Applied 

Multidisciplinary Clinic Applies to service events 
where three or more health 
providers ( each of a different 
speciality) are present 

55 per cent 

 

Section 5.7 contains a table that outlines the price weights that apply to each Tier 2 Clinic, 

As per IHPA s definitions non admitted services provided in the home (Tier 2 clinics, 10.15, 10.16, 
10.17 and 10.18) are counted and funded on a per calendar month basis. 

Tier 2 Clinic 10.19 Ventilation  home delivered is now being block funded. 



 
For Official Use Only-I2-A2  16 

SA has expanded the endoscopy clinic and created a 10.80 series for reporting purposes which will 
map to Tier 2 clinics 10.06 or 10.09 for funding purposes.  

In addition SA has added the 10.90 series clinics for Home Oxygen, which is not in scope in the 
national model and the weights used, are based on the 2015 16 funding rates. 

Based on SA hospitals cost data it was determined that there is sufficient cost differential between 
peer groups that warranted a peer group adjustment to be applied.  SA has included the following 
peer group adjustment that is to be applied to non-admitted service events. 

Peer Group Amount Applied 

Metro - WCH 0.7756 

Metro - Large 1.1903 

Metro - Other 0.8235 

Country - Large 0.4147 

Country - Other 0.3312 

Refer Section 5.11 for list of hospitals by Peer Group 

4.1.4 Emergency Department / Services 

For 2018 19, the SA Health will use Urgency Related Groups (URG) classification version 1.4 and 
Urgency Diagnostic Groups (UDG) classification version 1.3 to fund all emergency activity performed 
in hospitals classified as having an Emergency Department or Emergency Services respectively. 

Section 5.8 provides the list of hospitals by emergency classification type. 

The 2018 19 NEP Determination also includes a number of price weight adjustments that have been 
incorporated into the 2018 19 funding model, as summarised in the following table. 

Name of Adjustment Description Amount Applied 

Indigenous Adjustment Applies to Aboriginal and / or Torres 
Strait Islander patients. 

4 per cent 

Remoteness Adjustment Applies to Acute Outer Regional 8 per cent 

Remoteness Adjustment 

 

Applies to Acute Remote  

Applies to ED Remote 

25 per cent 

22 per cent 

Remoteness Adjustment 

 

Applies to Acute Very Remote  

Applies to ED Very Remote 

29 per cent 

22 per cent 

Emergency Age Adjustment   
age 65 to 79 years 

Applies to patients aged between 
65 and 79 years inclusive 

13 per cent 

Emergency Age Adjustment   
age 80+ years 

Applies to patients aged 80 years or 
older 

20 per cent 

 



 
For Official Use Only-I2-A2  17 

Sections 5.9 and 5.10 also contains tables that outline the price weights that apply to each URG and 
UDG respectively. 

If an ED presentation cannot be classified to the URG classification it will default to a UDG where 
possible. 

Based on SA hospitals cost data and National peer group cost data it was determined that there is 
sufficient cost differential between peer groups that warranted a peer group adjustment to be applied.  
SA has included the following peer group adjustment that is to be applied to emergency activity. 

Peer Group Amount Applied 

Metro - WCH 1.0000 

Metro - Large 1.0350 

Metro - Other 0.9650 

Country - Large 0.7562 

Country - Other 0.3203 

Refer Section 5.11 for list of hospitals by Peer Group 

 

4.2 Teaching Grant 
The following outlines the basic framework for funding teaching in recognised teaching hospitals. 

4.2.1 Nursing 

[Refer Technical Bulletin 4 for further information] 

The grant aims to cover the costs of graduate nurse training and on-going education and 
development of nursing staff. 

In 2018 19 for public acute hospitals: 

? $11 000 will be paid for each graduate nurse in an approved program with a maximum level of 
nurses undergoing such programs being set at 12% of the total nursing headcount (excluding 
external participants). 

? $4000 will be paid per nurse in an approved hospital course with the additional funding of $1000 
per external participant where the cost is incurred by the employing unit. 

? $6000 will be paid per participant for critical care, neonatal intensive care, cardiothoracic, 
emergency, aged care, child and adolescent mental health, and midwifery refresher courses for 
participants from rural health units. 

4.2.2 Medical Officers 

The grant is calculated on the basis of: 

? A training component for training medical officer (TMO) paid at the rate of 50% of their base 
salary to compensate for their reduced clinical productivity. 

? A supervisory component for visiting medical officer / salaried medical officer time paid at 25% of 
a senior director s salary, applied to the number of TMO full time equivalents  supervised. 



 
For Official Use Only-I2-A2  18 

? A supervision allowance for medical undergraduates paid at 10% of the total hospital medical 
salaries and wages payments. 

4.2.3 Other Health Professionals 

The actual cost to hospitals for the education and supervision of allied health, dental, scientific and 
technical staff has not been measured.  The pre-casemix Output Performance Model used 5% of the 
total salaries and wages for these health workers and this formula will be applied until such time as 
the true cost is calculated for allied health, dental, technical and scientific staff.  The grant is to 
compensate hospitals for all professional training costs incurred through the employment of these 
employees. 

The grant will be calculated on the basis of 5% of the salaries and wages costs for allied health, 
dental, scientific and technical staff. 

 

4.3 Special Grants 
The following criteria determine the services that may be considered to receive a special grant: 

? where patient related costs are efficiently incurred but the related activity is not recorded in the 
hospital s patient activity data; or 

? where the classification systems and associated reimbursement mechanisms are not appropriate 
and DHW has endorsed the model of care/service provision difference; or 

? where the DHW endorsed service is not related to routine operations of the hospital; or 
? where it is not possible to recharge for the services; or 
? where provision for a special grant is made under arrangements with the Commonwealth 

Government. 

A list of the special grants for 2018 19 is contained in Section 5.5 

 

4.4 Rural Access Grant 
It is inevitable under Casemix that some small country hospitals with low activity levels and relatively 
high fixed costs will, sometimes inappropriately, appear to be 'inefficient' in comparison with other 
regional and metropolitan hospitals. 

Where Casemix-based payments to these small and grant funded hospitals (refer to Technical 
Bulletin 2 for further information) will not be sufficient to cover their expenditure: 

? A minimum budget will be set for hospitals with low activity volumes. 
? Country hospitals with a gap between the Casemix budget and their minimum budget will be 

given a rural access grant to make up the difference. 

? Those hospitals declared as minimum budget hospitals for 2018 19 will retain this status for the 
full financial year. 

A list of hospitals that receive the rural access grant for 2018 19 is contained in Section 5.6 

 

 



 
For Official Use Only-I2-A2        19 

 

5 Section 
 

5.1 Section 1: 2018 19 AR-DRG version 9.0 price weights and adjustments  
 

The following table is from the 2018 19 National Efficient Price Determination and, for each DRG, outlines the NWAU and associated adjustments that apply to it. 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

801A GIs Unrelated to Principal Diagnosis, Major Complexity NO NO 24.9 8 75 18% 129% 0.0000 0.9030 1.0293 9.1372 0.2715 

801B GIs Unrelated to Principal Diagnosis, Intermediate Complexity NO NO 10.3 3 31 15% 100% 0.0000 0.6569 1.2627 4.4451 0.2739 

801C GIs Unrelated to Principal Diagnosis, Minor Complexity NO NO 2.8 1 9 22% 100% 0.0000 0.0000 0.0000 1.2842 0.3010 

A13A Ventilation &gt;=336hours, Major Complexity NO NO 32.6 10 98 11% 148% 0.0000 1.8251 2.7359 29.1839 0.3421 

A13B Ventilation &gt;=336hours, Minor Complexity NO NO 13.2 4 40 13% 100% 0.0000 1.0193 4.0089 17.0548 0.3477 

A14A Ventilation &gt;=96hours &amp; &lt;336hours, Major Complexity NO NO 33.1 11 99 15% 120% 0.0000 2.5004 1.7130 21.3431 0.3515 

A14B Ventilation &gt;=96hours &amp; &lt;336hours, Intermediate Complexity NO NO 15.4 5 46 13% 113% 0.0000 0.9737 2.2123 12.0350 0.3647 

A14C Ventilation &gt;=96hours &amp; &lt;336hours, Minor Complexity NO NO 7.7 2 23 12% 100% 0.0000 0.3427 3.2481 6.8389 0.3633 

A15A Tracheostomy, Major Complexity NO NO 35.6 11 107 17% 100% 0.0000 3.4064 1.4188 19.0135 0.3239 

A15B Tracheostomy, Intermediate Complexity NO NO 18.4 6 55 20% 100% 0.0000 2.0044 1.6328 11.8012 0.2921 

A15C Tracheostomy, Minor Complexity NO NO 12.5 4 37 13% 100% 0.0000 0.8500 1.6709 7.5335 0.3812 

                                                      
 

 
1 excluding designated SD and unbundled ICU 



 
For Official Use Only-I2-A2        20 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

A40Z ECMO NO NO 13.0 4 39 13% 200% 0.0000 2.2828 4.1820 19.0109 0.4834 

B01Z Ventricular Shunt Revision NO NO 6.9 2 21 22% 84% 0.0000 0.7626 1.3358 3.4341 0.3242 

B02A Cranial Procedures, Major Complexity NO NO 19.4 6 58 18% 133% 0.0000 1.6436 1.5933 11.2035 0.2974 

B02B Cranial Procedures, Intermediate Complexity NO NO 9.5 3 29 24% 110% 0.0000 1.5362 1.4453 5.8722 0.2651 

B02C Cranial Procedures, Minor Complexity NO NO 6.2 2 19 26% 94% 0.0000 1.2376 1.3823 4.0022 0.2568 

B03A Spinal Procedures, Major Complexity NO NO 20.4 6 61 21% 108% 0.0000 1.9498 1.1603 8.9116 0.2890 

B03B Spinal Procedures, Intermediate Complexity NO NO 6.4 2 19 29% 100% 0.0000 1.7206 1.2646 4.2498 0.3451 

B03C Spinal Procedures, Minor Complexity NO NO 3.4 1 10 30% 100% 0.0000 0.0000 0.0000 2.6537 0.2972 

B04A Extracranial Vascular Procedures, Major Complexity NO NO 14.2 4 43 19% 100% 0.0000 1.2765 1.3961 6.8608 0.2677 

B04B Extracranial Vascular Procedures, Intermediate Complexity NO NO 6.9 2 21 16% 100% 0.0000 1.2534 1.5049 4.2631 0.2522 

B04C Extracranial Vascular Procedures, Minor Complexity NO NO 3.3 1 10 22% 100% 0.0000 0.0000 0.0000 2.3549 0.2506 

B05Z Carpal Tunnel Release NO NO 1.0 1 3 30% 100% 0.0000 0.0000 0.0000 0.4093 0.1102 

B06A Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Major Comp NO NO 16.3 5 49 12% 80% 0.0000 1.0882 1.2543 7.3596 0.2509 

B06B Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Interm Comp NO NO 6.8 2 21 15% 88% 0.0000 0.6382 1.4040 3.4463 0.2207 

B06C Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Minor Comp YES NO 2.3 1 8 23% 166% 0.6508 0.0000 0.0000 1.5351 0.2895 

B07A Cranial or Peripheral Nerve and Other Nervous System Procs, Major Comp NO NO 11.7 3 35 17% 100% 0.0000 0.9748 1.1384 4.3900 0.2273 

B07B Cranial or Peripheral Nerve and Other Nervous System Procs, Minor Comp YES NO 2.0 1 6 19% 113% 0.6289 0.0000 0.0000 1.3919 0.3540 

B40Z Plasmapheresis W Neurological Disease, Sameday NO NO 1.0 1 1 12% 100% 0.0000 0.0000 0.0000 0.2486 0.0000 

B41A Telemetric EEG Monitoring, Major Complexity NO NO 7.2 2 22 17% 148% 0.0000 0.0000 0.9700 1.9400 0.3053 

B41B Telemetric EEG Monitoring, Minor Complexity NO NO 3.8 1 11 15% 92% 0.0000 0.0000 0.0000 1.4004 0.2322 

B42A Nervous System Disorders W Ventilator Support, Major Complexity NO NO 16.0 5 48 7% 100% 0.0000 0.1054 1.4326 7.2683 0.2876 

B42B Nervous System Disorders W Ventilator Support, Intermediate Complexity NO NO 6.0 2 18 11% 140% 0.0000 0.0000 1.6374 3.2748 0.3066 



 
For Official Use Only-I2-A2        21 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

B42C Nervous System Disorders W Ventilator Support, Minor Complexity NO NO 2.2 1 7 10% 100% 0.0000 0.0000 0.0000 1.5190 0.3046 

B62Z Apheresis NO NO 1.0 1 3 7% 119% 0.0000 0.0000 0.0000 0.2409 0.1918 

B63A Dementia &amp; Other Chronic Disturbances of Cerebral Function, Major Complexity NO NO 18.5 6 55 4% 100% 0.0000 0.0000 0.7229 4.3371 0.1925 

B63B Dementia &amp; Other Chronic Disturbances of Cerebral Function, Minor Complexity NO NO 7.7 2 23 5% 100% 0.0000 0.0000 0.8936 1.7871 0.1897 

B64A Delirium, Major Complexity NO NO 8.4 2 25 8% 100% 0.0000 0.0000 1.0476 2.0951 0.2250 

B64B Delirium, Minor Complexity YES NO 3.1 1 9 13% 100% 0.0980 0.0000 0.0000 0.7363 0.2372 

B65Z Cerebral Palsy NO NO 1.4 1 4 6% 106% 0.0000 0.0000 0.0000 0.4937 0.3371 

B66A Nervous System Neoplasms, Major Complexity NO NO 11.2 3 34 8% 100% 0.0000 0.0000 1.0070 3.0211 0.2357 

B66B Nervous System Neoplasms, Minor Complexity YES NO 4.8 1 15 13% 124% 0.3351 0.0000 0.0000 1.2921 0.2253 

B67A Degenerative Nervous System Disorders, Major Complexity NO NO 13.2 4 40 5% 138% 0.0000 0.0000 0.8877 3.5509 0.2263 

B67B Degenerative Nervous System Disorders, Intermediate Complexity YES NO 6.4 2 19 8% 136% 0.1604 0.0000 0.7873 1.5746 0.2074 

B67C Degenerative Nervous System Disorders, Minor Complexity NO NO 1.2 1 4 13% 193% 0.0000 0.0000 0.0000 0.1965 0.1412 

B68A Multiple Sclerosis and Cerebellar Ataxia, Major Complexity YES NO 7.5 2 22 9% 159% 0.2980 0.0000 0.9868 1.9737 0.2552 

B68B Multiple Sclerosis and Cerebellar Ataxia, Minor Complexity NO NO 1.1 1 3 7% 189% 0.0000 0.0000 0.0000 0.2598 0.1975 

B69A TIA and Precerebral Occlusion, Major Complexity NO NO 5.6 1 17 15% 100% 0.0000 0.0000 0.0000 1.4256 0.2340 

B69B TIA and Precerebral Occlusion, Minor Complexity NO NO 2.0 1 6 21% 100% 0.0000 0.0000 0.0000 0.4816 0.2401 

B70A Stroke and Other Cerebrovascular Disorders, Major Complexity NO NO 20.1 6 60 8% 100% 0.0000 0.0000 0.9157 5.4942 0.2512 

B70B Stroke and Other Cerebrovascular Disorders, Intermediate Complexity NO NO 8.3 2 25 11% 100% 0.0000 0.0000 1.0974 2.1948 0.2384 

B70C Stroke and Other Cerebrovascular Disorders, Minor Complexity YES NO 4.4 1 13 14% 200% 0.1988 0.0000 0.0000 1.1343 0.2415 

B70D Stroke and Other Cerebrovascular Disorders, Transferred &lt;5 Days YES NO 2.4 1 4 17% 100% 0.1921 0.0000 0.0000 0.7817 0.0000 

B71A Cranial and Peripheral Nerve Disorders, Major Complexity YES NO 5.9 1 18 9% 149% 0.2116 0.0000 0.0000 1.4564 0.2650 



 
For Official Use Only-I2-A2        22 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

B71B Cranial and Peripheral Nerve Disorders, Minor Complexity NO NO 1.1 1 3 11% 200% 0.0000 0.0000 0.0000 0.1930 0.1378 

B72A Nervous System Infection Except Viral Meningitis, Major Complexity NO NO 11.4 3 34 8% 124% 0.0000 0.0000 1.2520 3.7561 0.2824 

B72B Nervous System Infection Except Viral Meningitis, Minor Complexity NO NO 3.5 1 10 11% 176% 0.0000 0.0000 0.0000 0.5985 0.1912 

B73A Viral Meningitis, Major Complexity NO NO 4.9 1 15 9% 88% 0.0000 0.0000 0.0000 1.3508 0.2435 

B73B Viral Meningitis, Minor Complexity NO NO 2.5 1 7 11% 124% 0.0000 0.0000 0.0000 0.6871 0.2724 

B74A Nontraumatic Stupor and Coma, Major Complexity NO NO 5.8 1 17 11% 100% 0.0000 0.0000 0.0000 1.4345 0.2602 

B74B Nontraumatic Stupor and Coma, Minor Complexity NO NO 1.6 1 5 13% 128% 0.0000 0.0000 0.0000 0.3184 0.2223 

B75Z Febrile Convulsions NO NO 1.2 1 4 9% 100% 0.0000 0.0000 0.0000 0.3060 0.2346 

B76A Seizures, Major Complexity YES NO 5.0 1 15 10% 132% 0.1969 0.0000 0.0000 1.2988 0.2524 

B76B Seizures, Minor Complexity YES NO 1.9 1 6 14% 175% 0.1199 0.0000 0.0000 0.4810 0.2588 

B77A Headaches, Major Complexity YES NO 3.3 1 10 12% 135% 0.1284 0.0000 0.0000 0.8100 0.2400 

B77B Headaches, Minor Complexity NO NO 1.2 1 4 19% 175% 0.0000 0.0000 0.0000 0.1910 0.1257 

B78A Intracranial Injuries, Major Complexity NO NO 11.2 3 34 9% 100% 0.0000 0.0000 1.0565 3.1696 0.2605 

B78B Intracranial Injuries, Minor Complexity NO NO 3.5 1 10 11% 110% 0.0000 0.0000 0.0000 0.8888 0.2565 

B78C Intracranial Injuries, Transferred &lt;5 Days NO NO 1.5 1 4 16% 100% 0.0000 0.0000 0.0000 0.4525 0.0000 

B79A Skull Fractures, Major Complexity NO NO 5.3 1 16 17% 100% 0.0000 0.0000 0.0000 1.4777 0.2627 

B79B Skull Fractures, Minor Complexity NO NO 1.7 1 5 10% 147% 0.0000 0.0000 0.0000 0.3986 0.2535 

B80A Other Head Injuries, Major Complexity YES NO 4.0 1 12 15% 100% 0.1208 0.0000 0.0000 0.8462 0.2138 

B80B Other Head Injuries, Minor Complexity NO NO 1.1 1 3 19% 87% 0.0000 0.0000 0.0000 0.1488 0.1123 

B81A Other Disorders of the Nervous System, Major Complexity NO NO 8.9 2 27 9% 122% 0.0000 0.0000 1.1079 2.2157 0.2151 

B81B Other Disorders of the Nervous System, Minor Complexity YES NO 3.6 1 11 15% 151% 0.2472 0.0000 0.0000 0.8082 0.2126 

B82A Chronic &amp; Unspec Para/Quadriplegia, Major Complexity NO NO 22.1 7 66 6% 100% 0.0000 0.0000 0.8077 5.6538 0.2543 

B82B Chronic &amp; Unspec Para/Quadriplegia, Intermediate Complexity NO NO 6.2 2 19 6% 100% 0.0000 0.0000 0.8953 1.7906 0.2486 



 
For Official Use Only-I2-A2        23 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

B82C Chronic &amp; Unspec Para/Quadriplegia, Minor Complexity NO NO 2.6 1 8 10% 100% 0.0000 0.0000 0.0000 0.6664 0.2581 

B83A Acute Paraplegia and Quadriplegia and Spinal Cord Conditions, Major Complexity NO NO 26.9 8 81 6% 100% 0.0000 0.0000 1.0136 8.1090 0.2603 

B83B Acute Paraplegia and Quadriplegia and Spinal Cord Conditions, Interm Comp NO NO 8.0 2 24 11% 100% 0.0000 0.0000 0.9943 1.9885 0.2150 

B83C Acute Paraplegia and Quadriplegia and Spinal Cord Conditions, Minor Complexity NO NO 3.4 1 10 8% 100% 0.0000 0.0000 0.0000 0.9717 0.2705 

C01A Procedures for Penetrating Eye Injury, Major Complexity NO NO 4.3 1 13 12% 100% 0.0000 0.0000 0.0000 2.4489 0.3567 

C01B Procedures for Penetrating Eye Injury, Minor Complexity NO NO 1.8 1 5 12% 100% 0.0000 0.0000 0.0000 1.2486 0.4474 

C02A Enucleations and Orbital Procedures, Major Complexity YES NO 5.6 1 17 17% 143% 0.5781 0.0000 0.0000 2.6119 0.3445 

C02B Enucleations and Orbital Procedures, Minor Complexity YES NO 1.9 1 6 23% 100% 0.6452 0.0000 0.0000 1.4715 0.2862 

C03A Retinal Procedures, Major Complexity NO NO 1.4 1 4 89% 133% 0.0000 0.0000 0.0000 0.8468 0.2898 

C03B Retinal Procedures, Minor Complexity NO NO 1.0 1 3 97% 200% 0.0000 0.0000 0.0000 0.3277 0.1724 

C04A Major Corneal, Scleral and Conjunctival Procedures, Major Complexity NO NO 5.0 1 15 19% 100% 0.0000 0.0000 0.0000 2.2383 0.3031 

C04B Major Corneal, Scleral and Conjunctival Procedures, Minor Complexity NO NO 1.3 1 4 34% 100% 0.0000 0.0000 0.0000 1.2556 0.3107 

C05Z Dacryocystorhinostomy NO NO 1.2 1 3 38% 100% 0.0000 0.0000 0.0000 0.9176 0.3474 

C10Z Strabismus Procedures NO NO 1.0 1 3 35% 109% 0.0000 0.0000 0.0000 0.7824 0.2734 

C11Z Eyelid Procedures YES NO 1.9 1 6 35% 108% 0.5573 0.0000 0.0000 1.0523 0.3258 

C12A Other Corneal, Scleral and Conjunctival Procedures, Major Complexity NO NO 4.4 1 13 25% 100% 0.0000 0.0000 0.0000 1.4995 0.2730 

C12B Other Corneal, Scleral and Conjunctival Procedures, Minor Complexity NO NO 1.0 1 3 35% 143% 0.0000 0.0000 0.0000 0.6190 0.2406 

C13Z Lacrimal Procedures NO NO 1.1 1 3 23% 92% 0.0000 0.0000 0.0000 0.4638 0.1612 

C14A Other Eye Procedures, Major Complexity NO NO 4.5 1 13 9% 100% 0.0000 0.0000 0.0000 1.3432 0.3077 

C14B Other Eye Procedures, Minor Complexity NO NO 1.0 1 3 32% 113% 0.0000 0.0000 0.0000 0.4326 0.1748 

C15Z Glaucoma and Complex Cataract Procedures NO NO 1.3 1 4 53% 151% 0.0000 0.0000 0.0000 0.7573 0.2712 

C16Z Lens Procedures NO NO 1.0 1 4 83% 182% 0.0000 0.0000 0.0000 0.5284 0.2119 



 
For Official Use Only-I2-A2        24 

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V9.0 Description 

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ment 

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ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

C60A Acute and Major Eye Infections, Major Complexity NO NO 7.3 2 22 3% 100% 0.0000 0.0000 1.0564 2.1128 0.2927 

C60B Acute and Major Eye Infections, Minor Complexity NO NO 3.1 1 9 5% 149% 0.0000 0.0000 0.0000 0.8493 0.2869 

C61A Neurological and Vascular Disorders of the Eye, Major Complexity YES NO 4.1 1 12 15% 130% 0.2749 0.0000 0.0000 1.1347 0.2563 

C61B Neurological and Vascular Disorders of the Eye, Minor Complexity YES NO 2.5 1 8 16% 200% 0.1427 0.0000 0.0000 0.6858 0.2641 

C62A Hyphaema and Medically Managed Trauma to the Eye, Major Complexity YES NO 4.7 1 14 11% 144% 0.1355 0.0000 0.0000 1.1370 0.2342 

C62B Hyphaema and Medically Managed Trauma to the Eye, Minor Complexity NO NO 1.2 1 4 19% 185% 0.0000 0.0000 0.0000 0.1962 0.1278 

C63A Other Disorders of the Eye, Major Complexity YES NO 4.2 1 13 7% 130% 0.3133 0.0000 0.0000 1.1852 0.2554 

C63B Other Disorders of the Eye, Minor Complexity YES NO 2.1 1 6 13% 180% 0.1582 0.0000 0.0000 0.5633 0.2402 

D01Z Cochlear Implant NO NO 1.2 1 3 81% 122% 0.0000 0.0000 0.0000 6.5079 0.7224 

D02A Head and Neck Procedures, Major Complexity NO NO 8.8 2 27 15% 100% 0.0000 1.1336 2.3423 5.8182 0.4280 

D02B Head and Neck Procedures, Minor Complexity NO NO 2.2 1 7 15% 100% 0.0000 0.0000 0.0000 1.8345 0.4516 

D03A Surgical Repair for Cleft Lip and Palate Disorders, Major Complexity NO NO 2.2 1 7 13% 100% 0.0000 0.0000 0.0000 2.1731 0.4838 

D03B Surgical Repair for Cleft Lip and Palate Disorders, Minor Complexity NO NO 1.6 1 5 14% 100% 0.0000 0.0000 0.0000 1.6218 0.4740 

D04A Maxillo Surgery, Major Complexity NO NO 2.6 1 8 17% 94% 0.0000 0.0000 0.0000 2.3903 0.3929 

D04B Maxillo Surgery, Minor Complexity NO NO 1.6 1 5 18% 113% 0.0000 0.0000 0.0000 1.4512 0.4294 

D05Z Parotid Gland Procedures NO NO 2.4 1 7 18% 100% 0.0000 0.0000 0.0000 2.4027 0.4576 

D06Z Sinus and Complex Middle Ear Procedures NO NO 1.2 1 4 30% 100% 0.0000 0.0000 0.0000 1.3189 0.4545 

D10Z Nasal Procedures NO NO 1.1 1 3 23% 82% 0.0000 0.0000 0.0000 1.0055 0.3771 

D11Z Tonsillectomy and Adenoidectomy NO NO 1.1 1 3 19% 100% 0.0000 0.0000 0.0000 0.7158 0.3521 

D12A Other Ear, Nose, Mouth and Throat Procedures, Major Complexity YES NO 5.2 1 15 12% 105% 0.6770 0.0000 0.0000 2.2104 0.2959 

D12B Other Ear, Nose, Mouth and Throat Procedures, Minor Complexity NO NO 1.3 1 4 23% 100% 0.0000 0.0000 0.0000 0.7600 0.2292 

D13Z Myringotomy W Tube Insertion NO NO 1.1 1 3 32% 106% 0.0000 0.0000 0.0000 0.3957 0.1272 



 
For Official Use Only-I2-A2        25 

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ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

D14A Mouth and Salivary Gland Procedures, Major Complexity NO NO 2.0 1 6 13% 113% 0.0000 0.0000 0.0000 1.0743 0.3183 

D14B Mouth and Salivary Gland Procedures, Minor Complexity NO NO 1.1 1 3 15% 109% 0.0000 0.0000 0.0000 0.5510 0.1956 

D15Z Mastoid Procedures NO NO 2.1 1 6 37% 95% 0.0000 0.0000 0.0000 2.0742 0.6256 

D40Z Dental Extractions and Restorations NO NO 1.1 1 3 14% 100% 0.0000 0.0000 0.0000 0.6579 0.1794 

D60A Ear, Nose, Mouth and Throat Malignancy, Major Complexity NO NO 8.9 2 27 8% 100% 0.0000 0.2085 1.4446 3.0976 0.2696 

D60B Ear, Nose, Mouth and Throat Malignancy, Minor Complexity YES NO 2.7 1 8 11% 148% 0.3593 0.0000 0.0000 0.9077 0.2475 

D61A Dysequilibrium, Major Complexity YES NO 4.0 1 12 15% 100% 0.1028 0.0000 0.0000 0.9277 0.2194 

D61B Dysequilibrium, Minor Complexity NO NO 1.4 1 4 18% 154% 0.0000 0.0000 0.0000 0.2314 0.1674 

D62A Epistaxis, Major Complexity NO NO 3.8 1 11 11% 100% 0.0000 0.0000 0.0000 0.9882 0.2443 

D62B Epistaxis, Minor Complexity NO NO 1.4 1 4 11% 120% 0.0000 0.0000 0.0000 0.2404 0.1491 

D63A Otitis Media and Upper Respiratory Infections, Major Complexity YES NO 3.1 1 9 9% 112% 0.1474 0.0000 0.0000 0.8243 0.2502 

D63B Otitis Media and Upper Respiratory Infections, Minor Complexity NO NO 1.3 1 4 9% 120% 0.0000 0.0000 0.0000 0.2542 0.1975 

D64A Laryngotracheitis and Epiglottitis, Major Complexity NO NO 1.7 1 5 9% 107% 0.0000 0.0000 0.0000 0.5428 0.2994 

D64B Laryngotracheitis and Epiglottitis, Minor Complexity NO NO 1.1 1 3 9% 80% 0.0000 0.0000 0.0000 0.2066 0.1579 

D65A Nasal Trauma and Deformity, Major Complexity NO NO 3.4 1 10 12% 100% 0.0000 0.0000 0.0000 0.6938 0.2281 

D65B Nasal Trauma and Deformity, Minor Complexity NO NO 1.1 1 3 18% 113% 0.0000 0.0000 0.0000 0.2650 0.1256 

D66A Other Ear, Nose, Mouth and Throat Disorders, Major Complexity YES NO 3.9 1 12 10% 100% 0.3092 0.0000 0.0000 1.0310 0.2468 

D66B Other Ear, Nose, Mouth and Throat Disorders, Minor Complexity NO NO 1.2 1 4 14% 100% 0.0000 0.0000 0.0000 0.2901 0.1484 

D67A Oral and Dental Disorders, Major Complexity YES NO 4.1 1 12 7% 129% 0.2369 0.0000 0.0000 1.0934 0.2555 

D67B Oral and Dental Disorders, Minor Complexity NO NO 1.3 1 4 17% 127% 0.0000 0.0000 0.0000 0.2742 0.1383 

E01A Major Chest Procedures, Major Complexity NO NO 19.5 6 59 16% 95% 0.0000 1.2431 1.1718 8.2741 0.2836 

E01B Major Chest Procedures, Intermediate Complexity NO NO 9.9 3 30 18% 100% 0.0000 1.1076 1.2117 4.7426 0.2629 



 
For Official Use Only-I2-A2        26 

AR-DRG 
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Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

E01C Major Chest Procedures, Minor Complexity NO NO 6.2 2 19 18% 119% 0.0000 0.5995 1.3594 3.3183 0.2825 

E02A Other Respiratory System GIs, Major Complexity NO NO 12.5 4 37 13% 129% 0.0000 0.6196 1.0436 4.7940 0.2718 

E02B Other Respiratory System GIs, Intermediate Complexity YES NO 3.5 1 11 18% 80% 0.6404 0.0000 0.0000 1.8134 0.2709 

E02C Other Respiratory System GIs, Minor Complexity NO NO 1.1 1 3 17% 94% 0.0000 0.0000 0.0000 0.8190 0.3242 

E03Z Lung or Heart-Lung Transplant NO NO 23.2 10 98 12% 100% 0.0000 4.5443 1.9412 23.9563 0.6039 

E40A Respiratory System Disorders W Ventilator Support, Major Complexity NO NO 9.7 3 29 10% 100% 0.0000 0.0000 1.7351 5.2054 0.2954 

E40B Respiratory System Disorders W Ventilator Support, Minor Complexity NO NO 5.0 1 15 11% 81% 0.0000 0.0000 0.0000 2.8042 0.2651 

E41A Respiratory System Disorders W Non-Invasive Ventilation, Major Complexity NO NO 11.6 3 35 9% 85% 0.0000 0.0000 1.5143 4.5429 0.2954 

E41B Respiratory System Disorders W Non-Invasive Ventilation, Minor Complexity NO NO 6.0 2 18 8% 80% 0.0000 0.0000 1.1219 2.2437 0.2830 

E42A Bronchoscopy, Major Complexity NO NO 12.5 4 38 12% 142% 0.0000 0.2771 0.9302 3.9979 0.2681 

E42B Bronchoscopy, Intermediate Complexity YES NO 6.2 2 19 14% 127% 0.5056 0.3541 1.0322 2.4185 0.2683 

E42C Bronchoscopy, Minor Complexity YES NO 2.9 1 9 26% 113% 0.4405 0.0000 0.0000 1.2408 0.2359 

E60A Cystic Fibrosis, Major Complexity NO NO 12.0 4 36 4% 143% 0.0000 0.0000 0.9624 3.8496 0.2505 

E60B Cystic Fibrosis, Minor Complexity NO NO 7.4 2 22 3% 134% 0.0000 0.0000 1.2815 2.5631 0.1962 

E61A Pulmonary Embolism, Major Complexity NO NO 6.7 2 20 13% 100% 0.0000 0.0000 0.9515 1.9030 0.2378 

E61B Pulmonary Embolism, Minor Complexity YES NO 3.2 1 10 18% 100% 0.1610 0.0000 0.0000 0.7862 0.1772 

E62A Respiratory Infections and Inflammations, Major Complexity NO NO 6.4 2 19 9% 100% 0.0000 0.0000 0.8656 1.7311 0.2397 

E62B Respiratory Infections and Inflammations, Minor Complexity YES NO 3.0 1 9 10% 80% 0.1114 0.0000 0.0000 0.7599 0.2254 

E63A Sleep Apnoea, Major Complexity NO NO 2.2 1 7 15% 124% 0.0000 0.0000 0.0000 0.5864 0.2709 

E63B Sleep Apnoea, Minor Complexity NO NO 1.2 1 4 31% 100% 0.0000 0.0000 0.0000 0.2931 0.1668 

E64A Pulmonary Oedema and Respiratory Failure, Major Complexity NO NO 6.8 2 20 10% 100% 0.0000 0.0000 0.9996 1.9991 0.2370 

E64B Pulmonary Oedema and Respiratory Failure, Minor Complexity NO NO 2.6 1 8 10% 100% 0.0000 0.0000 0.0000 0.7041 0.2312 



 
For Official Use Only-I2-A2        27 

AR-DRG 
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Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

E65A Chronic Obstructive Airways Disease, Major Complexity NO NO 6.1 2 18 8% 100% 0.0000 0.0000 0.7849 1.5697 0.2309 

E65B Chronic Obstructive Airways Disease, Minor Complexity NO NO 2.9 1 9 10% 175% 0.0000 0.0000 0.0000 0.6696 0.2233 

E66A Major Chest Trauma, Major Complexity NO NO 9.3 3 28 9% 100% 0.0000 0.0000 0.8568 2.5704 0.2298 

E66B Major Chest Trauma, Intermediate Complexity NO NO 4.2 1 12 10% 100% 0.0000 0.0000 0.0000 1.0733 0.2500 

E66C Major Chest Trauma, Minor Complexity NO NO 1.9 1 6 14% 100% 0.0000 0.0000 0.0000 0.4310 0.2421 

E67A Respiratory Signs and Symptoms, Major Complexity YES NO 3.3 1 10 14% 86% 0.2411 0.0000 0.0000 0.8868 0.2450 

E67B Respiratory Signs and Symptoms, Minor Complexity NO NO 1.2 1 4 15% 80% 0.0000 0.0000 0.0000 0.2422 0.1812 

E68A Pneumothorax, Major Complexity NO NO 5.9 1 18 10% 100% 0.0000 0.0000 0.0000 1.6617 0.2674 

E68B Pneumothorax, Minor Complexity NO NO 2.5 1 7 14% 117% 0.0000 0.0000 0.0000 0.6564 0.2694 

E69A Bronchitis and Asthma, Major Complexity NO NO 3.2 1 10 9% 100% 0.0000 0.0000 0.0000 0.8415 0.2503 

E69B Bronchitis and Asthma, Minor Complexity NO NO 1.4 1 4 8% 80% 0.0000 0.0000 0.0000 0.3262 0.2281 

E70A Whooping Cough and Acute Bronchiolitis, Major Complexity NO NO 2.8 1 8 5% 100% 0.0000 0.0000 0.0000 0.9942 0.3761 

E70B Whooping Cough and Acute Bronchiolitis, Minor Complexity NO NO 1.7 1 6 5% 83% 0.0000 0.0000 0.0000 0.5524 0.3266 

E71A Respiratory Neoplasms, Major Complexity NO NO 9.0 2 27 9% 100% 0.0000 0.0000 1.2582 2.5164 0.2462 

E71B Respiratory Neoplasms, Minor Complexity YES NO 4.2 1 13 12% 133% 0.2861 0.0000 0.0000 1.0661 0.2460 

E72Z Respiratory Problems Arising from Neonatal Period NO NO 2.3 1 11 10% 80% 0.0000 0.0000 0.0000 0.6349 0.2960 

E73A Pleural Effusion, Major Complexity NO NO 9.5 3 28 11% 100% 0.0000 0.0000 0.9233 2.7699 0.2503 

E73B Pleural Effusion, Intermediate Complexity NO NO 4.6 1 14 14% 100% 0.0000 0.0000 0.0000 1.2430 0.2411 

E73C Pleural Effusion, Minor Complexity YES NO 2.8 1 8 21% 100% 0.1745 0.0000 0.0000 0.7204 0.2120 

E74A Interstitial Lung Disease, Major Complexity NO NO 6.8 2 20 8% 100% 0.0000 0.0000 0.9170 1.8341 0.2361 

E74B Interstitial Lung Disease, Minor Complexity YES NO 4.0 1 12 12% 100% 0.2507 0.0000 0.0000 0.9722 0.2149 

E75A Other Respiratory System Disorders, Major Complexity NO NO 4.1 1 12 9% 121% 0.0000 0.0000 0.0000 1.0200 0.2525 



 
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ment 

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ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
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Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

E75B Other Respiratory System Disorders, Minor Complexity YES NO 2.0 1 6 11% 91% 0.1085 0.0000 0.0000 0.4917 0.2413 

E76Z Respiratory Tuberculosis NO NO 14.4 4 43 10% 100% 0.0000 0.0000 0.9985 3.9942 0.2226 

E77A Bronchiectasis, Major Complexity NO NO 8.1 2 24 8% 200% 0.0000 0.0000 1.0398 2.0796 0.2185 

E77B Bronchiectasis, Minor Complexity NO NO 4.9 1 15 8% 200% 0.0000 0.0000 0.0000 1.1146 0.1992 

F01A Implantation and Replacement of AICD, Total System, Major Complexity NO NO 10.8 3 32 69% 100% 0.0000 3.5927 1.7264 8.7719 0.3051 

F01B Implantation and Replacement of AICD, Total System, Minor Complexity YES NO 2.5 1 8 100% 100% 2.6494 0.0000 0.0000 4.5928 0.2991 

F02Z Other AICD Procedures NO NO 4.1 1 12 32% 100% 0.0000 0.0000 0.0000 2.2891 0.2943 

F03A Cardiac Valve Procs W CPB Pump W Invasive Cardiac Investigation, Maj Comp NO NO 22.5 7 67 22% 100% 0.0000 4.2970 1.3768 13.9346 0.2889 

F03B Cardiac Valve Procs W CPB Pump W Invasive Cardiac Investigation, Min Comp NO NO 12.9 4 39 22% 100% 0.0000 5.7893 1.0210 9.8734 0.2420 

F04A Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Major Comp NO NO 17.9 5 54 24% 105% 0.0000 3.6741 1.7774 12.5612 0.2995 

F04B Cardiac Valve Procs W CPB Pump W/O Invasive Cardiac Invest, Interm Comp NO NO 9.2 3 28 23% 105% 0.0000 4.8346 1.1034 8.1448 0.2992 

F04C Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Minor Comp NO NO 6.4 2 19 20% 106% 0.0000 5.8293 0.3680 6.5653 0.1730 

F05A Coronary Bypass W Invasive Cardiac Investigation, Major Complexity NO NO 18.3 6 55 17% 100% 0.0000 2.7209 1.3013 10.5288 0.3545 

F05B Coronary Bypass W Invasive Cardiac Investigation, Minor Complexity NO NO 12.0 4 36 18% 100% 0.0000 2.4232 1.3247 7.7222 0.3313 

F06A Coronary Bypass W/O Invasive Cardiac Investigation, Major Complexity NO NO 13.6 4 41 19% 100% 0.0000 2.5341 1.5386 8.6886 0.3032 

F06B Coronary Bypass W/O Invasive Cardiac Investigation, Intermediate Complexity NO NO 8.4 2 25 20% 100% 0.0000 2.4128 1.8943 6.2014 0.2861 

F06C Coronary Bypass W/O Invasive Cardiac Investigation, Minor Complexity NO NO 6.5 2 19 21% 100% 0.0000 2.0534 1.5519 5.1572 0.2924 

F07A Other Cardiothoracic/Vascular Procs W CPB Pump, Major Complexity NO NO 11.7 3 35 21% 107% 0.0000 3.2785 2.1243 9.6514 0.4660 

F07B Other Cardiothoracic/Vascular Procs W CPB Pump, Minor Complexity NO NO 6.2 2 19 24% 100% 0.0000 1.9860 1.8971 5.7802 0.3241 

F08A Major Reconstructive Vascular Procs W/O CPB Pump, Major Complexity NO NO 19.3 6 58 19% 100% 0.0000 3.7347 1.2562 11.2716 0.3090 

F08B Major Reconstructive Vascular Procs W/O CPB Pump, Intermediate Complexity NO NO 8.7 2 26 26% 100% 0.0000 3.3290 1.4495 6.2280 0.2525 



 
For Official Use Only-I2-A2        29 

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Day 

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ment 

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ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
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Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

F08C Major Reconstructive Vascular Procs W/O CPB Pump, Minor Complexity NO NO 4.4 1 13 34% 100% 0.0000 0.0000 0.0000 3.9549 0.2567 

F09A Other Cardiothoracic Procedures W/O CPB Pump, Major Complexity NO NO 10.0 3 30 16% 95% 0.0000 1.3799 1.5626 6.0675 0.2913 

F09B Other Cardiothoracic Procedures W/O CPB Pump, Intermediate Complexity NO NO 5.7 1 17 17% 100% 0.0000 0.0000 0.0000 3.4077 0.3215 

F09C Other Cardiothoracic Procedures W/O CPB Pump, Minor Complexity NO NO 2.3 1 7 19% 100% 0.0000 0.0000 0.0000 1.9768 0.3866 

F10A Interventional Coronary Procedures, Admitted for AMI, Major Complexity NO NO 7.0 2 21 27% 100% 0.0000 0.9058 1.3312 3.5681 0.3289 

F10B Interventional Coronary Procedures, Admitted for AMI, Minor Complexity NO NO 3.1 1 9 44% 100% 0.0000 0.0000 0.0000 2.0089 0.3143 

F11A Amputation, Except Upper Limb and Toe, for Circulatory Disorders, Major Comp NO NO 38.1 12 114 12% 100% 0.0000 1.5050 1.0605 14.2311 0.2797 

F11B Amputation, Except Upper Limb and Toe, for Circulatory Disorders, Minor Comp NO NO 16.7 5 50 12% 100% 0.0000 0.7694 1.2060 6.7997 0.3175 

F12A Implant and Replacement of Pacemaker, Total System, Major Complexity NO NO 8.2 2 24 41% 100% 0.0000 1.2691 1.5105 4.2902 0.2822 

F12B Implant and Replacement of Pacemaker, Total System, Minor Complexity YES NO 2.8 1 8 61% 100% 1.0132 0.0000 0.0000 2.2086 0.2560 

F13A Amputation, Upper Limb and Toe, for Circulatory Disorders, Major Complexity NO NO 17.0 5 51 10% 100% 0.0000 0.4736 1.2609 6.7782 0.3220 

F13B Amputation, Upper Limb and Toe, for Circulatory Disorders, Minor Complexity NO NO 7.3 2 22 15% 100% 0.0000 0.4834 1.1647 2.8128 0.2785 

F14A Vascular Procs, Ex Major Reconstruction, W/O CPB Pump, Major Complexity NO NO 13.2 4 40 17% 127% 0.0000 1.1496 1.2474 6.1393 0.2860 

F14B Vascular Procs, Ex Major Reconstruction, W/O CPB Pump, Interm Comp NO NO 4.4 1 13 26% 117% 0.0000 0.0000 0.0000 2.5665 0.2647 

F14C Vascular Procs, Ex Major Reconstruction, W/O CPB Pump, Minor Complexity YES NO 1.9 1 6 33% 135% 0.8860 0.0000 0.0000 1.6242 0.2789 

F17A Insertion and Replacement of Pacemaker Generator, Major Complexity NO NO 3.6 1 11 100% 100% 0.0000 0.0000 0.0000 2.2112 0.3376 

F17B Insertion and Replacement of Pacemaker Generator, Minor Complexity NO NO 1.1 1 3 97% 100% 0.0000 0.0000 0.0000 1.1777 0.1389 

F18Z Other Pacemaker Procedures NO NO 4.3 1 13 20% 100% 0.0000 0.0000 0.0000 2.2093 0.3220 

F19A Trans-Vascular Percutaneous Cardiac Intervention, Major Complexity NO NO 6.2 2 19 21% 95% 0.0000 1.6936 1.6262 4.9460 0.2502 

F19B Trans-Vascular Percutaneous Cardiac Intervention, Minor Complexity NO NO 1.6 1 5 30% 139% 0.0000 0.0000 0.0000 2.1784 0.1619 

F20Z Vein Ligation and Stripping NO NO 1.2 1 4 20% 100% 0.0000 0.0000 0.0000 1.0033 0.3289 



 
For Official Use Only-I2-A2        30 

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Day 

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ment 

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ICU ALOS

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Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

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Base 

Short-Stay 
Outlier Per 

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Inlier 

Long-Stay 
Outlier Per 

Diem 

F21A Other Circulatory System GIs, Major Complexity NO NO 25.4 8 76 12% 100% 0.0000 0.5444 1.0102 8.6259 0.2739 

F21B Other Circulatory System GIs, Intermediate Complexity NO NO 9.9 3 30 11% 100% 0.0000 0.4831 0.9643 3.3761 0.2373 

F21C Other Circulatory System GIs, Minor Complexity YES NO 3.4 1 10 14% 113% 0.7661 0.0000 0.0000 1.6553 0.2044 

F22Z Insertion of Artificial Heart Device NO NO 43.9 14 132 32% 153% 0.0000 23.5919 2.4783 58.2877 0.6040 

F23Z Heart Transplant NO NO 21.6 13 121 32% 100% 0.0000 3.6712 1.7823 26.8407 0.5327 

F24A Interventional Coronary Procs, Not Adm for AMI, Major Comp NO NO 6.3 2 19 27% 100% 0.0000 1.0285 1.3029 3.6344 0.2898 

F24B Interventional Coronary Procs, Not Adm for AMI, Minor Comp NO NO 1.6 1 5 45% 168% 0.0000 0.0000 0.0000 1.7130 0.2622 

F40A Circulatory Disorders W Ventilator Support, Major Complexity NO NO 10.3 3 31 13% 100% 0.0000 0.2167 1.7852 5.5724 0.3128 

F40B Circulatory Disorders W Ventilator Support, Minor Complexity NO NO 2.9 1 9 15% 100% 0.0000 0.0000 0.0000 1.9263 0.3373 

F41A Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Major Comp NO NO 7.1 2 21 16% 100% 0.0000 0.3466 1.2631 2.8728 0.2754 

F41B Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Minor Comp YES NO 3.6 1 11 22% 100% 0.5232 0.0000 0.0000 1.5860 0.2497 

F42A Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Major Comp NO NO 5.9 1 18 18% 124% 0.0000 0.0000 0.0000 2.2037 0.2732 

F42B Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Minor Comp YES NO 2.7 1 8 28% 196% 0.5403 0.0000 0.0000 1.1983 0.2274 

F43A Circulatory Disorders W Non-Invasive Ventilation, Major Complexity NO NO 15.0 4 45 10% 100% 0.0000 0.0000 1.3982 5.5928 0.2659 

F43B Circulatory Disorders W Non-Invasive Ventilation, Minor Complexity NO NO 7.6 2 23 12% 100% 0.0000 0.0000 1.4136 2.8272 0.2673 

F60A Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Proc NO NO 4.9 1 16 10% 100% 0.0000 0.0000 0.0000 1.3598 0.2561 

F60B Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Proc, Transf &lt;5 Days NO NO 1.5 1 4 22% 100% 0.0000 0.0000 0.0000 0.5383 0.0000 

F61A Infective Endocarditis, Major Complexity NO NO 23.2 7 70 11% 100% 0.0000 0.0000 1.0104 7.0725 0.2036 

F61B Infective Endocarditis, Intermediate Complexity NO NO 13.3 4 40 11% 100% 0.0000 0.0000 1.0247 4.0987 0.1957 

F61C Infective Endocarditis, Minor Complexity NO NO 7.4 2 22 11% 100% 0.0000 0.0000 1.0024 2.0049 0.1317 

F62A Heart Failure and Shock, Major Complexity NO NO 8.3 2 25 9% 100% 0.0000 0.0000 1.0944 2.1887 0.2445 



 
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Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

F62B Heart Failure and Shock, Minor Complexity NO NO 3.6 1 11 11% 100% 0.0000 0.0000 0.0000 0.8636 0.2304 

F62C Heart Failure and Shock, Transferred &lt;5 Days NO NO 1.6 1 4 18% 100% 0.0000 0.0000 0.0000 0.4213 0.0000 

F63A Venous Thrombosis, Major Complexity NO NO 5.7 1 17 13% 100% 0.0000 0.0000 0.0000 1.3157 0.2274 

F63B Venous Thrombosis, Minor Complexity YES NO 3.6 1 11 18% 100% 0.0976 0.0000 0.0000 0.6297 0.1153 

F64A Skin Ulcers in Circulatory Disorders, Major Complexity NO NO 13.3 4 40 7% 100% 0.0000 0.0000 0.8603 3.4414 0.2317 

F64B Skin Ulcers in Circulatory Disorders, Intermediate Complexity NO NO 6.2 2 18 9% 100% 0.0000 0.0000 0.7823 1.5646 0.2011 

F64C Skin Ulcers in Circulatory Disorders, Minor Complexity YES NO 3.9 1 12 10% 100% 0.1877 0.0000 0.0000 0.8831 0.1632 

F65A Peripheral Vascular Disorders, Major Complexity NO NO 6.5 2 20 11% 100% 0.0000 0.0000 0.9524 1.9049 0.2220 

F65B Peripheral Vascular Disorders, Minor Complexity YES NO 2.9 1 9 17% 135% 0.2617 0.0000 0.0000 0.8091 0.1950 

F66A Coronary Atherosclerosis, Major Complexity NO NO 4.1 1 12 10% 100% 0.0000 0.0000 0.0000 1.0910 0.2552 

F66B Coronary Atherosclerosis, Minor Complexity NO NO 1.4 1 4 21% 100% 0.0000 0.0000 0.0000 0.2898 0.2142 

F67A Hypertension, Major Complexity YES NO 4.5 1 13 11% 183% 0.1533 0.0000 0.0000 1.1509 0.2424 

F67B Hypertension, Minor Complexity NO NO 1.4 1 4 15% 128% 0.0000 0.0000 0.0000 0.2500 0.1787 

F68Z Congenital Heart Disease NO NO 1.8 1 5 18% 186% 0.0000 0.0000 0.0000 0.4413 0.2169 

F69A Valvular Disorders, Major Complexity YES NO 6.0 2 18 11% 100% 0.2258 0.0000 0.8880 1.7760 0.2435 

F69B Valvular Disorders, Minor Complexity NO NO 1.2 1 4 25% 200% 0.0000 0.0000 0.0000 0.2075 0.1547 

F72A Unstable Angina, Major Complexity YES NO 3.9 1 12 14% 100% 0.1403 0.0000 0.0000 1.0649 0.2413 

F72B Unstable Angina, Minor Complexity YES NO 1.9 1 6 19% 100% 0.1031 0.0000 0.0000 0.5091 0.2361 

F73A Syncope and Collapse, Major Complexity NO NO 4.9 1 15 11% 100% 0.0000 0.0000 0.0000 1.1655 0.2318 

F73B Syncope and Collapse, Minor Complexity YES NO 1.8 1 6 20% 127% 0.1153 0.0000 0.0000 0.4355 0.2313 

F74A Chest Pain, Major Complexity NO NO 2.0 1 6 17% 178% 0.0000 0.0000 0.0000 0.4360 0.2409 

F74B Chest Pain, Minor Complexity NO NO 1.1 1 3 24% 169% 0.0000 0.0000 0.0000 0.1492 0.1057 

F75A Other Circulatory Disorders, Major Complexity NO NO 9.9 3 30 11% 154% 0.0000 0.0000 1.0775 3.2325 0.2439 



 
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Lower 
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Upper 
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Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

F75B Other Circulatory Disorders, Intermediate Complexity YES NO 4.9 1 15 12% 175% 0.2771 0.0000 0.0000 1.4237 0.2530 

F75C Other Circulatory Disorders, Minor Complexity YES NO 2.6 1 8 14% 200% 0.2109 0.0000 0.0000 0.7082 0.2366 

F76A Arrhythmia, Cardiac Arrest and Conduction Disorders, Major Complexity NO NO 4.3 1 13 12% 154% 0.0000 0.0000 0.0000 1.1175 0.2419 

F76B Arrhythmia, Cardiac Arrest and Conduction Disorders, Minor Complexity YES NO 1.9 1 6 20% 200% 0.1601 0.0000 0.0000 0.4775 0.2223 

G01A Rectal Resection, Major Complexity NO NO 26.1 8 78 16% 100% 0.0000 2.6830 1.1026 11.5040 0.2950 

G01B Rectal Resection, Intermediate Complexity NO NO 13.9 4 42 17% 100% 0.0000 2.0446 1.2292 6.9613 0.2891 

G01C Rectal Resection, Minor Complexity NO NO 8.1 2 24 19% 100% 0.0000 1.6709 1.5133 4.6974 0.2831 

G02A Major Small and Large Bowel Procedures, Major Complexity NO NO 24.2 8 73 13% 127% 0.0000 1.6547 1.1092 10.5282 0.2950 

G02B Major Small and Large Bowel Procedures, Intermediate Complexity NO NO 10.5 3 31 16% 116% 0.0000 1.2912 1.1967 4.8813 0.2844 

G02C Major Small and Large Bowel Procedures, Minor Complexity NO NO 5.6 1 17 17% 100% 0.0000 0.0000 0.0000 3.0403 0.3184 

G03A Stomach, Oesophageal and Duodenal Procedures, Major Complexity NO NO 17.0 5 51 16% 100% 0.0000 1.9596 1.4353 9.1361 0.3079 

G03B Stomach, Oesophageal and Duodenal Procedures, Intermediate Complexity NO NO 8.0 2 24 15% 117% 0.0000 1.1261 1.6593 4.4448 0.3323 

G03C Stomach, Oesophageal and Duodenal Procedures, Minor Complexity NO NO 3.8 1 11 15% 119% 0.0000 0.0000 0.0000 2.3537 0.3299 

G04A Peritoneal Adhesiolysis, Major Complexity NO NO 13.4 4 40 11% 121% 0.0000 1.2048 1.1079 5.6365 0.3119 

G04B Peritoneal Adhesiolysis, Intermediate Complexity NO NO 6.0 2 18 15% 133% 0.0000 0.8497 1.0253 2.9003 0.2870 

G04C Peritoneal Adhesiolysis, Minor Complexity NO NO 2.6 1 9 16% 125% 0.0000 0.0000 0.0000 1.6293 0.3255 

G05A Minor Small and Large Bowel Procedures, Major Complexity NO NO 10.4 3 31 14% 100% 0.0000 1.1118 1.0329 4.2106 0.2732 

G05B Minor Small and Large Bowel Procedures, Minor Complexity NO NO 3.7 1 11 15% 80% 0.0000 0.0000 0.0000 1.9595 0.3531 

G06Z Pyloromyotomy NO NO 3.2 1 11 17% 100% 0.0000 0.0000 0.0000 1.8326 0.3896 

G07A Appendicectomy, Major Complexity NO NO 4.4 1 13 12% 136% 0.0000 0.0000 0.0000 2.0347 0.3173 

G07B Appendicectomy, Minor Complexity NO NO 2.1 1 7 14% 121% 0.0000 0.0000 0.0000 1.2585 0.3020 

G10A Hernia Procedures, Major Complexity NO NO 3.7 1 11 15% 88% 0.0000 0.0000 0.0000 1.9713 0.2978 



 
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Upper 
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Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

G10B Hernia Procedures, Minor Complexity NO NO 1.3 1 4 23% 80% 0.0000 0.0000 0.0000 0.9914 0.2692 

G11A Anal and Stomal Procedures, Major Complexity NO NO 4.5 1 14 13% 168% 0.0000 0.0000 0.0000 1.5287 0.2501 

G11B Anal and Stomal Procedures, Minor Complexity NO NO 1.4 1 4 16% 107% 0.0000 0.0000 0.0000 0.6831 0.2538 

G12A Other Digestive System GIs, Major Complexity NO NO 18.4 6 55 12% 100% 0.0000 0.6161 1.0277 6.7825 0.2745 

G12B Other Digestive System GIs, Intermediate Complexity NO NO 7.2 2 22 14% 126% 0.0000 0.5084 1.1179 2.7442 0.2448 

G12C Other Digestive System GIs, Minor Complexity YES NO 3.3 1 10 18% 132% 0.7348 0.0000 0.0000 1.5273 0.2397 

G46A Complex Endoscopy, Major Complexity YES NO 6.9 2 21 14% 162% 0.4891 0.3275 1.0382 2.4038 0.2804 

G46B Complex Endoscopy, Minor Complexity NO NO 1.1 1 3 34% 200% 0.0000 0.0000 0.0000 0.4326 0.3086 

G47A Gastroscopy, Major Complexity NO NO 6.3 2 19 12% 163% 0.0000 0.2206 0.9379 2.0964 0.2642 

G47B Gastroscopy, Intermediate Complexity YES NO 3.0 1 9 19% 138% 0.3616 0.0000 0.0000 0.9897 0.2306 

G47C Gastroscopy, Minor Complexity YES NO 2.0 1 6 28% 153% 0.2849 0.0000 0.0000 0.7131 0.2059 

G48A Colonoscopy, Major Complexity YES NO 6.2 2 18 14% 170% 0.3615 0.2205 0.8317 1.8840 0.2330 

G48B Colonoscopy, Minor Complexity NO NO 1.1 1 3 39% 200% 0.0000 0.0000 0.0000 0.3458 0.1104 

G60A Digestive Malignancy, Major Complexity NO NO 8.1 2 24 8% 100% 0.0000 0.0000 1.0275 2.0550 0.2277 

G60B Digestive Malignancy, Minor Complexity YES NO 3.5 1 10 13% 100% 0.2705 0.0000 0.0000 0.7384 0.2027 

G61A Gastrointestinal Haemorrhage, Major Complexity NO NO 4.2 1 13 13% 111% 0.0000 0.0000 0.0000 0.9522 0.2317 

G61B Gastrointestinal Haemorrhage, Minor Complexity YES NO 2.1 1 6 14% 137% 0.1106 0.0000 0.0000 0.4892 0.2078 

G64A Inflammatory Bowel Disease, Major Complexity YES NO 5.1 1 15 11% 173% 0.2308 0.0000 0.0000 1.1971 0.2350 

G64B Inflammatory Bowel Disease, Minor Complexity NO NO 1.1 1 3 8% 100% 0.0000 0.0000 0.0000 0.2975 0.2277 

G65A Gastrointestinal Obstruction, Major Complexity NO NO 5.8 1 17 10% 112% 0.0000 0.0000 0.0000 1.4783 0.2558 

G65B Gastrointestinal Obstruction, Minor Complexity NO NO 2.6 1 8 15% 89% 0.0000 0.0000 0.0000 0.6221 0.2279 

G66A Abdominal Pain and Mesenteric Adenitis, Major Complexity YES NO 2.5 1 8 15% 123% 0.1101 0.0000 0.0000 0.6059 0.2357 



 
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Private 
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Service Adj. 
Paediatric 

Adj. Same Day 
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Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

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G66B Abdominal Pain and Mesenteric Adenitis, Minor Complexity NO NO 1.2 1 4 19% 138% 0.0000 0.0000 0.0000 0.1999 0.1534 

G67A Oesophagitis and Gastroenteritis, Major Complexity NO NO 3.8 1 11 10% 106% 0.0000 0.0000 0.0000 0.8995 0.2466 

G67B Oesophagitis and Gastroenteritis, Minor Complexity NO NO 1.3 1 4 13% 110% 0.0000 0.0000 0.0000 0.2337 0.1757 

G70A Other Digestive System Disorders, Major Complexity NO NO 5.4 1 16 10% 161% 0.0000 0.0000 0.0000 1.3019 0.2538 

G70B Other Digestive System Disorders, Intermediate Complexity YES NO 2.8 1 9 13% 159% 0.1468 0.0000 0.0000 0.6512 0.2109 

G70C Other Digestive System Disorders, Minor Complexity NO NO 1.3 1 4 17% 153% 0.0000 0.0000 0.0000 0.2333 0.1740 

H01A Pancreas, Liver and Shunt Procedures, Major Complexity NO NO 20.5 6 61 16% 100% 0.0000 2.9734 1.1580 9.9212 0.2975 

H01B Pancreas, Liver and Shunt Procedures, Intermediate Complexity NO NO 8.5 2 26 18% 100% 0.0000 0.6096 2.2949 5.1993 0.3062 

H01C Pancreas, Liver and Shunt Procedures, Minor Complexity NO NO 2.9 1 9 23% 100% 0.0000 0.0000 0.0000 1.8536 0.4599 

H02A Major Biliary Tract Procedures, Major Complexity NO NO 20.1 6 60 15% 93% 0.0000 1.4689 1.1491 8.3635 0.2944 

H02B Major Biliary Tract Procedures, Intermediate Complexity NO NO 9.0 3 27 20% 100% 0.0000 0.6914 1.0926 3.9692 0.2541 

H02C Major Biliary Tract Procedures, Minor Complexity NO NO 3.9 1 12 23% 100% 0.0000 0.0000 0.0000 1.7735 0.3106 

H05A Hepatobiliary Diagnostic Procedures, Major Complexity NO NO 10.5 3 31 20% 100% 0.0000 0.7100 1.4108 4.9426 0.2718 

H05B Hepatobiliary Diagnostic Procedures, Intermediate Complexity NO NO 4.2 1 13 16% 100% 0.0000 0.0000 0.0000 1.9498 0.3040 

H05C Hepatobiliary Diagnostic Procedures, Minor Complexity NO NO 1.4 1 4 35% 100% 0.0000 0.0000 0.0000 0.6789 0.3392 

H06A Other Hepatobiliary and Pancreas GIs, Major Complexity NO NO 19.6 13 29 10% 100% 0.0000 0.4592 0.5286 7.3311 0.3000 

H06B Other Hepatobiliary and Pancreas GIs, Intermediate Complexity NO NO 8.5 2 25 18% 100% 0.0000 0.3772 1.3771 3.1314 0.2298 

H06C Other Hepatobiliary and Pancreas GIs, Minor Complexity NO NO 1.6 1 5 63% 100% 0.0000 0.0000 0.0000 0.8093 0.2979 

H07A Open Cholecystectomy, Major Complexity NO NO 15.2 5 46 14% 100% 0.0000 1.3734 1.0173 6.4600 0.3079 

H07B Open Cholecystectomy, Intermediate Complexity NO NO 7.8 2 23 14% 100% 0.0000 1.3553 1.2838 3.9229 0.2721 

H07C Open Cholecystectomy, Minor Complexity NO NO 4.7 1 14 14% 100% 0.0000 0.0000 0.0000 2.6669 0.3136 



 
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Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
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Base 

Short-Stay 
Outlier Per 

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Inlier 

Long-Stay 
Outlier Per 

Diem 

H08A Laparoscopic Cholecystectomy, Major Complexity NO NO 6.0 2 18 17% 100% 0.0000 0.8523 1.0627 2.9777 0.2738 

H08B Laparoscopic Cholecystectomy, Minor Complexity NO NO 2.0 1 6 19% 125% 0.0000 0.0000 0.0000 1.5255 0.2771 

H09Z Liver Transplant NO NO 20.9 6 63 6% 156% 0.0000 4.3635 2.8453 21.4352 0.5264 

H60A Cirrhosis and Alcoholic Hepatitis, Major Complexity NO NO 12.0 3 36 10% 100% 0.0000 0.0000 1.2287 3.6860 0.2639 

H60B Cirrhosis and Alcoholic Hepatitis, Intermediate Complexity NO NO 5.0 1 15 11% 100% 0.0000 0.0000 0.0000 1.3837 0.2515 

H60C Cirrhosis and Alcoholic Hepatitis, Minor Complexity YES NO 3.2 1 10 15% 100% 0.2615 0.0000 0.0000 0.8202 0.2195 

H61A Malignancy of Hepatobiliary System and Pancreas, Major Complexity NO NO 8.6 2 26 13% 100% 0.0000 0.1448 1.2095 2.5637 0.2591 

H61B Malignancy of Hepatobiliary System and Pancreas, Minor Complexity YES NO 4.2 1 13 19% 137% 0.3302 0.0000 0.0000 1.0811 0.2465 

H62A Disorders of Pancreas, Except Malignancy, Major Complexity NO NO 6.8 2 20 12% 151% 0.0000 0.0000 1.0003 2.0005 0.2881 

H62B Disorders of Pancreas, Except Malignancy, Minor Complexity YES NO 3.0 1 9 16% 168% 0.2492 0.0000 0.0000 0.7519 0.2381 

H63A Other Disorders of Liver, Major Complexity NO NO 7.4 2 22 13% 142% 0.0000 0.0000 0.9643 1.9286 0.2277 

H63B Other Disorders of Liver, Intermediate Complexity YES NO 3.7 1 11 19% 152% 0.2034 0.0000 0.0000 0.7712 0.1701 

H63C Other Disorders of Liver, Minor Complexity YES NO 2.2 1 6 28% 146% 0.2550 0.0000 0.0000 0.6092 0.2000 

H64A Disorders of the Biliary Tract, Major Complexity NO NO 7.2 2 22 15% 157% 0.0000 0.1494 1.0617 2.2728 0.2581 

H64B Disorders of the Biliary Tract, Intermediate Complexity YES NO 3.7 1 11 18% 173% 0.3375 0.0000 0.0000 1.0595 0.2478 

H64C Disorders of the Biliary Tract, Minor Complexity YES NO 2.4 1 7 23% 142% 0.2637 0.0000 0.0000 0.6750 0.2344 

H65A Bleeding Oesophageal Varices, Major Complexity NO NO 9.3 3 28 13% 100% 0.0000 0.4694 1.0538 3.6308 0.2610 

H65B Bleeding Oesophageal Varices, Intermediate Complexity NO NO 4.7 1 14 13% 100% 0.0000 0.0000 0.0000 1.8922 0.3223 

H65C Bleeding Oesophageal Varices, Minor Complexity NO NO 2.6 1 8 14% 100% 0.0000 0.0000 0.0000 1.0018 0.3557 

I01A Bilateral and Multiple Major Joint Procs of Lower Limb, Major Complexity NO NO 24.8 8 75 27% 100% 0.0000 3.7508 1.1144 12.6658 0.2457 

I01B Bilateral and Multiple Major Joint Procs of Lower Limb, Minor Complexity NO NO 6.3 2 19 27% 100% 0.0000 4.1599 1.1132 6.3863 0.2313 



 
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Patient 

Service Adj. 
Paediatric 

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Outlier Per 

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Long-Stay 
Outlier Per 

Diem 

I02A Microvascular Tissue Transfers or Skin Grafts, Excluding Hand, Major Complexity NO NO 38.2 12 115 15% 100% 0.0000 4.1908 1.1364 17.8271 0.3000 

I02B Microvascular Tissue Transfers or Skin Grafts, Ex Hand, Intermediate Comp NO NO 17.7 5 53 15% 100% 0.0000 0.9755 1.4995 8.4731 0.3111 

I02C Microvascular Tissue Transfers or Skin Grafts, Excluding Hand, Minor Complexity NO NO 6.8 2 20 14% 83% 0.0000 0.5166 1.7578 4.0321 0.3321 

I03A Hip Replacement for Trauma, Major Complexity NO NO 17.2 5 52 23% 100% 0.0000 2.0719 0.9287 6.7153 0.2466 

I03B Hip Replacement for Trauma, Minor Complexity NO NO 8.2 2 25 29% 100% 0.0000 2.1216 0.9647 4.0509 0.2362 

I04A Knee Replacement, Major Complexity NO NO 9.8 3 30 28% 100% 0.0000 2.0638 1.0709 5.2766 0.2468 

I04B Knee Replacement, Minor Complexity NO NO 4.7 1 14 42% 100% 0.0000 0.0000 0.0000 3.7899 0.2328 

I05A Other Joint Replacement, Major Complexity NO NO 8.9 2 27 37% 100% 0.0000 2.9523 1.4525 5.8572 0.2475 

I05B Other Joint Replacement, Minor Complexity NO NO 3.0 1 9 34% 100% 0.0000 0.0000 0.0000 3.9061 0.2805 

I06Z Spinal Fusion for Deformity NO NO 8.5 2 26 41% 110% 0.0000 3.8509 3.5721 10.9950 0.4865 

I07Z Amputation NO NO 23.3 8 73 24% 100% 0.0000 1.0376 0.9631 8.7420 0.2663 

I08A Other Hip and Femur Procedures, Major Complexity NO NO 19.7 6 59 15% 91% 0.0000 1.4853 0.9728 7.3219 0.2387 

I08B Other Hip and Femur Procedures, Intermediate Complexity NO NO 10.7 3 32 20% 90% 0.0000 1.2630 1.0132 4.3026 0.2292 

I08C Other Hip and Femur Procedures, Minor Complexity NO NO 6.3 2 19 23% 100% 0.0000 0.9759 0.9609 2.8977 0.2369 

I09A Spinal Fusion, Major Complexity NO NO 19.2 6 58 25% 100% 0.0000 4.5532 1.1667 11.5537 0.2731 

I09B Spinal Fusion, Intermediate Complexity NO NO 7.6 2 23 40% 100% 0.0000 3.1065 1.7599 6.6262 0.3226 

I09C Spinal Fusion, Minor Complexity NO NO 4.3 1 13 33% 100% 0.0000 0.0000 0.0000 4.7882 0.3525 

I10A Other Back and Neck Procedures, Major Complexity NO NO 9.3 3 28 16% 100% 0.0000 1.3214 1.1198 4.6809 0.2748 

I10B Other Back and Neck Procedures, Minor Complexity NO NO 2.9 1 9 35% 100% 0.0000 0.0000 0.0000 2.0608 0.2820 

I11Z Limb Lengthening Procedures NO NO 6.0 1 14 24% 142% 0.0000 0.0000 0.0000 3.5895 0.2941 

I12A Misc Musculoskeletal Procs for Infect/ Inflam of Bone/Joint, Major Complexity NO NO 23.0 15 35 9% 108% 0.0000 0.7500 0.4697 7.7949 0.2418 

I12B Misc Musculoskeletal Procs for Infect/ Inflam of Bone/Joint, Intermediate Comp NO NO 11.1 3 33 9% 91% 0.0000 0.6066 1.0073 3.6285 0.1907 



 
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Service Adj. 
Paediatric 

Adj. Same Day 
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Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

I12C Misc Musculoskeletal Procs for Infect/ Inflam of Bone/Joint, Minor Complexity NO NO 4.4 1 13 11% 119% 0.0000 0.0000 0.0000 1.5219 0.2160 

I13A Humerus, Tibia, Fibula and Ankle Procedures, Major Complexity NO NO 12.2 4 36 18% 100% 0.0000 1.1720 1.0258 5.2754 0.2629 

I13B Humerus, Tibia, Fibula and Ankle Procedures, Intermediate Complexity NO NO 5.0 1 15 23% 86% 0.0000 0.0000 0.0000 2.6966 0.2798 

I13C Humerus, Tibia, Fibula and Ankle Procedures, Minor Complexity NO NO 2.4 1 7 25% 80% 0.0000 0.0000 0.0000 1.7200 0.3408 

I15Z Cranio-Facial Surgery NO NO 4.8 1 14 24% 164% 0.0000 0.0000 0.0000 3.0569 0.2778 

I16Z Other Shoulder Procedures NO NO 1.3 1 4 25% 100% 0.0000 0.0000 0.0000 1.5580 0.4578 

I17A Maxillo-Facial Surgery, Major Complexity NO NO 3.6 1 11 18% 100% 0.0000 0.0000 0.0000 3.0119 0.4087 

I17B Maxillo-Facial Surgery, Minor Complexity NO NO 1.5 1 4 14% 100% 0.0000 0.0000 0.0000 1.5486 0.4824 

I18A Other Knee Procedures, Major Complexity YES NO 3.9 1 12 17% 106% 0.6699 0.0000 0.0000 1.7190 0.2113 

I18B Other Knee Procedures, Minor Complexity NO NO 1.0 1 3 36% 154% 0.0000 0.0000 0.0000 0.6876 0.2082 

I19A Other Elbow and Forearm Procedures, Major Complexity NO NO 6.3 2 19 20% 100% 0.0000 1.1124 1.1122 3.3369 0.2538 

I19B Other Elbow and Forearm Procedures, Minor Complexity NO NO 1.7 1 5 30% 87% 0.0000 0.0000 0.0000 1.5551 0.2992 

I20A Other Foot Procedures, Major Complexity NO NO 5.5 1 16 19% 108% 0.0000 0.0000 0.0000 2.5013 0.2467 

I20B Other Foot Procedures, Minor Complexity NO NO 1.5 1 5 21% 100% 0.0000 0.0000 0.0000 1.2616 0.3031 

I21A 
Local Excision and Removal of Internal 
Fixation Devices of Hip &amp; Femur, Maj 
Comp 

NO NO 4.5 1 13 12% 80% 0.0000 0.0000 0.0000 1.8489 0.2942 

I21B Local Excision and Removal of Internal Fixation Devs of Hip &amp; Femur, Min Comp NO NO 1.1 1 3 9% 93% 0.0000 0.0000 0.0000 0.9753 0.2986 

I23A Local Excision &amp; Removal of Internal Fixation Device, Ex Hip &amp; Fmr, Maj Comp YES NO 2.9 1 9 14% 112% 0.6626 0.0000 0.0000 1.6305 0.2338 

I23B Local Excision &amp; Removal of Internal Fixation Device, Ex Hip &amp; Fmr, Min Comp NO NO 1.0 1 3 15% 100% 0.0000 0.0000 0.0000 0.5649 0.1641 

I24A Arthroscopy, Major Complexity NO NO 3.4 1 10 16% 100% 0.0000 0.0000 0.0000 1.4651 0.2182 

I24B Arthroscopy, Minor Complexity NO NO 1.1 1 3 16% 100% 0.0000 0.0000 0.0000 0.7044 0.2548 

I25A Bone and Joint Diagnostic Procedures Including Biopsy, Major Complexity NO NO 11.8 3 35 12% 93% 0.0000 0.3171 1.3068 4.2374 0.2401 

I25B Bone and Joint Diagnostic Procedures Including Biopsy, Minor Complexity YES NO 4.4 1 13 17% 108% 0.4808 0.0000 0.0000 1.6569 0.2238 



 
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I27A Soft Tissue Procedures, Major Complexity NO NO 11.4 3 34 10% 81% 0.0000 0.6912 1.2816 4.5362 0.2557 

I27B Soft Tissue Procedures, Minor Complexity YES NO 2.2 1 7 16% 115% 0.5684 0.0000 0.0000 1.2574 0.2719 

I28A Other Musculoskeletal Procedures, Major Complexity NO NO 12.6 4 38 13% 100% 0.0000 0.9017 0.9301 4.6219 0.2516 

I28B Other Musculoskeletal Procedures, Intermediate Complexity YES NO 2.7 1 8 26% 112% 1.0472 0.0000 0.0000 1.8410 0.2352 

I28C Other Musculoskeletal Procedures, Minor Complexity YES NO 2.0 1 6 18% 111% 0.5723 0.0000 0.0000 1.0868 0.2581 

I29Z Knee Reconstructions, and Revisions of Reconstructions NO NO 1.3 1 4 32% 112% 0.0000 0.0000 0.0000 1.7094 0.4721 

I30Z Hand Procedures NO NO 1.2 1 4 21% 93% 0.0000 0.0000 0.0000 0.8282 0.2198 

I31A Revision of Hip Replacement, Major Complexity NO NO 26.1 8 78 22% 100% 0.0000 3.0916 1.0144 11.2068 0.2255 

I31B Revision of Hip Replacement, Intermediate Complexity NO NO 12.1 4 36 25% 100% 0.0000 2.8282 0.9657 6.6911 0.2200 

I31C Revision of Hip Replacement, Minor Complexity NO NO 6.9 2 21 37% 100% 0.0000 2.6445 1.0574 4.7593 0.2020 

I32A Revision of Knee Replacement, Major Complexity NO NO 20.2 13 30 25% 100% 0.0000 3.9533 0.4573 9.8988 0.1585 

I32B Revision of Knee Replacement, Minor Complexity NO NO 7.5 2 23 25% 100% 0.0000 1.8855 1.7029 5.2912 0.1587 

I33A Hip Replacement for Non-Trauma, Major Complexity NO NO 9.4 3 28 41% 100% 0.0000 2.5064 0.9644 5.3996 0.2613 

I33B Hip Replacement for Non-Trauma, Minor Complexity NO NO 4.4 1 13 53% 100% 0.0000 0.0000 0.0000 3.9319 0.2180 

I60Z Femoral Shaft Fractures NO NO 9.4 3 28 5% 100% 0.0000 0.2099 0.9866 3.1697 0.2501 

I61A Distal Femoral Fractures, Major Complexity NO NO 14.1 4 42 9% 100% 0.0000 0.0000 0.7963 3.1853 0.2124 

I61B Distal Femoral Fractures, Minor Complexity NO NO 4.9 1 15 7% 113% 0.0000 0.0000 0.0000 0.8147 0.2268 

I63A Sprains, Strains and Dislocations of Hip, Pelvis and Thigh, Major Complexity NO NO 5.2 1 16 9% 100% 0.0000 0.0000 0.0000 1.1783 0.2400 

I63B Sprains, Strains and Dislocations of Hip, Pelvis and Thigh, Minor Complexity NO NO 1.5 1 4 14% 127% 0.0000 0.0000 0.0000 0.2903 0.2084 

I64A Osteomyelitis, Major Complexity NO NO 14.6 4 44 8% 110% 0.0000 0.0000 0.9390 3.7559 0.1752 

I64B Osteomyelitis, Minor Complexity NO NO 6.6 2 20 8% 100% 0.0000 0.0000 0.7416 1.4832 0.1203 



 
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I65A Musculoskeletal Malignant Neoplasms, Major Complexity NO NO 10.3 3 31 9% 100% 0.0000 0.0000 1.0918 3.2753 0.2563 

I65B Musculoskeletal Malignant Neoplasms, Minor Complexity NO NO 4.1 1 12 10% 115% 0.0000 0.0000 0.0000 1.1996 0.2500 

I66A Inflammatory Musculoskeletal Disorders, Major Complexity NO NO 7.1 2 21 11% 114% 0.0000 0.0000 1.0897 2.1794 0.2678 

I66B Inflammatory Musculoskeletal Disorders, Minor Complexity NO NO 1.3 1 4 10% 100% 0.0000 0.0000 0.0000 0.3148 0.2321 

I67A Septic Arthritis, Major Complexity NO NO 12.5 4 38 9% 100% 0.0000 0.0000 0.9281 3.7122 0.1989 

I67B Septic Arthritis, Minor Complexity NO NO 4.7 1 14 8% 117% 0.0000 0.0000 0.0000 0.7895 0.1581 

I68A Non-surgical Spinal Disorders, Major Complexity NO NO 6.3 2 19 10% 113% 0.0000 0.0000 0.8549 1.7099 0.2049 

I68B Non-surgical Spinal Disorders, Minor Complexity NO NO 1.6 1 5 12% 150% 0.0000 0.0000 0.0000 0.3034 0.2127 

I69A Bone Diseases and Arthropathies, Major Complexity NO NO 5.6 1 17 10% 80% 0.0000 0.0000 0.0000 1.2571 0.2311 

I69B Bone Diseases and Arthropathies, Minor Complexity NO NO 1.8 1 5 12% 138% 0.0000 0.0000 0.0000 0.2682 0.1885 

I71A Other Musculotendinous Disorders, Major Complexity NO NO 4.3 1 13 10% 91% 0.0000 0.0000 0.0000 0.9823 0.2438 

I71B Other Musculotendinous Disorders, Minor Complexity NO NO 1.4 1 4 15% 157% 0.0000 0.0000 0.0000 0.2285 0.1632 

I72A Specific Musculotendinous Disorders, Major Complexity NO NO 5.8 1 17 7% 100% 0.0000 0.0000 0.0000 1.2833 0.2412 

I72B Specific Musculotendinous Disorders, Minor Complexity NO NO 1.9 1 6 12% 100% 0.0000 0.0000 0.0000 0.3037 0.1863 

I73A Aftercare of Musculoskeletal Implants or Prostheses, Major Complexity NO NO 11.8 3 35 6% 87% 0.0000 0.0000 0.9171 2.7514 0.1843 

I73B Aftercare of Musculoskeletal Implants or Prostheses, Intermediate Complexity NO NO 4.4 1 13 12% 100% 0.0000 0.0000 0.0000 0.6705 0.1337 

I73C Aftercare of Musculoskeletal Implants or Prostheses, Minor Complexity NO NO 1.3 1 4 14% 159% 0.0000 0.0000 0.0000 0.3105 0.1587 

I74A Injuries to Forearm, Wrist, Hand and Foot, Major Complexity NO NO 4.0 1 12 13% 88% 0.0000 0.0000 0.0000 0.7929 0.2118 

I74B Injuries to Forearm, Wrist, Hand and Foot, Minor Complexity NO NO 1.2 1 3 27% 133% 0.0000 0.0000 0.0000 0.3083 0.1731 

I75A Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Major Complexity NO NO 9.6 3 29 8% 84% 0.0000 0.0000 0.7845 2.3534 0.1984 

I75B Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Intermediate Complexity NO NO 2.1 1 6 14% 130% 0.0000 0.0000 0.0000 0.4204 0.2240 



 
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I75C Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Minor Complexity NO NO 1.2 1 4 16% 166% 0.0000 0.0000 0.0000 0.1802 0.1329 

I76A Other Musculoskeletal Disorders, Major Complexity NO NO 6.5 2 20 10% 100% 0.0000 0.1091 0.8344 1.7780 0.1936 

I76B Other Musculoskeletal Disorders, Minor Complexity NO NO 1.4 1 4 18% 129% 0.0000 0.0000 0.0000 0.2385 0.1762 

I77A Fractures of Pelvis, Major Complexity NO NO 10.9 3 33 8% 100% 0.0000 0.0000 0.8945 2.6835 0.2136 

I77B Fractures of Pelvis, Minor Complexity NO NO 3.7 1 11 11% 100% 0.0000 0.0000 0.0000 0.7678 0.2207 

I78A Fractures of Neck of Femur, Major Complexity NO NO 13.3 4 40 9% 100% 0.0000 0.0000 0.7293 2.9174 0.1955 

I78B Fractures of Neck of Femur, Minor Complexity NO NO 5.0 1 15 14% 100% 0.0000 0.0000 0.0000 0.9726 0.2108 

I79A Pathological Fractures, Major Complexity NO NO 14.9 4 45 9% 100% 0.0000 0.0000 1.0256 4.1023 0.2533 

I79B Pathological Fractures, Intermediate Complexity NO NO 7.0 2 21 10% 100% 0.0000 0.0000 0.9605 1.9211 0.2344 

I79C Pathological Fractures, Minor Complexity NO NO 3.4 1 10 10% 100% 0.0000 0.0000 0.0000 0.8419 0.2531 

I80Z Femoral Fractures, Transferred to Acute Facility &lt;2 Days NO NO 1.0 1 1 53% 100% 0.0000 0.0000 0.0000 0.2192 0.0000 

J01A Microvas Tiss Transf for Skin, Subcut Tiss &amp; Breast Dsrds, Major Complexity NO NO 21.4 7 64 25% 100% 0.0000 4.3945 1.1587 12.5051 0.2729 

J01B Microvas Tiss Transf for Skin, Subcut Tiss &amp; Breast Dsrds, Minor Complexity NO NO 8.7 2 26 28% 100% 0.0000 2.9167 1.4815 5.8798 0.2335 

J06A Major Procedures for Breast Disorders, Major Complexity NO NO 6.2 2 19 18% 100% 0.0000 1.0489 0.9704 2.9897 0.1859 

J06B Major Procedures for Breast Disorders, Minor Complexity NO NO 3.0 1 9 29% 93% 0.0000 0.0000 0.0000 1.7945 0.1744 

J07Z Minor Procedures for Breast Disorders NO NO 1.1 1 3 32% 100% 0.0000 0.0000 0.0000 0.8676 0.3049 

J08A Other Skin Grafts and Debridement Procedures, Major Complexity NO NO 19.1 6 57 7% 100% 0.0000 0.4922 0.9717 6.3223 0.2549 

J08B Other Skin Grafts and Debridement Procedures, Intermediate Complexity YES NO 4.6 1 14 11% 115% 0.6367 0.0000 0.0000 1.6446 0.2372 

J08C Other Skin Grafts and Debridement Procedures, Minor Complexity YES NO 2.5 1 8 24% 121% 0.5735 0.0000 0.0000 1.2985 0.2273 

J09Z Perianal and Pilonidal Procedures NO NO 2.1 1 7 13% 105% 0.0000 0.0000 0.0000 0.7532 0.2719 

J10A Plastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Major Comp YES NO 3.7 1 11 21% 100% 0.6796 0.0000 0.0000 1.9876 0.2463 

J10B Plastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Minor Comp NO NO 1.1 1 3 30% 105% 0.0000 0.0000 0.0000 0.6189 0.1805 



 
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J11A Other Skin, Subcutaneous Tissue and Breast Procedures, Major Complexity YES NO 4.4 1 13 16% 100% 0.5447 0.0000 0.0000 1.3813 0.2281 

J11B Other Skin, Subcutaneous Tissue and Breast Procedures, Minor Complexity NO NO 1.0 1 3 25% 109% 0.0000 0.0000 0.0000 0.4304 0.1353 

J12A Lower Limb Procedures W Ulcer or Cellulitis, Major Complexity NO NO 17.8 5 53 9% 100% 0.0000 0.2633 1.0617 5.5720 0.2784 

J12B Lower Limb Procedures W Ulcer or Cellulitis, Minor Complexity NO NO 6.5 2 20 8% 100% 0.0000 0.2581 0.9658 2.1896 0.2352 

J13A Lower Limb Procedures W/O Ulcer or Cellulitis, Major Complexity NO NO 7.7 2 23 10% 100% 0.0000 0.5079 1.1816 2.8711 0.2459 

J13B Lower Limb Procedures W/O Ulcer or Cellulitis, Minor Complexity YES NO 3.9 1 12 15% 100% 0.5520 0.0000 0.0000 1.5928 0.2365 

J14Z Major Breast Reconstructions NO NO 6.6 2 23 19% 100% 0.0000 0.9645 2.0644 5.0932 0.3943 

J60A Skin Ulcers, Major Complexity NO NO 10.6 3 32 7% 100% 0.0000 0.0000 0.9033 2.7100 0.2232 

J60B Skin Ulcers, Intermediate Complexity YES NO 5.4 1 16 9% 100% 0.1677 0.0000 0.0000 1.0738 0.1875 

J60C Skin Ulcers, Minor Complexity YES NO 4.4 1 13 10% 100% 0.1713 0.0000 0.0000 0.7318 0.1584 

J62A Malignant Breast Disorders, Major Complexity NO NO 8.6 2 26 7% 100% 0.0000 0.0000 1.1334 2.2668 0.2355 

J62B Malignant Breast Disorders, Minor Complexity YES NO 4.4 1 13 13% 100% 0.2250 0.0000 0.0000 0.8582 0.1754 

J63A Non-Malignant Breast Disorders, Major Complexity YES NO 2.9 1 9 9% 100% 0.2364 0.0000 0.0000 0.7675 0.2021 

J63B Non-Malignant Breast Disorders, Minor Complexity YES NO 2.5 1 8 10% 100% 0.2741 0.0000 0.0000 0.5964 0.1892 

J64A Cellulitis, Major Complexity NO NO 5.9 1 18 9% 95% 0.0000 0.0000 0.0000 1.4059 0.2247 

J64B Cellulitis, Minor Complexity YES NO 2.9 1 9 8% 125% 0.1533 0.0000 0.0000 0.6730 0.1502 

J65A Trauma to Skin, Subcutaneous Tissue and Breast, Major Complexity YES NO 5.0 1 15 11% 85% 0.1216 0.0000 0.0000 1.1538 0.2226 

J65B Trauma to Skin, Subcutaneous Tissue and Breast, Minor Complexity NO NO 1.2 1 4 17% 128% 0.0000 0.0000 0.0000 0.2069 0.1545 

J67A Minor Skin Disorders, Major Complexity YES NO 4.0 1 12 8% 115% 0.2470 0.0000 0.0000 1.0108 0.2368 

J67B Minor Skin Disorders, Minor Complexity YES NO 2.0 1 6 18% 128% 0.1895 0.0000 0.0000 0.4220 0.1970 

J68A Major Skin Disorders, Major Complexity YES NO 5.1 1 15 7% 100% 0.2322 0.0000 0.0000 1.4230 0.2607 

J68B Major Skin Disorders, Minor Complexity YES NO 2.9 1 9 8% 115% 0.1747 0.0000 0.0000 0.7781 0.2474 

J69A Skin Malignancy, Major Complexity NO NO 10.7 3 32 7% 100% 0.0000 0.0000 1.0608 3.1823 0.2392 



 
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J69B Skin Malignancy, Minor Complexity YES NO 5.1 1 15 7% 100% 0.1596 0.0000 0.0000 1.2128 0.2209 

K01A GIs for Diabetic Complications, Major Complexity NO NO 30.7 10 92 8% 100% 0.0000 0.7289 1.0042 10.7704 0.2834 

K01B GIs for Diabetic Complications, Intermediate Complexity NO NO 17.9 5 54 7% 100% 0.0000 0.4016 1.0585 5.6941 0.2392 

K01C GIs for Diabetic Complications, Minor Complexity NO NO 7.8 2 24 8% 100% 0.0000 0.3301 1.2002 2.7305 0.2554 

K02Z Pituitary Procedures NO NO 7.0 2 21 26% 100% 0.0000 1.3643 1.4187 4.2017 0.3539 

K03Z Adrenal Procedures NO NO 4.5 2 20 15% 100% 0.0000 1.0573 1.0602 3.1777 0.4003 

K05A Parathyroid Procedures, Major Complexity NO NO 5.1 1 15 20% 100% 0.0000 0.0000 0.0000 2.5018 0.2683 

K05B Parathyroid Procedures, Minor Complexity NO NO 1.3 1 4 28% 100% 0.0000 0.0000 0.0000 1.3386 0.3235 

K06A Thyroid Procedures, Major Complexity NO NO 4.0 1 12 19% 100% 0.0000 0.0000 0.0000 2.9914 0.3838 

K06B Thyroid Procedures, Minor Complexity NO NO 1.6 1 5 19% 111% 0.0000 0.0000 0.0000 1.7170 0.4469 

K08Z Thyroglossal Procedures NO NO 1.4 1 4 15% 90% 0.0000 0.0000 0.0000 1.3441 0.4283 

K09A Other Endocrine, Nutritional and Metabolic GIs, Major Complexity NO NO 16.8 5 50 12% 100% 0.0000 0.7965 1.3107 7.3502 0.3027 

K09B Other Endocrine, Nutritional and Metabolic GIs, Minor Complexity NO NO 4.5 1 14 12% 100% 0.0000 0.0000 0.0000 2.5273 0.2811 

K10Z Revisional and Open Bariatric Procedures NO NO 10.2 3 30 15% 100% 0.0000 1.5016 0.8463 4.0407 0.2967 

K11Z Major Laparoscopic Bariatric Procedures NO NO 2.8 1 8 45% 100% 0.0000 0.0000 0.0000 2.2050 0.4656 

K12Z Other Bariatric Procedures NO NO 2.4 1 7 15% 100% 0.0000 0.0000 0.0000 1.5437 0.4362 

K13Z Plastic GIs for Endocrine, Nutritional and Metabolic Disorders NO NO 4.3 1 12 15% 100% 0.0000 0.0000 0.0000 2.1046 0.3222 

K40A Endoscopic and Investigative Procedures for Metabolic Disorders, Major Comp NO NO 9.6 3 29 10% 106% 0.0000 0.2967 1.1485 3.7423 0.2729 

K40B Endoscopic and Investigative Procedures for Metabolic Disorders, Minor Comp NO NO 1.1 1 3 28% 198% 0.0000 0.0000 0.0000 0.3809 0.3003 

K60A Diabetes, Major Complexity NO NO 5.6 1 17 9% 139% 0.0000 0.0000 0.0000 1.5964 0.2574 

K60B Diabetes, Minor Complexity YES NO 3.1 1 9 22% 192% 0.1804 0.0000 0.0000 0.7957 0.2165 

K61A Severe Nutritional Disturbance, Major Complexity NO NO 12.4 4 37 8% 109% 0.0000 0.0000 0.9266 3.7062 0.2769 

K61B Severe Nutritional Disturbance, Minor Complexity NO NO 6.2 2 19 4% 100% 0.0000 0.0000 0.9269 1.8538 0.2378 



 
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K62A Miscellaneous Metabolic Disorders, Major Complexity NO NO 6.0 2 18 9% 143% 0.0000 0.0000 0.8771 1.7543 0.2445 

K62B Miscellaneous Metabolic Disorders, Intermediate Complexity YES NO 2.9 1 9 11% 141% 0.1468 0.0000 0.0000 0.7684 0.2418 

K62C Miscellaneous Metabolic Disorders, Minor Complexity YES NO 1.9 1 6 12% 162% 0.0943 0.0000 0.0000 0.4429 0.2452 

K63A Inborn Errors of Metabolism, Major Complexity NO NO 4.6 1 14 7% 124% 0.0000 0.0000 0.0000 1.3701 0.3436 

K63B Inborn Errors of Metabolism, Minor Complexity NO NO 1.1 1 3 9% 138% 0.0000 0.0000 0.0000 0.2276 0.1741 

K64A Endocrine Disorders, Major Complexity YES NO 4.6 1 14 10% 162% 0.2559 0.0000 0.0000 1.3388 0.2381 

K64B Endocrine Disorders, Minor Complexity YES NO 2.4 1 7 12% 181% 0.1626 0.0000 0.0000 0.6618 0.2366 

L02A Operative Insertion of Peritoneal Catheter for Dialysis, Major Complexity NO NO 9.4 3 28 9% 100% 0.0000 0.5732 1.1931 4.1524 0.3131 

L02B Operative Insertion of Peritoneal Catheter for Dialysis, Minor Complexity NO NO 1.5 1 5 9% 100% 0.0000 0.0000 0.0000 0.9402 0.3432 

L03A Kidney, Ureter and Major Bladder Procs for Neoplasm, Major Complexity NO NO 14.6 4 44 17% 100% 0.0000 2.0540 1.6301 8.5745 0.3636 

L03B Kidney, Ureter and Major Bladder Procs for Neoplasm, Intermediate Comp NO NO 6.1 2 18 19% 100% 0.0000 0.8063 1.8572 4.5207 0.3959 

L03C Kidney, Ureter and Major Bladder Procs for Neoplasm, Minor Complexity NO NO 3.4 1 10 21% 100% 0.0000 0.0000 0.0000 2.7561 0.5459 

L04A Kidney, Ureter and Major Bladder Procs for Non-Neoplasm, Major Complexity NO NO 12.0 4 36 13% 100% 0.0000 1.0007 1.1306 5.5231 0.2995 

L04B Kidney, Ureter and Major Bladder Procs for Non-Neoplasm, Intermediate Comp YES NO 4.3 1 13 19% 100% 0.7790 0.0000 0.0000 2.3729 0.2652 

L04C Kidney, Ureter and Major Bladder Procs for Non-Neoplasm, Minor Complexity YES NO 1.8 1 6 25% 136% 0.7362 0.0000 0.0000 1.4738 0.3767 

L05A Transurethral Prostatectomy for Urinary Disorder, Major Complexity NO NO 8.6 2 26 18% 100% 0.0000 0.6700 1.2471 3.1643 0.2676 

L05B Transurethral Prostatectomy for Urinary Disorder, Minor Complexity NO NO 2.4 1 7 22% 100% 0.0000 0.0000 0.0000 1.3024 0.2538 

L06A Minor Bladder Procedures, Major Complexity NO NO 12.5 4 37 14% 100% 0.0000 0.8286 1.0176 4.8990 0.2788 

L06B Minor Bladder Procedures, Intermediate Complexity NO NO 4.3 1 13 15% 92% 0.0000 0.0000 0.0000 1.9914 0.2879 

L06C Minor Bladder Procedures, Minor Complexity YES NO 2.0 1 6 15% 121% 0.4929 0.0000 0.0000 1.1091 0.2828 

L07A Other Transurethral Procedures, Major Complexity NO NO 5.3 1 16 15% 100% 0.0000 0.0000 0.0000 1.9701 0.2522 



 
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L07B Other Transurethral Procedures, Minor Complexity NO NO 1.3 1 4 27% 121% 0.0000 0.0000 0.0000 0.7720 0.2971 

L08A Urethral Procedures, Major Complexity YES NO 4.8 1 14 15% 100% 0.5796 0.0000 0.0000 1.9254 0.3634 

L08B Urethral Procedures, Minor Complexity NO NO 1.3 1 4 15% 80% 0.0000 0.0000 0.0000 0.8898 0.2994 

L09A Other Procedures for Kidney and Urinary Tract Disorders, Major Complexity NO NO 17.7 5 53 12% 100% 0.0000 0.7115 1.2396 6.9096 0.3302 

L09B Other Procedures for Kidney and Urinary Tract Disorders, Intermediate Complexity NO NO 4.5 1 13 22% 112% 0.0000 0.0000 0.0000 1.7259 0.1986 

L09C Other Procedures for Kidney and Urinary Tract Disorders, Minor Complexity NO NO 1.2 1 4 20% 80% 0.0000 0.0000 0.0000 0.9861 0.3404 

L10A Kidney Transplant, Age &lt;=16 Years or Major Complexity NO NO 12.6 4 38 9% 100% 0.0000 1.9909 2.2081 10.8233 0.4666 

L10B Kidney Transplant, Age &gt;=17 Years and Minor Complexity NO NO 8.1 2 24 9% 100% 0.0000 1.8592 2.9938 7.8468 0.4741 

L40Z Ureteroscopy NO NO 1.4 1 6 16% 100% 0.0000 0.0000 0.0000 0.8157 0.2819 

L41Z Cystourethroscopy for Urinary Disorder, Sameday NO NO 1.0 1 1 27% 200% 0.0000 0.0000 0.0000 0.2327 0.0000 

L42Z ESW Lithotripsy NO NO 1.1 1 3 31% 100% 0.0000 0.0000 0.0000 0.7104 0.3005 

L60A Kidney Failure, Major Complexity NO NO 11.4 3 34 10% 100% 0.0000 0.0000 1.2178 3.6535 0.2820 

L60B Kidney Failure, Intermediate Complexity YES NO 4.8 1 14 11% 156% 0.3142 0.0000 0.0000 1.2920 0.2488 

L60C Kidney Failure, Minor Complexity YES NO 2.4 1 7 9% 145% 0.4792 0.0000 0.0000 0.5770 0.2191 

L61Z Haemodialysis NO NO 1.0 1 3 13% 200% 0.0000 0.0000 0.0000 0.1007 0.0806 

L62A Kidney and Urinary Tract Neoplasms, Major Complexity NO NO 10.6 3 32 10% 100% 0.0000 0.0000 1.0382 3.1147 0.2600 

L62B Kidney and Urinary Tract Neoplasms, Intermediate Complexity NO NO 5.0 1 15 10% 140% 0.0000 0.0000 0.0000 1.3242 0.2305 

L62C Kidney and Urinary Tract Neoplasms, Minor Complexity NO NO 1.8 1 5 15% 157% 0.0000 0.0000 0.0000 0.4858 0.2651 

L63A Kidney and Urinary Tract Infections, Major Complexity NO NO 5.3 1 16 10% 100% 0.0000 0.0000 0.0000 1.2851 0.2346 

L63B Kidney and Urinary Tract Infections, Minor Complexity YES NO 2.4 1 8 11% 125% 0.0939 0.0000 0.0000 0.5707 0.2130 

L64A Urinary Stones and Obstruction, Major Complexity YES NO 2.8 1 8 21% 175% 0.1252 0.0000 0.0000 0.9150 0.2631 

L64B Urinary Stones and Obstruction, Minor Complexity NO NO 1.2 1 4 29% 200% 0.0000 0.0000 0.0000 0.2503 0.1595 



 
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V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

L65A Kidney and Urinary Tract Signs and Symptoms, Major Complexity NO NO 5.4 1 16 9% 117% 0.0000 0.0000 0.0000 1.3511 0.2523 

L65B Kidney and Urinary Tract Signs and Symptoms, Minor Complexity YES NO 2.1 1 6 12% 164% 0.1171 0.0000 0.0000 0.5420 0.2286 

L66Z Urethral Stricture NO NO 1.7 1 5 14% 80% 0.0000 0.0000 0.0000 0.6109 0.2548 

L67A Other Kidney and Urinary Tract Disorders, Major Complexity YES NO 5.3 1 16 10% 135% 0.2616 0.0000 0.0000 1.4054 0.2429 

L67B Other Kidney and Urinary Tract Disorders, Intermediate Complexity YES NO 2.3 1 7 16% 196% 0.1773 0.0000 0.0000 0.5874 0.2093 

L67C Other Kidney and Urinary Tract Disorders, Minor Complexity NO NO 1.1 1 3 15% 200% 0.0000 0.0000 0.0000 0.1945 0.1501 

L68Z Peritoneal Dialysis NO NO 1.0 1 3 9% 200% 0.0000 0.0000 0.0000 0.1211 0.0919 

M01A Major Male Pelvic Procedures, Major Complexity NO NO 6.3 2 19 18% 100% 0.0000 2.7099 0.9694 4.6487 0.3259 

M01B Major Male Pelvic Procedures, Minor Complexity NO NO 3.3 1 10 17% 100% 0.0000 0.0000 0.0000 3.3416 0.1367 

M02A TURP for Reproductive System Disorder, Major Complexity NO NO 6.2 2 19 16% 100% 0.0000 0.6571 0.9092 2.4754 0.2703 

M02B TURP for Reproductive System Disorder, Minor Complexity NO NO 2.3 1 7 24% 100% 0.0000 0.0000 0.0000 1.3143 0.2738 

M03A Penis Procedures, Major Complexity NO NO 2.0 1 6 20% 82% 0.0000 0.0000 0.0000 1.5906 0.3833 

M03B Penis Procedures, Minor Complexity NO NO 1.2 1 4 18% 100% 0.0000 0.0000 0.0000 0.9186 0.2950 

M04Z Testes Procedures NO NO 1.3 1 4 19% 86% 0.0000 0.0000 0.0000 0.8057 0.2637 

M05Z Circumcision NO NO 1.1 1 3 16% 87% 0.0000 0.0000 0.0000 0.6308 0.2041 

M06A Other Male Reproductive System GIs, Major Complexity YES NO 8.2 2 25 20% 100% 0.7870 0.7280 1.4656 3.6593 0.3032 

M06B Other Male Reproductive System GIs, Minor Complexity NO NO 1.5 1 5 26% 81% 0.0000 0.0000 0.0000 1.5047 0.3182 

M40Z Cystourethroscopy for Male Reproductive System Disorder, Sameday NO NO 1.0 1 1 46% 100% 0.0000 0.0000 0.0000 0.2265 0.0000 

M60A Male Reproductive System Malignancy, Major Complexity NO NO 7.9 2 24 7% 100% 0.0000 0.0981 0.9931 2.0843 0.2250 

M60B Male Reproductive System Malignancy, Minor Complexity NO NO 1.1 1 4 30% 100% 0.0000 0.0000 0.0000 0.3626 0.2524 

M61A Benign Prostatic Hypertrophy, Major Complexity NO NO 4.5 1 14 11% 100% 0.0000 0.0000 0.0000 1.1534 0.2338 

M61B Benign Prostatic Hypertrophy, Minor Complexity NO NO 1.3 1 4 16% 100% 0.0000 0.0000 0.0000 0.4029 0.2416 



 
For Official Use Only-I2-A2        46 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

M62A Male Reproductive System Inflammation, Major Complexity YES NO 4.9 1 15 12% 100% 0.2294 0.0000 0.0000 1.2005 0.2156 

M62B Male Reproductive System Inflammation, Minor Complexity YES NO 2.4 1 7 11% 126% 0.1176 0.0000 0.0000 0.5655 0.1942 

M63Z Male Sterilisation Procedures NO NO 1.0 1 3 23% 100% 0.0000 0.0000 0.0000 0.4410 0.1455 

M64A Other Male Reproductive System Disorders, Major Complexity NO NO 2.7 1 8 11% 100% 0.0000 0.0000 0.0000 0.6508 0.2196 

M64B Other Male Reproductive System Disorders, Minor Complexity NO NO 1.2 1 3 18% 130% 0.0000 0.0000 0.0000 0.2537 0.1470 

N01Z Pelvic Evisceration and Radical Vulvectomy NO NO 7.7 2 23 17% 100% 0.0000 1.3217 1.3257 3.9731 0.3888 

N04A Hysterectomy for Non-Malignancy, Major Complexity NO NO 4.4 1 13 13% 100% 0.0000 0.0000 0.0000 2.9393 0.3616 

N04B Hysterectomy for Non-Malignancy, Minor Complexity NO NO 2.6 1 8 15% 100% 0.0000 0.0000 0.0000 2.0498 0.3506 

N05A Oophorectomy &amp; Complex Fallopian Tube Procs for Non-Malignancy, Maj Comp NO NO 4.2 1 13 12% 100% 0.0000 0.0000 0.0000 2.5775 0.3496 

N05B Oophorectomy &amp; Complex Fallopian Tube Procs for Non-Malignancy, Min Comp NO NO 1.6 1 5 15% 100% 0.0000 0.0000 0.0000 1.4815 0.3709 

N06A Female Reproductive System Reconstructive Procs, Major Complexity NO NO 3.7 1 11 15% 100% 0.0000 0.0000 0.0000 2.3079 0.3455 

N06B Female Reproductive System Reconstructive Procs, Minor Complexity NO NO 1.9 1 6 21% 100% 0.0000 0.0000 0.0000 1.3849 0.3801 

N07A Other Uterus and Adnexa Procedures for Non-Malignancy, Major Complexity YES NO 1.9 1 6 17% 100% 0.8365 0.0000 0.0000 1.5299 0.3017 

N07B Other Uterus and Adnexa Procedures for Non-Malignancy, Minor Complexity NO NO 1.0 1 3 33% 100% 0.0000 0.0000 0.0000 0.5519 0.1736 

N08Z Endoscopic and Laparoscopic Procs, Female Reproductive System YES NO 1.9 1 6 17% 110% 0.7328 0.0000 0.0000 1.2966 0.3264 

N09A Other Vagina, Cervix and Vulva Procedures, Major Complexity NO NO 2.2 1 7 13% 100% 0.0000 0.0000 0.0000 1.0805 0.3190 

N09B Other Vagina, Cervix and Vulva Procedures, Minor Complexity NO NO 1.0 1 3 18% 125% 0.0000 0.0000 0.0000 0.4953 0.1762 

N10Z Diagnostic Curettage and Diagnostic Hysteroscopy NO NO 1.1 1 3 19% 100% 0.0000 0.0000 0.0000 0.4811 0.1424 

N11A Other Female Reproductive System GIs, Major Complexity NO NO 5.8 1 17 13% 100% 0.0000 0.0000 0.0000 2.3636 0.3137 

N11B Other Female Reproductive System GIs, Minor Complexity NO NO 1.0 1 3 15% 100% 0.0000 0.0000 0.0000 0.3721 0.2977 

N12A Uterus and Adnexa Procedures for Malignancy, Major Complexity NO NO 10.3 3 31 15% 100% 0.0000 1.4670 1.4353 5.7728 0.4052 



 
For Official Use Only-I2-A2        47 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

N12B Uterus and Adnexa Procedures for Malignancy, Intermediate Complexity NO NO 4.6 1 14 16% 100% 0.0000 0.0000 0.0000 3.0125 0.3220 

N12C Uterus and Adnexa Procedures for Malignancy, Minor Complexity NO NO 2.5 1 8 17% 100% 0.0000 0.0000 0.0000 2.0892 0.3707 

N60A Female Reproductive System Malignancy, Major Complexity NO NO 9.6 3 29 7% 100% 0.0000 0.0000 0.9717 2.9152 0.2403 

N60B Female Reproductive System Malignancy, Minor Complexity NO NO 2.8 1 8 7% 139% 0.0000 0.0000 0.0000 0.7290 0.2429 

N61A Female Reproductive System Infections, Major Complexity NO NO 3.4 1 10 12% 100% 0.0000 0.0000 0.0000 0.8961 0.2596 

N61B Female Reproductive System Infections, Minor Complexity NO NO 1.6 1 5 8% 170% 0.0000 0.0000 0.0000 0.3717 0.2636 

N62A Menstrual &amp; Other Female Reproductive System Disorders, Major Complexity NO NO 2.2 1 7 10% 109% 0.0000 0.0000 0.0000 0.5764 0.2574 

N62B Menstrual &amp; Other Female Reproductive System Disorders, Minor Complexity NO NO 1.2 1 4 14% 158% 0.0000 0.0000 0.0000 0.2217 0.1445 

O01A Caesarean Delivery, Major Complexity NO NO 7.0 2 21 10% 100% 0.0000 0.8439 1.1705 3.1850 0.2684 

O01B Caesarean Delivery, Intermediate Complexity NO NO 4.2 1 13 14% 100% 0.0000 0.0000 0.0000 2.2002 0.2369 

O01C Caesarean Delivery, Minor Complexity NO NO 3.1 1 9 16% 100% 0.0000 0.0000 0.0000 1.8164 0.2761 

O02A Vaginal Delivery W GIs, Major Complexity NO NO 4.2 1 12 10% 100% 0.0000 0.0000 0.0000 2.3360 0.3369 

O02B Vaginal Delivery W GIs, Minor Complexity NO NO 2.9 1 9 9% 100% 0.0000 0.0000 0.0000 1.6428 0.3431 

O03Z Ectopic Pregnancy NO NO 1.7 1 5 13% 100% 0.0000 0.0000 0.0000 1.0774 0.3032 

O04A Postpartum and Post Abortion W GIs, Major Complexity NO NO 4.4 1 13 15% 100% 0.0000 0.0000 0.0000 1.7998 0.2783 

O04B Postpartum and Post Abortion W GIs, Minor Complexity YES NO 2.1 1 7 19% 100% 0.4821 0.0000 0.0000 0.9893 0.2886 

O05Z Abortion W GIs NO NO 1.1 1 3 20% 100% 0.0000 0.0000 0.0000 0.4814 0.1905 

O60A Vaginal Delivery, Major Complexity NO NO 3.8 1 12 12% 100% 0.0000 0.0000 0.0000 1.6418 0.2747 

O60B Vaginal Delivery, Intermediate Complexity NO NO 2.5 1 7 14% 118% 0.0000 0.0000 0.0000 1.1219 0.3015 

O60C Vaginal Delivery, Minor Complexity NO NO 1.8 1 5 15% 114% 0.0000 0.0000 0.0000 0.8145 0.3196 

O61A Postpartum and Post Abortion W/O GIs, Major Complexity NO NO 4.4 1 13 8% 100% 0.0000 0.0000 0.0000 1.1887 0.2724 

O61B Postpartum and Post Abortion W/O GIs, Minor Complexity YES NO 2.2 1 7 7% 100% 0.1330 0.0000 0.0000 0.5917 0.2134 



 
For Official Use Only-I2-A2        48 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

O63A Abortion W/O GIs, Major Complexity NO NO 1.5 1 5 16% 100% 0.0000 0.0000 0.0000 0.6434 0.4301 

O63B Abortion W/O GIs, Minor Complexity NO NO 1.1 1 3 16% 100% 0.0000 0.0000 0.0000 0.2098 0.1495 

O66A Antenatal and Other Obstetric Admissions, Major Complexity YES NO 3.3 1 10 6% 100% 0.1812 0.0000 0.0000 0.8662 0.2157 

O66B Antenatal and Other Obstetric Admissions, Intermediate Complexity NO NO 1.3 1 4 9% 169% 0.0000 0.0000 0.0000 0.2401 0.1754 

O66C Antenatal and Other Obstetric Admissions, Minor Complexity NO NO 1.0 1 3 15% 100% 0.0000 0.0000 0.0000 0.1140 0.0899 

P01Z Neonate W Sig GI/Vent&gt;=96hrs, Died or Transfer to Acute Facility &lt;5Days NO YES 1.7 1 4 10% 100% 0.0000 0.0000 0.0000 1.7376 0.5823 

P02Z Cardiothoracic and Vascular Procedures for Neonates NO YES 33.8 21 48 10% 100% 0.0000 3.1742 1.2485 29.3935 0.7168 

P03A Neonate, AdmWt 1000-1499g W Signif GI/Vent&gt;=96hrs, Major Complexity NO YES 62.9 41 94 10% 100% 0.0000 0.0000 0.6959 28.5324 0.4087 

P03B Neonate, AdmWt 1000-1499g W Signif GI/Vent&gt;=96hrs, Minor Complexity NO YES 38.7 12 116 9% 100% 0.0000 0.1490 1.3451 16.2907 0.3681 

P04A Neonate, AdmWt 1500-1999g W Signif GI/Vent&gt;=96hrs, Major Complexity NO YES 57.1 19 171 12% 100% 0.0000 0.2599 1.3909 26.6876 0.4434 

P04B Neonate, AdmWt 1500-1999g W Signif GI/Vent&gt;=96hrs, Minor Complexity NO YES 28.2 9 84 10% 100% 0.0000 0.0000 1.2506 11.2556 0.3227 

P05A Neonate, AdmWt 2000-2499g W Signif GI/Vent&gt;=96hrs, Major Complexity NO YES 47.4 31 71 12% 100% 0.0000 0.6265 0.8364 26.5548 0.4623 

P05B Neonate, AdmWt 2000-2499g W Signif GI/Vent&gt;=96hrs, Minor Complexity NO YES 19.1 6 57 12% 100% 0.0000 0.3342 1.3838 8.6369 0.3447 

P06A Neonate, AdmWt &gt;=2500g W Significant GI/Vent&gt;=96hrs, Major Complexity NO YES 39.6 13 119 9% 100% 0.0000 0.5173 1.5822 21.0858 0.5109 

P06B Neonate, AdmWt &gt;=2500g W Significant GI/Vent&gt;=96hrs, Minor Complexity NO YES 11.8 3 35 10% 100% 0.0000 0.5067 1.8972 6.1984 0.4288 

P07Z Neonate, AdmWt &lt;750g W Significant GIs NO YES 120.9 39 358 10% 100% 0.0000 0.2263 1.6270 63.6787 0.4926 

P08Z Neonate, AdmWt 750-999g W Significant GIs NO YES 87.7 32 297 10% 100% 0.0000 0.7902 1.4696 47.8172 0.4158 

P60A Neonate W/O Sig GI/Vent&gt;=96hrs, Died/ Transfer Acute Facility &lt;5 Days, MajC NO YES 2.4 1 4 13% 100% 0.0000 0.0000 0.0000 1.1804 0.0000 

P60B Neonate W/O Sig GI/Vent&gt;=96hrs, Died/ Transfer Acute Facility &lt;5 Days, MinC YES YES 2.0 1 4 11% 100% 0.2247 0.0000 0.0000 0.9040 0.0000 

P61Z Neonate, AdmWt &lt;750g W/O Significant GI procedure NO YES 83.0 27 249 9% 100% 0.0000 0.0000 1.6254 43.8870 0.4283 

P62A Neonate, AdmWt 750-999g W/O Significant GIs, Major Complexity NO YES 72.3 24 217 9% 100% 0.0000 0.0000 1.4020 33.6474 0.3964 



 
For Official Use Only-I2-A2        49 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

P62B Neonate, AdmWt 750-999g W/O Significant GIs, Minor Complexity NO YES 30.1 10 90 8% 100% 0.0000 0.0000 1.3927 13.9274 0.3146 

P63A Neonate, AdmWt 1000-1249g W/O Signif GI/Vent&gt;=96hrs, Major Complexity NO YES 33.6 11 101 9% 100% 0.0000 0.0000 1.0622 11.6841 0.3334 

P63B Neonate, AdmWt 1000-1249g W/O Signif GI/Vent&gt;=96hrs, Minor Complexity NO YES 12.9 4 39 9% 100% 0.0000 0.0000 1.5569 6.2276 0.2858 

P64A Neonate, AdmWt 1250-1499g W/O Signif GI/Vent&gt;=96hrs, Major Complexity NO YES 33.5 11 101 9% 100% 0.0000 0.0000 1.0041 11.0455 0.2812 

P64B Neonate, AdmWt 1250-1499g W/O Signif GI/Vent&gt;=96hrs, Minor Complexity NO YES 21.8 7 65 9% 100% 0.0000 0.0000 1.0070 7.0487 0.2544 

P65A Neonate, AdmWt 1500-1999g W/O Signif GI/Vent&gt;=96hrs, Extreme Comp NO YES 28.6 9 86 5% 100% 0.0000 0.0000 0.9843 8.8589 0.2949 

P65B Neonate, AdmWt 1500-1999g W/O Signif GI/Vent&gt;=96hrs, Major Complexity NO YES 20.5 6 62 9% 100% 0.0000 0.0000 1.0643 6.3858 0.2880 

P65C Neonate, AdmWt 1500-1999g W/O Signif GI/Vent&gt;=96hrs, Intermediate Comp NO YES 16.8 5 50 9% 100% 0.0000 0.0000 0.9974 4.9871 0.2773 

P65D Neonate, AdmWt 1500-1999g W/O Signif GI/Vent&gt;=96hrs, Minor Complexity NO YES 12.3 4 37 8% 100% 0.0000 0.0000 0.9922 3.9689 0.2876 

P66A Neonate, AdmWt 2000-2499g W/O Signif GI/Vent&gt;=96hrs, Extreme Comp NO YES 17.9 11 27 6% 100% 0.0000 0.0000 0.5139 5.6528 0.2804 

P66B Neonate, AdmWt 2000-2499g W/O Signif GI/Vent&gt;=96hrs, Major Complexity NO YES 12.6 4 38 8% 100% 0.0000 0.0000 0.9763 3.9052 0.2709 

P66C Neonate, AdmWt 2000-2499g W/O Signif GI/Vent&gt;=96hrs, Intermediate Comp NO YES 8.4 2 25 8% 100% 0.0000 0.0000 1.3201 2.6401 0.2724 

P66D Neonate, AdmWt 2000-2499g W/O Signif GI/Vent&gt;=96hrs, Minor Complexity NO YES 4.0 1 13 5% 100% 0.0000 0.0000 0.0000 1.2610 0.2767 

P67A Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs,&lt;37 Comp Wks Gest, Extr Comp NO YES 13.9 4 42 9% 100% 0.0000 0.0000 1.1175 4.4700 0.2839 

P67B Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs, &lt;37 Comp Wks Gest, Maj Comp NO YES 9.2 3 28 6% 100% 0.0000 0.0000 0.9947 2.9842 0.2790 

P67C Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs, &lt;37 Comp Wks Gest, Int Comp NO YES 7.3 2 22 9% 100% 0.0000 0.0000 1.1872 2.3744 0.2751 

P67D Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs, &lt;37 Comp Wks Gest, Min Comp NO YES 5.0 1 15 5% 100% 0.0000 0.0000 0.0000 1.5980 0.2792 

P68A Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs,&gt;=37Comp Wks Gest, Ext Comp NO YES 8.3 2 25 12% 100% 0.0000 0.0000 1.4629 2.9258 0.3063 

P68B Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs,&gt;=37Comp Wks Gest, Maj Comp NO YES 4.3 1 13 11% 100% 0.0000 0.0000 0.0000 1.4431 0.3086 

P68C Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs,&gt;=37 Comp Wks Gest, Int Comp NO YES 3.0 1 9 12% 100% 0.0000 0.0000 0.0000 1.0360 0.2864 

P68D Neonate,AdmWt&gt;=2500g w/o Sig GI/Vent &gt;=96hrs,&gt;=37Comp Wks Gest, Min Comp NO YES 2.1 1 6 11% 100% 0.0000 0.0000 0.0000 0.7316 0.2657 



 
For Official Use Only-I2-A2        50 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

Q01Z Splenectomy NO NO 6.4 2 19 15% 100% 0.0000 1.1051 1.2592 3.6234 0.3117 

Q02A Blood and Immune System Disorders W Other GIs, Major Complexity NO NO 9.9 3 30 13% 134% 0.0000 0.4935 1.2273 4.1753 0.3012 

Q02B Blood and Immune System Disorders W Other GIs, Minor Complexity YES NO 2.9 1 9 19% 113% 0.5876 0.0000 0.0000 1.4094 0.2340 

Q60A Reticuloendothelial and Immunity Disorders, Major Complexity YES NO 5.6 1 17 9% 140% 0.2521 0.0000 0.0000 1.6539 0.3212 

Q60B Reticuloendothelial and Immunity Disorders, Minor Complexity NO NO 1.1 1 3 12% 153% 0.0000 0.0000 0.0000 0.1953 0.1456 

Q61A Red Blood Cell Disorders, Major Complexity YES NO 4.3 1 13 14% 135% 0.3128 0.0000 0.0000 1.1332 0.2441 

Q61B Red Blood Cell Disorders, Intermediate Complexity NO NO 1.1 1 3 18% 166% 0.0000 0.0000 0.0000 0.1954 0.1491 

Q61C Red Blood Cell Disorders, Minor Complexity NO NO 1.0 1 3 27% 100% 0.0000 0.0000 0.0000 0.0644 0.0515 

Q62A Coagulation Disorders, Major Complexity YES NO 6.0 1 18 14% 87% 0.2253 0.0000 0.0000 1.5922 0.2654 

Q62B Coagulation Disorders, Minor Complexity YES NO 2.5 1 7 13% 118% 0.1646 0.0000 0.0000 0.5398 0.1973 

R01A Lymphoma and Leukaemia W Major GIs, Major Complexity NO NO 19.7 6 59 15% 100% 0.0000 0.8969 1.4052 9.3281 0.3540 

R01B Lymphoma and Leukaemia W Major GIs, Minor Complexity NO NO 4.2 1 12 23% 100% 0.0000 0.0000 0.0000 2.1230 0.4142 

R02A Other Neoplastic Disorders W Major GIs, Major Complexity NO NO 13.5 4 41 18% 100% 0.0000 2.1719 1.1809 6.8956 0.2636 

R02B Other Neoplastic Disorders W Major GIs, Intermediate Complexity NO NO 7.5 2 23 18% 100% 0.0000 0.8166 1.6151 4.0467 0.1925 

R02C Other Neoplastic Disorders W Major GIs, Minor Complexity NO NO 3.9 1 12 20% 100% 0.0000 0.0000 0.0000 1.8632 0.1975 

R03A Lymphoma and Leukaemia W Other GIs, Major Complexity NO NO 30.1 10 90 16% 100% 0.0000 0.5963 1.1550 12.1460 0.3430 

R03B Lymphoma and Leukaemia W Other GIs, Intermediate Complexity NO NO 11.4 3 34 14% 108% 0.0000 0.4540 1.4965 4.9436 0.2980 

R03C Lymphoma and Leukaemia W Other GIs, Minor Complexity YES NO 4.9 1 15 26% 158% 0.5459 0.0000 0.0000 1.9352 0.2450 

R04A Other Neoplastic Disorders W Other GIs, Major Complexity NO NO 8.0 2 24 16% 100% 0.0000 0.6911 1.5956 3.8822 0.2475 

R04B Other Neoplastic Disorders W Other GIs, Minor Complexity YES NO 3.1 1 9 17% 100% 0.8653 0.0000 0.0000 1.6217 0.2865 

R05A Allogeneic Bone Marrow Transplant, Age &lt;=16 Years or Major Complexity NO NO 50.2 16 150 8% 170% 0.0000 0.0000 1.6692 26.7076 0.4709 



 
For Official Use Only-I2-A2        51 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

R05B Allogeneic Bone Marrow Transplant, Age &gt;=17 Years and Minor Complexity NO NO 24.4 8 73 6% 100% 0.0000 0.1063 1.5878 12.8085 0.4271 

R06A Autologous Bone Marrow Transplant, Major Complexity NO NO 22.5 15 34 8% 200% 0.0000 0.0000 0.6071 9.1058 0.3850 

R06B Autologous Bone Marrow Transplant, Minor Complexity NO NO 12.6 4 38 9% 100% 0.0000 0.0000 1.2846 5.1382 0.2915 

R60A Acute Leukaemia, Major Complexity NO NO 17.1 11 26 9% 117% 0.0000 0.0903 0.7108 7.9090 0.3272 

R60B Acute Leukaemia, Intermediate Complexity YES NO 6.3 2 19 11% 100% 0.3294 0.1192 1.1039 2.3271 0.2974 

R60C Acute Leukaemia, Minor Complexity YES NO 4.9 1 15 14% 160% 0.2365 0.0000 0.0000 1.3165 0.1345 

R61A Lymphoma and Non-Acute Leukaemia, Major Complexity NO NO 10.0 3 30 10% 149% 0.0000 0.0000 1.1724 3.5173 0.2948 

R61B Lymphoma and Non-Acute Leukaemia, Intermediate Complexity YES NO 4.1 1 12 11% 160% 0.2698 0.0000 0.0000 1.3922 0.2623 

R61C Lymphoma and Non-Acute Leukaemia, Minor Complexity NO NO 1.1 1 3 16% 200% 0.0000 0.0000 0.0000 0.2375 0.1734 

R62A Other Neoplastic Disorders, Major Complexity NO NO 9.3 3 28 9% 88% 0.0000 0.0000 1.0058 3.0173 0.2541 

R62B Other Neoplastic Disorders, Intermediate Complexity YES NO 4.6 1 14 6% 95% 0.9552 0.0000 0.0000 1.2689 0.2158 

R62C Other Neoplastic Disorders, Minor Complexity YES NO 2.7 1 8 11% 142% 0.4914 0.0000 0.0000 0.6664 0.1709 

R63Z Chemotherapy NO NO 1.0 1 3 9% 100% 0.0000 0.0000 0.0000 0.2635 0.1736 

T01A Infectious and Parasitic Diseases W GIs, Major Complexity NO NO 26.1 8 78 11% 127% 0.0000 0.7342 1.1818 10.1890 0.2969 

T01B Infectious and Parasitic Diseases W GIs, Intermediate Complexity NO NO 11.8 3 36 12% 107% 0.0000 0.4195 1.2449 4.1542 0.2457 

T01C Infectious and Parasitic Diseases W GIs, Minor Complexity NO NO 7.0 2 21 13% 100% 0.0000 0.3359 1.0378 2.4115 0.2350 

T40Z Infectious and Parasitic Diseases W Ventilator Support NO NO 8.6 2 24 11% 100% 0.0000 0.0000 2.2731 4.5462 0.3190 

T60A Septicaemia, Major Complexity NO NO 13.3 4 40 11% 115% 0.0000 0.0000 1.0489 4.1956 0.2369 

T60B Septicaemia, Intermediate Complexity NO NO 7.0 2 21 11% 110% 0.0000 0.0000 0.9958 1.9916 0.2378 

T60C Septicaemia, Minor Complexity NO NO 4.1 1 12 12% 115% 0.0000 0.0000 0.0000 1.0392 0.2362 

T61A Postoperative Infections, Major Complexity NO NO 6.5 2 19 8% 121% 0.0000 0.0000 0.8124 1.6248 0.2003 

T61B Postoperative Infections, Minor Complexity NO NO 3.3 1 10 8% 146% 0.0000 0.0000 0.0000 0.6458 0.1593 



 
For Official Use Only-I2-A2        52 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

T62A Fever of Unknown Origin, Major Complexity NO NO 5.5 1 17 12% 115% 0.0000 0.0000 0.0000 1.4497 0.2576 

T62B Fever of Unknown Origin, Minor Complexity NO NO 2.1 1 6 12% 92% 0.0000 0.0000 0.0000 0.4932 0.2622 

T63A Viral Illnesses, Major Complexity YES NO 4.3 1 13 9% 122% 0.1673 0.0000 0.0000 1.0967 0.2527 

T63B Viral Illnesses, Minor Complexity NO NO 1.4 1 5 10% 117% 0.0000 0.0000 0.0000 0.3086 0.2148 

T64A Other Infectious and Parasitic Diseases, Major Complexity NO NO 17.5 11 26 7% 100% 0.0000 0.0000 0.5699 6.2687 0.2699 

T64B Other Infectious and Parasitic Diseases, Intermediate Complexity NO NO 9.2 3 28 8% 105% 0.0000 0.0000 0.8438 2.5313 0.1983 

T64C Other Infectious and Parasitic Diseases, Minor Complexity YES NO 4.9 1 15 10% 100% 0.2484 0.0000 0.0000 1.1371 0.1884 

U40A Mental Health Treatment W ECT, Sameday, Major Complexity NO NO 1.0 1 1 18% 100% 0.0000 0.0000 0.0000 0.1913 0.0000 

U40B Mental Health Treatment W ECT, Sameday, Minor Complexity NO NO 1.0 1 1 12% 100% 0.0000 0.0000 0.0000 0.1587 0.0000 

U60Z Mental Health Treatment W/O ECT, Sameday NO NO 1.0 1 1 14% 200% 0.0000 0.0000 0.0000 0.1008 0.0000 

U61A Schizophrenia Disorders, Major Complexity NO NO 44.7 29 67 2% 100% 0.0000 0.0000 0.3390 9.8306 0.1841 

U61B Schizophrenia Disorders, Minor Complexity NO NO 19.7 13 30 1% 100% 0.0000 0.0000 0.3496 4.5444 0.1849 

U62A Paranoia and Acute Psychotic Disorders, Major Complexity NO NO 22.4 14 34 2% 100% 0.0000 0.0000 0.4368 6.1148 0.2051 

U62B Paranoia and Acute Psychotic Disorders, Minor Complexity NO NO 11.1 7 17 2% 191% 0.0000 0.0000 0.4135 2.8943 0.1968 

U63A Major Affective Disorders, Major Complexity NO NO 27.7 18 42 2% 184% 0.0000 0.0000 0.3946 7.1023 0.2083 

U63B Major Affective Disorders, Minor Complexity NO NO 12.4 8 19 2% 154% 0.0000 0.0000 0.4219 3.3753 0.2007 

U64A Other Affective and Somatoform Disorders, Major Complexity NO NO 12.9 8 19 3% 170% 0.0000 0.0000 0.4270 3.4157 0.1924 

U64B Other Affective and Somatoform Disorders, Minor Complexity NO NO 5.9 3 9 2% 179% 0.0000 0.0000 0.5108 1.5323 0.2028 

U65A Anxiety Disorders, Major Complexity NO NO 8.5 5 13 5% 159% 0.0000 0.0000 0.5037 2.5186 0.2180 

U65B Anxiety Disorders, Minor Complexity NO NO 3.2 2 5 6% 182% 0.0000 0.0000 0.4449 0.8898 0.2290 

U66A Eating and Obsessive-Compulsive Disorders, Major Complexity NO NO 23.9 15 36 3% 110% 0.0000 0.0000 0.5078 7.6167 0.2479 



 
For Official Use Only-I2-A2        53 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

U66B Eating and Obsessive-Compulsive Disorders, Minor Complexity NO NO 12.9 8 19 3% 118% 0.0000 0.0000 0.5650 4.5200 0.2793 

U67A Personality Disorders and Acute Reactions, Major Complexity NO NO 11.2 7 17 3% 176% 0.0000 0.0000 0.4361 3.0528 0.2006 

U67B Personality Disorders and Acute Reactions, Minor Complexity NO NO 4.8 3 7 2% 181% 0.0000 0.0000 0.4452 1.3357 0.2165 

U68A Childhood Mental Disorders, Major Complexity NO NO 9.8 6 15 2% 134% 0.0000 0.0000 0.5883 3.5299 0.2740 

U68B Childhood Mental Disorders, Minor Complexity NO NO 5.4 3 8 2% 139% 0.0000 0.0000 0.6479 1.9438 0.2625 

V60A Alcohol Intoxication and Withdrawal, Major Complexity NO NO 3.5 2 5 6% 100% 0.0000 0.0000 0.4459 0.8919 0.2105 

V60B Alcohol Intoxication and Withdrawal, Minor Complexity NO NO 1.3 1 2 12% 85% 0.0000 0.0000 0.0000 0.1867 0.1345 

V61A Drug Intoxication and Withdrawal, Major Complexity NO NO 7.3 4 11 3% 160% 0.0000 0.0000 0.4692 1.8769 0.2146 

V61B Drug Intoxication and Withdrawal, Minor Complexity NO NO 3.3 2 5 4% 100% 0.0000 0.0000 0.3999 0.7998 0.1871 

V62A Alcohol Use and Dependence, Major Complexity NO NO 8.7 5 13 4% 100% 0.0000 0.0000 0.4144 2.0721 0.2331 

V62B Alcohol Use and Dependence, Minor Complexity NO NO 4.3 2 6 3% 100% 0.0000 0.0000 0.4317 0.8634 0.1574 

V63Z Opioid Use and Dependence NO NO 5.0 3 7 4% 100% 0.0000 0.0000 0.4131 1.2394 0.1858 

V64A Other Drug Use and Dependence, Major Complexity NO NO 8.9 5 13 3% 100% 0.0000 0.0000 0.3744 1.8720 0.1808 

V64B Other Drug Use and Dependence, Minor Complexity NO NO 3.9 2 6 3% 100% 0.0000 0.0000 0.4528 0.9056 0.1849 

W01A Vent, Trac &amp; Cran Procs for Mult Sig Trauma, Major Complexity NO NO 30.4 10 91 12% 100% 0.0000 3.3569 2.0923 24.2803 0.3818 

W01B Vent, Trac &amp; Cran Procs for Mult Sig Trauma, Intermediate Complexity NO NO 18.5 6 55 12% 100% 0.0000 1.7842 2.2344 15.1907 0.3576 

W01C Vent, Trac &amp; Cran Procs for Mult Sig Trauma, Minor Complexity NO NO 9.9 3 30 12% 100% 0.0000 1.2213 2.3423 8.2483 0.4157 

W02A Hip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Major Complexity NO NO 21.9 7 66 18% 100% 0.0000 2.0828 1.3196 11.3199 0.3157 

W02B Hip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Minor Complexity NO NO 12.2 4 36 20% 100% 0.0000 1.3152 0.9970 5.3031 0.2727 

W03Z Abdominal Procedures for Multiple Significant Trauma NO NO 10.0 3 30 14% 100% 0.0000 0.9635 1.3674 5.0656 0.3690 

W04A Multiple Significant Trauma W Other GIs, Major Complexity NO NO 18.1 6 54 15% 100% 0.0000 1.5320 1.2862 9.2495 0.3433 



 
For Official Use Only-I2-A2        54 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

W04B Multiple Significant Trauma W Other GIs, Minor Complexity NO NO 8.2 2 24 15% 100% 0.0000 1.1902 1.6640 4.5182 0.3321 

W60Z Multiple Sig Trauma, Transferred to Acute Facility &lt;5 Days NO NO 1.6 1 4 24% 100% 0.0000 0.0000 0.0000 1.2700 0.0000 

W61A Multiple Significant Trauma W/O GIs, Major Complexity NO NO 13.6 4 41 9% 100% 0.0000 0.0000 0.9663 3.8654 0.2566 

W61B Multiple Significant Trauma W/O GIs, Minor Complexity NO NO 5.4 1 16 10% 116% 0.0000 0.0000 0.0000 1.5151 0.2660 

X02A Microvascular Tissue Transfer and Skin Grafts for Injuries to Hand, Major Comp NO NO 7.8 2 23 30% 100% 0.0000 0.6738 1.9798 4.6335 0.3594 

X02B Microvascular Tissue Transfer and Skin Grafts for Injuries to Hand, Minor Comp NO NO 1.7 1 5 31% 120% 0.0000 0.0000 0.0000 0.9898 0.4795 

X04A Other Procedures for Injuries to Lower Limb, Major Complexity NO NO 10.7 3 32 12% 100% 0.0000 0.6868 1.0974 3.9789 0.2421 

X04B Other Procedures for Injuries to Lower Limb, Minor Complexity YES NO 2.3 1 7 16% 105% 0.4724 0.0000 0.0000 1.0546 0.2686 

X05A Other Procedures for Injuries to Hand, Major Complexity NO NO 3.2 1 10 13% 110% 0.0000 0.0000 0.0000 1.6189 0.2874 

X05B Other Procedures for Injuries to Hand, Minor Complexity NO NO 1.3 1 4 21% 92% 0.0000 0.0000 0.0000 0.6025 0.2086 

X06A Other Procedures for Other Injuries, Major Complexity NO NO 12.3 4 37 10% 144% 0.0000 0.7558 1.0038 4.7711 0.2500 

X06B Other Procedures for Other Injuries, Intermediate Complexity NO NO 4.2 1 13 15% 100% 0.0000 0.0000 0.0000 1.6410 0.2501 

X06C Other Procedures for Other Injuries, Minor Complexity NO NO 1.8 1 5 13% 92% 0.0000 0.0000 0.0000 0.8266 0.2964 

X07A Skin Grafts for Injuries Excluding Hand, Major Complexity NO NO 23.5 7 70 12% 100% 0.0000 0.8070 1.0971 8.4865 0.3148 

X07B Skin Grafts for Injuries Excluding Hand, Intermediate Complexity NO NO 9.3 3 28 9% 100% 0.0000 0.5292 0.9965 3.5186 0.2653 

X07C Skin Grafts for Injuries Excluding Hand, Minor Complexity NO NO 4.5 1 13 10% 100% 0.0000 0.0000 0.0000 1.8226 0.2987 

X40A Injuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Major Comp NO NO 6.2 2 19 7% 100% 0.0000 0.0000 1.6447 3.2893 0.2651 

X40B Injuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Minor Comp NO NO 3.2 1 9 9% 100% 0.0000 0.0000 0.0000 1.5341 0.2557 

X60A Injuries, Major Complexity YES NO 4.8 1 14 11% 100% 0.1730 0.0000 0.0000 1.0556 0.2134 

X60B Injuries, Minor Complexity NO NO 1.2 1 4 18% 158% 0.0000 0.0000 0.0000 0.2105 0.1570 

X61A Allergic Reactions, Major Complexity NO NO 1.8 1 5 16% 115% 0.0000 0.0000 0.0000 0.4226 0.2805 



 
For Official Use Only-I2-A2        55 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

X61B Allergic Reactions, Minor Complexity NO NO 1.0 1 3 12% 100% 0.0000 0.0000 0.0000 0.1187 0.0823 

X62A Poisoning/Toxic Effects of Drugs and Other Substances, Major Complexity YES NO 4.4 1 13 7% 150% 0.1461 0.0000 0.0000 1.1001 0.2388 

X62B Poisoning/Toxic Effects of Drugs and Other Substances, Minor Complexity NO NO 1.3 1 4 9% 108% 0.0000 0.0000 0.0000 0.2546 0.1788 

X63A Sequelae of Treatment, Major Complexity YES NO 5.7 1 17 10% 137% 0.2030 0.0000 0.0000 1.3861 0.2261 

X63B Sequelae of Treatment, Minor Complexity YES NO 2.3 1 7 13% 100% 0.1401 0.0000 0.0000 0.5001 0.1535 

X64A Other Injuries, Poisonings and Toxic Effects, Major Complexity NO NO 5.9 1 18 11% 100% 0.0000 0.0000 0.0000 1.4019 0.2278 

X64B Other Injuries, Poisonings and Toxic Effects, Intermediate Complexity NO NO 1.7 1 5 12% 144% 0.0000 0.0000 0.0000 0.3569 0.2442 

X64C Other Injuries, Poisonings and Toxic Effects, Minor Complexity NO NO 1.1 1 3 16% 118% 0.0000 0.0000 0.0000 0.1774 0.1329 

Y01Z Vent &gt;=96hrs or Trach for Burns or GIs for Severe Full Thickness Burns NO NO 25.5 18 164 7% 100% 0.0000 4.7871 2.1714 43.8732 0.9659 

Y02A Skin Grafts for Other Burns, Major Complexity NO NO 16.8 11 25 6% 100% 0.0000 0.6290 0.7834 9.2468 0.4655 

Y02B Skin Grafts for Other Burns, Intermediate Complexity NO NO 6.4 2 19 4% 100% 0.0000 0.3397 1.7253 3.7903 0.3787 

Y02C Skin Grafts for Other Burns, Minor Complexity NO NO 2.2 1 7 9% 100% 0.0000 0.0000 0.0000 1.0523 0.5357 

Y03A Other GIs for Other Burns, Major Complexity NO NO 7.8 2 23 7% 100% 0.0000 0.3999 1.4028 3.2055 0.2847 

Y03B Other GIs for Other Burns, Minor Complexity NO NO 1.7 1 5 10% 100% 0.0000 0.0000 0.0000 0.7770 0.3662 

Y60Z Burns, Transferred to Acute Facility &lt;5 Days NO NO 1.3 1 4 4% 100% 0.0000 0.0000 0.0000 0.4412 0.0000 

Y61Z Severe Burns NO NO 4.3 1 10 4% 143% 0.0000 0.0000 0.0000 0.9844 0.3236 

Y62A Other Burns, Major Complexity YES NO 5.8 1 17 4% 123% 0.2349 0.0000 0.0000 1.6723 0.3184 

Y62B Other Burns, Minor Complexity YES NO 2.2 1 7 5% 149% 0.1186 0.0000 0.0000 0.5540 0.2667 

Z01A Other Contacts W Health Services W GIs, Major Complexity NO NO 9.4 3 28 15% 100% 0.0000 0.6618 1.1462 4.1005 0.2082 

Z01B Other Contacts W Health Services W GIs, Minor Complexity NO NO 1.2 1 4 38% 100% 0.0000 0.0000 0.0000 0.6664 0.2674 

Z40Z Other Contacts W Health Services W Endoscopy NO NO 1.1 1 3 39% 175% 0.0000 0.0000 0.0000 0.2783 0.0944 

Z61A Signs and Symptoms, Major Complexity YES NO 5.7 1 17 9% 124% 0.2077 0.0000 0.0000 1.3014 0.2151 



 
For Official Use Only-I2-A2        56 

AR-DRG 
V9.0 Description 

Same-
Day 

Pay-
ment 

Bundled 
ICU ALOS

1  

Inlier Bounds Adjustments Price Weights 

Lower 
Bound 

Upper 
Bound 

Private 
Patient 

Service Adj. 
Paediatric 

Adj. Same Day 
Short-Stay 

Outlier 
Base 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-Stay 
Outlier Per 

Diem 

Z61B Signs and Symptoms, Minor Complexity YES NO 2.4 1 7 15% 114% 0.2176 0.0000 0.0000 0.5188 0.2109 

Z63A Other Follow Up After Surgery or Medical Care, Major Complexity NO NO 9.3 3 28 8% 167% 0.0000 0.0000 0.7754 2.3262 0.2050 

Z60A Rehabilitation, Major Complexity NO NO 0.0 0 0 0% 0% 0.0000 0.0000 0.0000 0.0000 0.0000 

Z60B Rehabilitation, Minor Complexity NO NO 0.0 0 0 0% 0% 0.0000 0.0000 0.0000 0.0000 0.0000 

Z63B Other Follow Up After Surgery or Medical Care, Minor Complexity NO NO 3.4 1 10 16% 80% 0.0000 0.0000 0.0000 0.6261 0.1672 

Z64A Other Factors Influencing Health Status, Major Complexity NO NO 6.2 2 19 9% 100% 0.0000 0.0000 0.9028 1.8057 0.1871 

Z64B Other Factors Influencing Health Status, Minor Complexity YES NO 4.2 1 13 49% 125% 0.1991 0.0000 0.0000 0.5996 0.1876 

Z65Z Congenital Anomalies and Problems Arising from Neonatal Period NO NO 2.5 1 12 14% 116% 0.0000 0.0000 0.0000 0.6250 0.3216 

Z66Z Sleep Disorders NO NO 2.3 1 8 11% 94% 0.0000 0.0000 0.0000 0.4101 0.1843 

 



 
For Official Use Only-I2-A2   57   

5.2 Section 2: ICD-10-AM 10th edition Procedure Codes Eligible for 
Radiotherapy Adjustments 
 

The following table lists the ICD-10-AM 10th edition procedure codes that are eligible for a 
radiotherapy adjustment.  This is from the 2018 19 National Efficient Price Determination, published 
by IHPA. 

Procedure 
Codes Description 

15000-00 Radiation treatment, superficial, 1 field 

15003-00 Radiation treatment, superficial, &gt;= 2 fields 

15100-00 Radiation treatment, orthovoltage, 1 field 

15103-00 Radiation treatment, orthovoltage, &gt;= 2 fields 

15224-00 Radiation treatment, megavoltage, 1 field, single modality linear accelerator 

15239-00 Radiation treatment, megavoltage, &gt;= 2 fields, single modality linear accelerator 

15254-00 Radiation treatment, megavoltage, 1 field, dual modality linear accelerator 

15269-00 Radiation treatment, megavoltage, &gt;= 2 fields, dual modality linear accelerator 

15600-00 Stereotactic radiation treatment, single dose 

15600-01 Stereotactic radiation treatment, fractionated 

15600-02 Hemi body irradiation 

15600-03 Total body irradiation 

15600-04 Total skin irradiation 

15303-00 Brachytherapy, intrauterine, low dose rate 

15304-00 Brachytherapy, intrauterine, high dose rate 

15311-00 Brachytherapy, intravaginal, low dose rate 

15312-00 Brachytherapy, intravaginal, high dose rate 

15319-00 Brachytherapy, combined intrauterine and intravaginal, low dose rate 

15320-00 Brachytherapy, combined intrauterine and intravaginal, high dose rate 

90764-00 Brachytherapy, intracavitary, low dose rate 

90764-01 Brachytherapy, intracavitary, high dose rate 

15327-00 Brachytherapy with implantation of removable single plane, low dose rate 

15327-01 Brachytherapy with implantation of removable single plane, pulsed dose rate 

15327-02 Brachytherapy with implantation of removable multiple planes or volume implant, low dose rate 

15327-03 Brachytherapy with implantation of removable multiple planes or volume implant, pulsed dose rate 

15327-04 Brachytherapy with implantation of permanent implant, &lt; 10 sources 

15327-05 Brachytherapy with implantation of permanent implant, &gt;= 10 sources 

15327-06 Brachytherapy with implantation of removable single plane, high dose rate 

15327-07 Brachytherapy with implantation of removable multiple planes or volume implant, high dose rate 

15338-00 Brachytherapy, prostate 

15360-00 Brachytherapy, intravascular 

15339-00 Removal of sealed radioactive source 

15012-00 Brachytherapy, eye 

90766-00 Brachytherapy using surface applicators, other sites 

16003-00 Administration of a therapeutic dose of Yttrium 90 

16009-00 Administration of a therapeutic dose of Iodine 131 



 
For Official Use Only-I2-A2   58   

Procedure 
Codes Description 

16012-00 Administration of a therapeutic dose of Phosphorous 32 

16015-00 Administration of a therapeutic dose of Strontium 89 

16018-00 Administration of a therapeutic dose of 153 SM-Lexidronan 

90960-00 Administration of a therapeutic dose of other unsealed radioisotope 

15342-00 Construction and application of radioactive surface mould 

15351-00 Construction and application of eye applicator 

90765-00 Construction and fitting of immobilisation device, simple 

90765-01 Construction and fitting of immobilisation device, intermediate 

90765-02 Construction and fitting of immobilisation device, complex 

90765-03 Construction and fitting of customised blocks 

90765-04 Construction and fitting of treatment accessories 

15500-00 Radiation field setting using simulator, simple 

15503-00 Radiation field setting using simulator, intermediate 

15506-00 Radiation field setting using simulator, complex 

15506-01 Radiation field setting using dedicated CT scanner 

15506-02 Radiation field setting for intensity modulated radiation therapy [IMRT] 

15509-00 Radiation field setting using diagnostic x-ray unit 

15550-00 Radiation field setting for three dimensional conformal radiation therapy [3DCRT] 

15518-00 Dosimetry by CT interfacing computer, simple 

15521-00 Dosimetry by CT interfacing computer, intermediate 

15524-00 Dosimetry by CT interfacing computer, complex 

15524-01 Dosimetry by CT interfacing computer for intensity modulated radiation therapy [IMRT] 

15527-00 Dosimetry by non-CT interfacing computer, simple 

15530-00 Dosimetry by non-CT interfacing computer, intermediate 

15533-00 Dosimetry by non-CT interfacing computer, complex 

15536-00 Brachytherapy planning, simple 

15536-01 Brachytherapy planning, intermediate 

15536-02 Brachytherapy planning, complex 

15539-00 Brachytherapy planning, prostate 

15541-00 Brachytherapy planning, intravascular 

15556-00 Dosimetry by CT interfacing computer for three dimensional conformal radiation therapy [3DCRT] 

15556-01 Dosimetry by non-CT interfacing computer for three dimensional conformal radiation therapy [3DCRT] 

37217-01 Implantation of fiducial markers 

 

 



 
For Official Use Only-I2-A2   59 
 

5.3 Section 3: ICD-10-AM 10th edition Procedure Codes Eligible for Dialysis 
Adjustment 
 

The following table lists the ICD-10-AM 10th edition procedure codes that are eligible for a dialysis 
adjustment.  Note that a patient is only eligible for a dialysis adjustment if he or she is assigned to a 
procedure code listed in the following table and is not assigned to AR-DRG L61Z (Haemodialysis) or 
L68Z (Peritoneal Dialysis). 

This table is from the 2018 19 National Efficient Price Determination published by IHPA. 

 

Procedure 
Codes Description 

13100-00 Haemodialysis 

13100-01 Intermittent haemofiltration 

13100-02 Continuous haemofiltration 

13100-03 Intermittent haemodiafiltration 

13100-04 Continuous haemodiafiltration 

13100-05 Haemoperfusion 

13100-06 Peritoneal dialysis, short term 

13100-07 Intermittent peritoneal dialysis, long term 

13100-08 Continuous peritoneal dialysis, long term 

 



 
For Official Use Only-I2-A2   60 
 

 

5.4 Section 4: 2018 19 AN-SNAP v4.0 price weights 
 

The following table lists the price weights for admitted subacute and non-acute patients using AN-SNAP V4.0  

This table is from the 2018 19 National Efficient Price Determination published by IHPA 

 

 

AN-
SNAP 

V4.0 
Care Type Episode Type Description Same Day ALOS 

Inlier Bounds Price Weights 

Lower 
Bound 

Upper 
Bound 

Same 
Day 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-
Stay 

Outlier 
Per Diem 

4AZ1 Rehabilitation Admitted Adult Rehabilitation 
 Weighted FIM motor score 13-18, Brain, 
Spine, MMT, Age &gt;= 49  NO 56.9 42 84 0.0000 0.3756 15.7757 0.2635 

4AZ2 Rehabilitation Admitted Adult Rehabilitation 
 Weighted FIM motor score 13-18, Brain, 
Spine, MMT, Age &lt;= 48  NO 83.9 58 108 0.0000 0.3997 23.1826 0.2830 

4AZ3 Rehabilitation Admitted Adult Rehabilitation 
 Weighted FIM motor score 13-18, All other 
impairments, Age &gt;= 65  NO 27.9 19 42 0.0000 0.3435 6.5265 0.2038 

4AZ4 Rehabilitation Admitted Adult Rehabilitation 
 Weighted FIM motor score 13-18, All other 
impairments, Age &lt;= 64  NO 42.0 30 66 0.0000 0.3618 10.8537 0.2037 

4AA1 Rehabilitation Admitted Adult Rehabilitation 
 Stroke, weighted FIM motor 51-91, FIM 
cognition 29-35  NO 14.2 10 23 0.0000 0.3037 3.0371 0.1619 

4AA2 Rehabilitation Admitted Adult Rehabilitation 
 Stroke, weighted FIM motor 51-91, FIM 
cognition 19-28  NO 18.2 12 28 0.0000 0.3204 3.8454 0.1828 

4AA3 Rehabilitation Admitted Adult Rehabilitation 
 Stroke, weighted FIM motor 51-91, FIM 
cognition 5-18  NO 28.2 18 43 0.0000 0.3335 6.0033 0.2030 

4AA4 Rehabilitation Admitted Adult Rehabilitation 
 Stroke, weighted FIM motor 36-50, Age &gt;= 
68  NO 28.2 17 41 0.0000 0.3437 5.8428 0.1967 

4AA5 Rehabilitation Admitted Adult Rehabilitation 
 Stroke, weighted FIM motor 36-50, Age &lt;= 
67  NO 36.8 23 56 0.0000 0.3674 8.4512 0.2085 

4AA6 Rehabilitation Admitted Adult Rehabilitation 
 Stroke, weighted FIM motor 19-35, Age &gt;= 
68  NO 33.8 22 51 0.0000 0.3457 7.6059 0.2173 

4AA7 Rehabilitation Admitted Adult Rehabilitation 
 Stroke, weighted FIM motor 19-35, Age &lt;= 
67  NO 49.7 31 68 0.0000 0.3740 11.5945 0.2446 

4AB1 Rehabilitation Admitted Adult Rehabilitation 
 Brain dysfunction, weighted FIM motor 71-
91, FIM cognition 26-35  NO 13.9 8 20 0.0000 0.3799 3.0396 0.2211 

4AB2 Rehabilitation Admitted Adult Rehabilitation 
 Brain dysfunction, weighted FIM motor 71-
91, FIM cognition 5-25  NO 23.8 13 31 0.0000 0.4082 5.3061 0.2529 



 
For Official Use Only-I2-A2   61 
 

AN-
SNAP 

V4.0 
Care Type Episode Type Description Same Day ALOS 

Inlier Bounds Price Weights 

Lower 
Bound 

Upper 
Bound 

Same 
Day 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-
Stay 

Outlier 
Per Diem 

4AB3 Rehabilitation Admitted Adult Rehabilitation 
 Brain dysfunction, weighted FIM motor 41-
70, FIM cognition 26-35  NO 20.2 13 30 0.0000 0.3298 4.2875 0.2379 

4AB4 Rehabilitation Admitted Adult Rehabilitation 
 Brain dysfunction, weighted FIM motor 41-
70, FIM cognition 17-25  NO 22.9 16 38 0.0000 0.3226 5.1612 0.1969 

4AB5 Rehabilitation Admitted Adult Rehabilitation 
 Brain dysfunction, weighted FIM motor 41-
70, FIM cognition 5-16  NO 33.8 21 50 0.0000 0.3634 7.6312 0.2223 

4AB6 Rehabilitation Admitted Adult Rehabilitation 
 Brain dysfunction, weighted FIM motor 29-
40  NO 35.0 21 48 0.0000 0.3451 7.2475 0.2340 

4AB7 Rehabilitation Admitted Adult Rehabilitation 
 Brain dysfunction, weighted FIM motor 19-
28  NO 42.3 26 60 0.0000 0.3652 9.4951 0.2242 

4AC1 Rehabilitation Admitted Adult Rehabilitation 
 Neurological conditions, weighted FIM 
motor 62-91  NO 15.6 10 24 0.0000 0.3136 3.1365 0.1679 

4AC2 Rehabilitation Admitted Adult Rehabilitation 
 Neurological conditions, weighted FIM 
motor 43-61  NO 22.8 15 35 0.0000 0.2974 4.4616 0.1847 

4AC3 Rehabilitation Admitted Adult Rehabilitation 
 Neurological conditions, weighted FIM 
motor 19-42  NO 28.8 21 45 0.0000 0.2961 6.2181 0.1923 

4AD1 Rehabilitation Admitted Adult Rehabilitation 
 Spinal cord dysfunction, Age &gt;= 50, 
weighted FIM motor 42-91  NO 33.3 22 51 0.0000 0.3735 8.2170 0.2354 

4AD2 Rehabilitation Admitted Adult Rehabilitation 
 Spinal cord dysfunction, Age &gt;= 50, 
weighted FIM motor 19-41  NO 51.4 32 69 0.0000 0.3761 12.0348 0.2467 

4AD3 Rehabilitation Admitted Adult Rehabilitation 
 Spinal cord dysfunction, Age &lt;= 49, 
weighted FIM motor 34-91  NO 36.8 21 56 0.0000 0.4638 9.7397 0.2870 

4AD4 Rehabilitation Admitted Adult Rehabilitation 
 Spinal cord dysfunction, Age &lt;= 49, 
weighted FIM motor 19-33  NO 61.1 50 97 0.0000 0.3458 17.2906 0.1912 

4AE1 Rehabilitation Admitted Adult Rehabilitation 
 Amputation of limb, Age &gt;= 54, weighted 
FIM motor 68-91  NO 23.0 15 35 0.0000 0.3272 4.9076 0.1812 

4AE2 Rehabilitation Admitted Adult Rehabilitation 
 Amputation of limb, Age &gt;= 54, weighted 
FIM motor 31-67  NO 27.1 18 41 0.0000 0.3269 5.8850 0.2006 

4AE3 Rehabilitation Admitted Adult Rehabilitation 
 Amputation of limb, Age &gt;= 54, weighted 
FIM motor 19-30  NO 26.0 17 39 0.0000 0.3706 6.2995 0.1894 

4AE4 Rehabilitation Admitted Adult Rehabilitation 
 Amputation of limb, Age &lt;= 53, weighted 
FIM motor 19-91  NO 26.1 19 40 0.0000 0.3366 6.3961 0.1932 

4AH1 Rehabilitation Admitted Adult Rehabilitation 
 Orthopaedic conditions, fractures, weighted 
FIM motor 49-91, FIM cognition 33-35  NO 14.1 9 22 0.0000 0.3087 2.7779 0.1640 

4AH2 Rehabilitation Admitted Adult Rehabilitation 
 Orthopaedic conditions, fractures, weighted 
FIM motor 49-91, FIM cognition 5-32  NO 18.9 12 29 0.0000 0.2975 3.5698 0.1716 

4AH3 Rehabilitation Admitted Adult Rehabilitation 
 Orthopaedic conditions, fractures, weighted 
FIM motor 38-48  NO 22.4 15 35 0.0000 0.2924 4.3859 0.1703 

4AH4 Rehabilitation Admitted Adult Rehabilitation 
 Orthopaedic conditions, fractures, weighted 
FIM motor 19-37  NO 24.0 16 37 0.0000 0.3067 4.9078 0.1748 

4A21 Rehabilitation Admitted Adult Rehabilitation 
 Orthopaedic conditions, all other (including 
replacements), weighted FIM motor 68-91  NO 11.0 7 17 0.0000 0.2906 2.0339 0.1669 



 
For Official Use Only-I2-A2   62 
 

AN-
SNAP 

V4.0 
Care Type Episode Type Description Same Day ALOS 

Inlier Bounds Price Weights 

Lower 
Bound 

Upper 
Bound 

Same 
Day 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-
Stay 

Outlier 
Per Diem 

4A22 Rehabilitation Admitted Adult Rehabilitation 
 Orthopaedic conditions, all other (including 
replacements), weighted FIM motor 50-67  NO 13.4 9 21 0.0000 0.2919 2.6270 0.1722 

4A23 Rehabilitation Admitted Adult Rehabilitation 
 Orthopaedic conditions, all other (including 
replacements), weighted FIM motor 19-49  NO 19.5 13 30 0.0000 0.2910 3.7828 0.1813 

4A31 Rehabilitation Admitted Adult Rehabilitation 
 Cardiac, Pain syndromes, Pulmonary, 
weighted FIM motor 72-91  NO 10.9 7 16 0.0000 0.3027 2.1187 0.1747 

4A32 Rehabilitation Admitted Adult Rehabilitation 
 Cardiac, Pain syndromes, Pulmonary, 
weighted FIM motor 55-71  NO 14.7 9 22 0.0000 0.3099 2.7892 0.1723 

4A33 Rehabilitation Admitted Adult Rehabilitation 
 Cardiac, Pain syndromes, Pulmonary, 
weighted FIM motor 34-54  NO 18.1 12 29 0.0000 0.3077 3.6929 0.1694 

4A34 Rehabilitation Admitted Adult Rehabilitation 
 Cardiac, Pain syndromes, Pulmonary, 
weighted FIM motor 19-33  NO 20.5 14 34 0.0000 0.3088 4.3232 0.1579 

4AP1 Rehabilitation Admitted Adult Rehabilitation 
 Major Multiple Trauma, weighted FIM motor 
19-91  NO 29.2 19 44 0.0000 0.3691 7.0131 0.2604 

4AR1 Rehabilitation Admitted Adult Rehabilitation  Reconditioning, weighted FIM motor 67-91  NO 13.3 8 20 0.0000 0.3181 2.5444 0.1741 

4AR2 Rehabilitation Admitted Adult Rehabilitation 
 Reconditioning, weighted FIM motor 50-66, 
FIM cognition 26-35  NO 15.8 11 25 0.0000 0.3022 3.3237 0.1748 

4AR3 Rehabilitation Admitted Adult Rehabilitation 
 Reconditioning, weighted FIM motor 50-66, 
FIM cognition 5-25  NO 17.4 11 27 0.0000 0.3264 3.5908 0.1889 

4AR4 Rehabilitation Admitted Adult Rehabilitation 
 Reconditioning, weighted FIM motor 34-49, 
FIM cognition 31-35  NO 18.7 12 29 0.0000 0.3596 4.3151 0.2281 

4AR5 Rehabilitation Admitted Adult Rehabilitation 
 Reconditioning, weighted FIM motor 34-49, 
FIM cognition 5-30  NO 20.1 13 31 0.0000 0.3256 4.2325 0.1880 

4AR6 Rehabilitation Admitted Adult Rehabilitation  Reconditioning, weighted FIM motor 19-33  NO 21.7 14 33 0.0000 0.3488 4.8832 0.2078 

4A91 Rehabilitation Admitted Adult Rehabilitation 
 All other impairments, weighted FIM motor 
55-91  NO 14.9 10 24 0.0000 0.3217 3.2170 0.1864 

4A92 Rehabilitation Admitted Adult Rehabilitation 
 All other impairments, weighted FIM motor 
33-54  NO 22.1 13 32 0.0000 0.3408 4.4300 0.2058 

4A93 Rehabilitation Admitted Adult Rehabilitation 
 All other impairments, weighted FIM motor 
19-32  NO 26.2 16 38 0.0000 0.3335 5.3361 0.2029 

4J01 Rehabilitation Admitted Adult Rehabilitation  Adult Same-Day Rehabilitation  YES 1.0 0 0 0.0978 0.0000 0.0000 0.0000 

4F01 Rehabilitation Admitted Paed Rehabilitation  Rehabilitation, Age &lt;= 3  NO 17.3 14 0 0.0000 0.7350 0.0000 0.0000 

4F02 Rehabilitation Admitted Paed Rehabilitation 
 Rehabilitation, Age &gt;= 4, Spinal cord 
dysfunction  NO 32.6 29 0 0.0000 0.4715 0.0000 0.0000 

4F03 Rehabilitation Admitted Paed Rehabilitation  Rehabilitation, Age &gt;= 4, Brain dysfunction  NO 24.7 19 0 0.0000 0.5787 0.0000 0.0000 

4F04 Rehabilitation Admitted Paed Rehabilitation 
 Rehabilitation, Age &gt;= 4, Neurological 
conditions  NO 11.5 10 0 0.0000 0.4759 0.0000 0.0000 



 
For Official Use Only-I2-A2   63 
 

AN-
SNAP 

V4.0 
Care Type Episode Type Description Same Day ALOS 

Inlier Bounds Price Weights 

Lower 
Bound 

Upper 
Bound 

Same 
Day 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-
Stay 

Outlier 
Per Diem 

4F05 Rehabilitation Admitted Paed Rehabilitation 
 Rehabilitation, Age &gt;= 4, All other 
impairments  NO 17.4 11 27 0.0000 0.5908 6.4993 0.4409 

4O01 Rehabilitation Admitted Paed Rehabilitation  Paediatric Same-Day Rehabilitation  YES 1.0 0 0 0.3414 0.0000 0.0000 0.0000 

4BS1 Palliative Care Admitted Adult Palliative Care  Stable phase, RUG-ADL 4-5  NO 7.1 5 12 0.0000 0.3395 1.6977 0.1981 

4BS2 Palliative Care Admitted Adult Palliative Care  Stable phase, RUG-ADL 6-16  NO 8.1 5 13 0.0000 0.3827 1.9135 0.2148 

4BS3 Palliative Care Admitted Adult Palliative Care  Stable phase, RUG-ADL 17-18  NO 7.3 5 12 0.0000 0.3529 1.7644 0.2225 

4BU1 Palliative Care Admitted Adult Palliative Care 
 Unstable phase, First Phase in Episode, 
RUG-ADL 4-13  NO 3.2 1 5 0.0000 0.0000 0.4865 0.2855 

4BU2 Palliative Care Admitted Adult Palliative Care 
 Unstable phase, First Phase in Episode, 
RUG-ADL 14-18  NO 2.8 1 5 0.0000 0.0000 0.4130 0.2563 

4BU3 Palliative Care Admitted Adult Palliative Care 
 Unstable phase, Not first Phase in Episode, 
RUG-ADL 4-5  NO 2.5 1 4 0.0000 0.0000 0.4816 0.3016 

4BU4 Palliative Care Admitted Adult Palliative Care 
 Unstable phase, Not first Phase in Episode, 
RUG-ADL 6-18  NO 2.0 1 4 0.0000 0.0000 0.4383 0.2431 

4BD1 Palliative Care Admitted Adult Palliative Care  Deteriorating phase, RUG-ADL 4-14  NO 5.3 3 9 0.0000 0.0000 1.2082 0.2030 

4BD2 Palliative Care Admitted Adult Palliative Care 
 Deteriorating phase, RUG-ADL 15-18, Age 
&gt;= 75  NO 4.3 2 7 0.0000 0.4407 0.8814 0.2186 

4BD3 Palliative Care Admitted Adult Palliative Care 
 Deteriorating phase, RUG-ADL 15-18, Age 
55-74  NO 4.8 2 7 0.0000 0.4543 0.9085 0.2362 

4BD4 Palliative Care Admitted Adult Palliative Care 
 Deteriorating phase, RUG-ADL 15-18, Age 
&lt;= 54  NO 5.1 3 9 0.0000 0.3930 1.1791 0.2292 

4BT1 Palliative Care Admitted Adult Palliative Care  Terminal phase  NO 2.4 1 4 0.0000 0.0000 0.5015 0.2599 

4K01 Palliative Care Admitted Adult Palliative Care  Adult Same-Day Palliative Care  YES 1.0 0 0 0.1483 0.0000 0.0000 0.0000 

4CH1 GEM Admitted GEM  FIM motor 57-91 with Delirium or Dementia  NO 21.0 14 33 0.0000 0.2680 3.7519 0.1624 

4CH2 GEM Admitted GEM  FIM motor 57-91 without Delirium or Dementia  NO 14.1 9 22 0.0000 0.2806 2.5255 0.1363 

4CM1 GEM Admitted GEM  FIM motor 18-56 with Delirium or Dementia  NO 22.4 14 34 0.0000 0.2936 4.1110 0.1652 

4CM2 GEM Admitted GEM  FIM motor 18-56 without Delirium or Dementia  NO 19.7 13 30 0.0000 0.2819 3.6649 0.1622 

4CL1 GEM Admitted GEM  FIM motor 13-17 with Delirium or Dementia  NO 24.4 18 39 0.0000 0.2662 4.7922 0.1679 

4CL2 GEM Admitted GEM  FIM motor 13-17 without Delirium or Dementia  NO 22.2 14 34 0.0000 0.2758 3.8611 0.1628 



 
For Official Use Only-I2-A2   64 
 

AN-
SNAP 

V4.0 
Care Type Episode Type Description Same Day ALOS 

Inlier Bounds Price Weights 

Lower 
Bound 

Upper 
Bound 

Same 
Day 

Short-Stay 
Outlier Per 

Diem 
Inlier 

Long-
Stay 

Outlier 
Per Diem 

4L01 GEM Admitted GEM  Same-Day GEM  YES 1.0 0 0 0.1123 0.0000 0.0000 0.0000 

4DS1 Psychogeriatric Care 
Admitted 
Psychogeriatric 

 HoNOS 65+ Overactive behaviour 3-4, LOS 
&lt;= 91  NO 22.2 15 36 0.0000 0.4645 6.9679 0.2922 

4DS2 Psychogeriatric Care 
Admitted 
Psychogeriatric 

 HoNOS 65+ Overactive behaviour 1-2, 
HoNOS 65+ ADL 4, LOS &lt;= 91  NO 26.9 22 51 0.0000 0.3753 8.2556 0.1847 

4DS3 Psychogeriatric Care 
Admitted 
Psychogeriatric 

 HoNOS 65+ Overactive behaviour 1-2, 
HoNOS 65+ ADL 0-3, LOS &lt;= 91  NO 22.3 14 34 0.0000 0.5049 7.0685 0.2870 

4DS4 Psychogeriatric Care 
Admitted 
Psychogeriatric 

 HoNOS 65+ Overactive behaviour 0, 
HoNOS 65+ total 18-48, LOS &lt;= 91  NO 22.8 24 55 0.0000 0.4300 10.3198 0.2358 

4DS5 Psychogeriatric Care 
Admitted 
Psychogeriatric 

 HoNOS 65+ Overactive behaviour 0, 
HoNOS 65+ total 0-17, LOS &lt;= 91  NO 23.2 17 40 0.0000 0.4941 8.3999 0.1958 

4DL1 Psychogeriatric Care 
Admitted 
Psychogeriatric  Long term care  NO 159.0 119 200 0.0000 0.2938 34.9662 0.2170 

4M01 Psychogeriatric Care 
Admitted 
Psychogeriatric  Same-Day Psychogeriatric Care  YES 1.0 0 0 0.1038 0.0000 0.0000 0.0000 

4ES1 Maintenance Admitted Non-Acute  Age &gt;= 60, RUG-ADL 4-11, LOS &lt;= 91  NO 13.2 8 20 0.0000 0.3356 2.6849 0.1978 

4ES2 Maintenance Admitted Non-Acute  Age &gt;= 60, RUG-ADL 12-15, LOS &lt;= 91  NO 13.8 8 20 0.0000 0.3415 2.7317 0.2020 

4ES3 Maintenance Admitted Non-Acute  Age &gt;= 60, RUG-ADL 16-18, LOS &lt;= 91  NO 14.3 10 23 0.0000 0.3151 3.1509 0.1918 

4ES4 Maintenance Admitted Non-Acute  Age 18-59, LOS &lt;= 91  NO 15.5 10 24 0.0000 0.3904 3.9041 0.2224 

4ES5 Maintenance Admitted Non-Acute  Age &lt;= 17, LOS &lt;= 91  NO 11.2 6 16 0.0000 0.6003 3.6019 0.3388 

4EL1 Maintenance Admitted Non-Acute  Long term care  NO 185.2 123 206 0.0000 0.2362 29.0539 0.1506 

 

 



 
For Official Use Only-I2-A2   65 
 

5.5 Section 5: Special Grants 
 

This table is from the 2018 19 SOYM working papers for the Casemix Pool which was approved in 
the 2018-19 budget. 

 

? 24 hour medical Emergency Care 
model 

? A&amp;E Agreements 
? ABSS 
? Artificial Limbs Scheme 
? Blood Management Program 
? Brennan Review 
? Carparking - Flinders Medical Centre 

loan with the Treasurer 

? Centre for Physical Ageing 
? Child Development Unit 
? Child Protection 
? Child Protection Services  (Nyland 

Review) 

? Country Outreach 
? Donate Life - RAH 
? DVA FFS 
? FBT 
? FFS Locums/Oncall Arrange 
? General Practitioner Fee For Service 
? GFU Transitionary Supplementation 
? GNP/TPPP 
? GP on call 
? HAC Operating Expenses 
? Heart Lung Transport 
? HIV/AIDS Infectious Diseases Unit 

(PHOFA) 

? Home Access Assist 
? Home Ventilation Funding 
? Hospital Links 
? JBI Evidence Based Nursing  
? KI Maternity Care Team 
? KidSafe SA 
? Lease &amp; Maint. Payments 

? Locality &amp; Zone Allowances 
? Medical Scholarships 
? Midwifery Model 
? National Bowel Cancer Screening 

Program 

? North West Children's and Families 
Integration Project 

? Northern Paediatric Unit 
? nRAH - Readiness and Transitionary 

Cost Pressures 

? Nurses PD 
? Nyland Royal Commission 
? Patient Transport 
? Pegademese costs 
? Pre-Vocational General Practice 

Placement (PGPPP) 

? Private Hospital Gross Up 
? Radiation Oncology 
? Remote Issues 
? Renal Dialysis 
? Residential Rent &amp; Property Lease 
? SA Multiple Births 
? Spasticity Rehabilitation 
? Stepdown Unit/Aboriginal Unit 
? Surgery Receptionist 
? TB State-wide Services 
? Toxicology Services 
? Weight Disorders Clinic 
? Workers Comp 





 
For Official Use Only-I2-A2   67 
 

5.6 Section 6: Low Volume / Minimum Budget / Grant Funded Hospitals 
 

This table is from the 2018 19 SOYM working papers for CHSA Analysis   Data for Grant Funded 
model and this list was approved in the 2018-19 budget. 

 

? Booleroo 
? Bordertown 
? Burra 
? Wudinna 
? Cleve 
? Coober Pedy 
? Cowell 
? Crystal Brook 
? Cummins 
? Elliston 
? Eudunda 
? Hawker 
? Gumeracha 
? Jamestown 
? Kangaroo Island 
? Kapunda 
? Karoonda 
? Kimba 
? Kingston 
? Lameroo 
? Laura 
? Tailem Bend 

? Loxton 
? CYP (Maitland) 
? Mannum 
? Meningie 
? Mt Pleasant 
? Ceduna 
? Orroroo 
? Penola 
? Peterborough 
? Pinnaroo 
? Port Broughton 
? Quorn 
? Renmark 
? Riverton 
? Roxby Downs 
? Snowtown 
? Southern Yorke 
? Strathalbyn 
? Streaky Bay 
? Tumby Bay 
? Waikerie 

 

 

 

 

 

 

  



 
For Official Use Only-I2-A2   68 
 

5.7 Section 7: Non-Admitted Patients - Tier 2 Clinic v5.0 
 

The Pricing Authority has determined the following services as eligible for Commonwealth Funding as 
a public hospital service: 

Category A (Specialist outpatient clinic services - Tier 2 non-admitted service class 10, 20 and 30) 

Category B (Other non-admitted patient services and non-medical specialist outpatient clinics   Tier 2 
non-admitted services class 40) 

 

Tier 2 Clinic 
V5.0 Description Price Weights 

10.01 Hyperbaric medicine 0.1033 

10.02 Interventional imaging 0.4000 

10.03 Minor surgical 0.0438 

10.04 Dental 0.0610 

10.05 Angioplasty/angiography 0.3018 

10.06 Endoscopy   gastrointestinal 0.3829 

10.07 Endoscopy   urological/gynaecological 0.0532 

10.08 Endoscopy   orthopaedic 0.0427 

10.09 Endoscopy   respiratory/ear, nose and throat (ENT) 0.0464 

10.10 Renal dialysis   hospital delivered 0.0575 

10.11 Chemotherapy treatment 0.0420 

10.12 Radiation therapy   treatment 0.0732 

10.13 Minor medical procedures 0.0990 

10.14 Pain management interventions 0.0741 

10.15* Renal dialysis   haemodialysis   home delivered 1.0300 

10.16* Renal dialysis   peritoneal dialysis   home delivered 1.0614 

10.17* Total parenteral nutrition   home delivered 2.4334 

10.18* Enteral nutrition   home delivered 0.1755 

10.19 Ventilation   home delivered Block funded 

10.20 Radiation therapy   simulation and planning 0.1825 

10.80 Colonoscopy Map to ABF Tier 2 10.06 

10.81 Oesophagoscopy Map to ABF Tier 2 10.06 

10.82 Other Endoscopy   gastrointestinal  Map to ABF Tier 2 10.06 

10.83 Other Endoscopy   respiratory / ear, nose and throat (ENT) Map to ABF Tier 2 10.09 

10.84 Panedoscopy Map to ABF Tier 2 10.06 

10.85 Sigmoidoscopy Map to ABF Tier 2 10.06 

10.86 Bronchoscopy Map to ABF Tier 2 10.09 
10.95* Home Oxygen Night 0.0472 

10.96* Home Oxygen Continuous 0.0541 

10.97* Home Oxygen Exercise 0.0304 

10.98* Home Oxygen Unusual 0.0887 



 
For Official Use Only-I2-A2   69 
 

Tier 2 Clinic 
V5.0 Description Price Weights 

10.99* Home Oxygen Palliative 0.0375 

20.01 Transplants 0.0993 

20.02 Anaesthetics 0.0599 

20.03 Pain management 0.0921 

20.04 Developmental disabilities 0.0789 

20.05 General medicine 0.0512 

20.06 General practice and primary care Out of scope 

20.07 General surgery 0.0530 

20.08 Genetics 0.1386 

20.09 Geriatric medicine 0.0703 

20.10 Haematology 0.0505 

20.11 Paediatric medicine 0.0643 

20.12 Paediatric surgery 0.0655 

20.13 Palliative care 0.0716 

20.14 Epilepsy 0.0619 

20.15 Neurology 0.0756 

20.16 Neurosurgery 0.0508 

20.17 Ophthalmology 0.0428 

20.18 Ear, nose and throat (ENT) 0.0496 

20.19 Respiratory 0.0682 

20.20 Respiratory   cystic fibrosis 0.1603 

20.21 Anti-coagulant Screening and Management 0.0569 

20.22 Cardiology 0.0581 

20.23 Cardiothoracic 0.0833 

20.24 Vascular surgery 0.0610 

20.25 Gastroenterology 0.0827 

20.26 Hepatobiliary 0.1073 

20.27 Craniofacial 0.0560 

20.28 Metabolic bone 0.0613 

20.29 Orthopaedics 0.0451 

20.30 Rheumatology 0.0631 

20.31 Spinal 0.0804 

20.32 Breast 0.0727 

20.33 Dermatology 0.0487 

20.34 Endocrinology 0.0598 

20.35 Nephrology 0.0859 

20.36 Urology 0.0578 

20.37 Assisted reproductive technology 0.0702 

20.38 Gynaecology 0.0580 

20.39 Gynaecological oncology 0.0642 

20.40 Obstetrics   management of pregnancy without complications 0.0436 

20.41 Immunology 0.0672 

20.42 Medical oncology   consultation 0.0854 



 
For Official Use Only-I2-A2   70 
 

Tier 2 Clinic 
V5.0 Description Price Weights 

20.43 Radiation therapy   consultation 0.0462 

20.44 Infectious diseases 0.0438 

20.45 Psychiatry 0.0403 

20.46 Plastic and reconstructive surgery 0.0424 

20.47 Rehabilitation 0.0462 

20.48 Multidisciplinary burns clinic 0.0660 

20.49 Geriatric evaluation and management (GEM) 0.0928 

20.50 Psychogeriatric 0.0574 

20.51 Sleep disorders 0.0526 

20.52 Addiction medicine 0.0512 

20.53 Obstetrics   management of complex pregnancy 0.0736 

20.54 Maternal fetal medicine 0.0736 

20.55 Telehealth   patient location 0.0201 

30.01 General imaging Not priced6 

30.02 Magnetic resonance imaging (MRI) Not priced6 

30.03 Computerised tomography (CT) Not priced6 

30.04 Nuclear medicine Not priced6 

30.05 Pathology (microbiology, haematology, biochemistry) Not priced6 

30.06 Positron emission tomography (PET) Not priced6 

30.07 Mammography screening Not priced6 

30.08 Clinical measurement Not priced6 

40.02 Aged care assessment Out of scope 

40.03 Aids and appliances 0.0428 

40.04 Clinical pharmacy 0.1083 

40.05 Hydrotherapy 0.0382 

40.06 Occupational therapy 0.0420 

40.07 Pre-admission and pre-anaesthesia 0.0552 

40.08 Primary health care Out of scope 

40.09 Physiotherapy 0.0307 

40.10 Sexual health 0.0312 

40.11 Social work 0.0558 

40.12 Rehabilitation 0.0455 

40.13 Wound management 0.0326 

40.14 Neuropsychology 0.1188 

40.15 Optometry 0.0087 

40.16 Orthoptics 0.0280 

40.17 Audiology 0.0534 

40.18 Speech pathology 0.0454 

40.21 Cardiac rehabilitation 0.0434 

40.22 Stomal therapy 0.0693 

40.23 Nutrition/dietetics 0.0377 

40.24 Orthotics 0.0552 

40.25 Podiatry 0.0357 



 
For Official Use Only-I2-A2   71 
 

Tier 2 Clinic 
V5.0 Description Price Weights 

40.27 Family planning Out of scope 

40.28 Midwifery and maternity 0.0382 

40.29 Psychology 0.0246 

40.30 Alcohol and other drugs 0.0402 

40.31 Burns 0.0454 

40.32 Continence 0.0236 

40.33 General counselling Out of scope 

40.34 Specialist mental health Block funded 

40.35 Palliative care 0.0546 

40.36 Geriatric evaluation and management (GEM) 0.0509 

40.37 Psychogeriatric 0.0184 

40.38 Infectious diseases 0.0834 

40.39 Neurology 0.0579 

40.40 Respiratory 0.0403 

40.41 Gastroenterology 0.0441 

40.42 Circulatory 0.0623 

40.43 Hepatobiliary 0.0908 

40.44 Orthopaedics 0.0297 

40.45 Dermatology 0.0303 

40.46 Endocrinology 0.0487 

40.47 Nephrology 0.0415 

40.48 Haematology and immunology 0.0606 

40.49 Gynaecology 0.0506 

40.50 Urology 0.0514 

40.51 Breast 0.0582 

40.52 Oncology 0.0276 

40.53 General medicine 0.0418 

40.54 General surgery 0.0362 

40.55 Paediatrics 0.0416 

40.56 Falls prevention 0.0134 

40.57 Cognition and memory 0.0519 

40.58 Hospital avoidance programs 0.0526 

40.59 Post-acute care 0.0443 

40.60 Pulmonary rehabilitation 0.0434 

40.61 Telehealth   patient location 0.0095 

 

*Note: 
 

The price weight for clinics 10.15, 10.16, 10.17, 10.18, 10.19, 10.95, 10.96, 10.97, 10.98, and 10.99 
are priced on a per calendar month basis. 

  



 
For Official Use Only-I2-A2   72 
 

 

5.8 Section 8: List of hospitals by Emergency Classification type 
 

The Department of Health and Wellbeing has determined the following public hospitals to be URG or 
UDG based on IHPA s definition of emergency services. 

 

 
Hospital 

code 
Hospital Name ED Classification 

1 WCH-Children's ED URG  

3 Women's and Children's Hospital URG  

5 Flinders Medical Centre URG  

8 Hampstead Rehabilitation Centre NA 

14 The Queen Elizabeth Hospital URG  

19 Royal Adelaide Hospital URG  

20 Gawler Health Service URG  

27 Lyell McEwin Hospital URG  

29 Lyell McEwin Hospital - WAU URG  

30 Modbury Hospital URG  

33 Noarlunga Health Services URG  

35 Pregnancy Advisory Centre NA 

36 Southern Districts War Memorial Private Hospital NA 

42 St. Margaret's Hospital NA 

49 Barossa Area Health Services - Angaston Campus UDG  

52 Balaklava &amp; Riverton Districts Health Service - Balaklava Campus UDG  

55 Barmera District Health Services UDG  

58 Riverland Regional Hospital - Berri URG 

67 Booleroo Centre District Hospital and Health Services UDG  

70 Bordertown Memorial Hospital UDG  

73 Burra; Clare &amp; Snowtown Health Service - Burra Campus UDG  

76 Central Eyre Peninsula Hospital UDG  

79 Burra; Clare &amp; Snowtown Health Service -Clare Campus UDG  

82 Eastern Eyre Health and Aged Care - Cleve Campus UDG  

85 Coober Pedy Hospital &amp; Health Services UDG  

88 Eastern Eyre Health and Aged Care - Cowell Campus UDG  

91 Crystal Brook District Hospital UDG  

94 Lower Eyre Health Services - Cummins Hospital Campus UDG  

97 Elliston Hospital UDG  

100 Eudunda &amp; Kapunda Health Service - Eudunda Campus UDG  

103 Hawker Memorial Hospital UDG  

106 Gumeracha Hospital UDG  

109 Jamestown Hospital &amp; Health Service UDG  

112 Kangaroo Island Health Service UDG  

115 Eudunda &amp; Kapunda Health Service - Kapunda Campus UDG  



 
For Official Use Only-I2-A2   73 
 

 
Hospital 

code 
Hospital Name ED Classification 

118 Karoonda &amp; District Soldiers' Memorial Hospital UDG  

121 Eastern Eyre Health and Aged Care - Kimba Campus UDG  

124 Kingston Soldiers' Memorial Hospital UDG  

127 Lameroo District Health Services UDG  

130 Laura &amp; Districts Hospital UDG  

133 Leigh Creek Hospital UDG  

136 Tailem Bend District Hospital UDG  

139 Loxton Hospital Complex UDG  

142 Central Yorke Peninsula Hospital UDG  

145 The Mannum District Hospital UDG  

151 Meningie &amp; Districts Memorial Hospital &amp; Health Services UDG  

154 Millicent &amp; District Hospital &amp; Health Services UDG  

160 Mount Barker District Soldiers' Memorial Hospital UDG  

163 Mount Gambier and Districts Health Service URG 

166 Mt Pleasant Hospital UDG  

169 Ceduna Hospital UDG  

172 Murray Bridge Soldiers' Memorial Hospital UDG  

175 Naracoorte Health Service UDG  

181 Oodnadatta  Hospital UDG  

184 Orroroo &amp; District Health Service UDG  

187 Penola War Memorial Hospital UDG  

190 Peterborough Soldiers' Memorial Hospital UDG  

193 Pinnaroo Soldiers' Memorial Hospital UDG  

196 Port Augusta Hospital &amp; Regional Health Services URG 

199 Port Broughton District Hospital &amp; Health Services UDG 

202 Port Lincoln Health Services URG  

205 Port Pirie Regional Health Service URG  

208 Quorn &amp; District Memorial Hospital UDG  

211 Renmark Paringa District Hospital UDG  

214 Balaklava &amp; Riverton Districts Health Service-Riverton Campus UDG  

217 Roxby Downs Health Centre UDG  

220 Burra; Clare &amp; Snowtown Health Service - Snowtown Campus UDG  

223 South Coast District Hospital UDG  

226 Southern Yorke Peninsula Health Service UDG  

229 Strathalbyn &amp; District Soldiers' Memorial Hospital UDG  

232 Streaky Bay Hospital UDG  

235 Barossa Area Health Services - Tanunda Campus UDG  

241 Lower Eyre Health Services - Tumby Bay Hospital Campus UDG  

244 Waikerie Hospital &amp; Health Services UDG  

247 Northern Yorke Peninsula Health Service UDG  

249 Whyalla Hospital &amp; Health Services URG 

296 WCH-Family Services (Helen Mayo) NA 



 
For Official Use Only-I2-A2   74 
 

 
Hospital 

code 
Hospital Name ED Classification 

300 Glenside Hospital NA 

306 James Nash House NA 

  



 
For Official Use Only-I2-A2   75 
 

5.9 Section 9: Emergency Department   Urgency Related Groups (URG) v1.4 
 

This table is from the 2018 19 National Efficient Price Determination published by IHPA. 

 

URG  
V1.4 Description 

Price 
Weights 

3 Adm_T1_Injury 0.4434 

4 Adm_T1_Poisoning/Toxic effects of drugs 0.3214 

5 Adm_T1_Respiratory system illness 0.3173 

6 Adm_T1_Circulatory system and Endocrine, nutritional and metabolic illness 0.2806 

7 Adm_T1_All other MDB groups 0.3333 

9 Adm_T2_Poisoning 0.2183 

10 Adm_T2_Injury 0.2828 

11 Adm_T2_Gastrointestinal system and Digestive system illness 0.2425 

12 Adm_T2_Respiratory system illness 0.2312 

14 Adm_T2_Neurological illness 0.2779 

15 Adm_T2_Toxic effects of drugs 0.2326 

16 Adm_T2_Circulatory system and Endocrine, nutritional and metabolic illness 0.2024 

17 Adm_T2_All other MDB groups 0.1938 

19 Adm_T3_Blood/Immune system illness &amp; system infection/parasites 0.1959 

20 Adm_T3_Injury 0.1924 

21 Adm_T3_Neurological illness 0.1990 

22 Adm_T3_Obstetric/Gynaecological illness 0.1130 

23 Adm_T3_Digestive system illness 0.1875 

24 Adm_T3_Circulatory system illness and endocrine, nutritional and metabolic illness 0.1802 

25 Adm_T3_Poisoning/Toxic effects of drugs 0.1728 

26 Adm_T3_Urological illness 0.1811 

27 Adm_T3_Respiratory system illness 0.1879 

29 Adm_T3_All other MDB groups 0.1686 

30 Adm_T4_Poisoning/Toxic effects of drugs 0.1291 

31 Adm_T4_Respiratory system illness 0.1544 

32 Adm_T4_Gastrointestinal system and Digestive system illness 0.1499 

33 Adm_T4_All other MDB groups 0.1399 

34 Adm_T4_Injury 0.1356 

35 Adm_T4_Social problem/Other presentation 0.1380 

37 Adm_T5_All other MDB groups 1 0.0815 

38 Dead on Arrival w any Triage w any MDB 0.0464 

39 N-A_T1_All MDB groups 0.3024 

40 N-A_T2_Toxic effects of drugs 0.2292 

43 N-A_T2_Circulatory system / Endocrine, nutritional and metabolic diseases 0.1728 

44 N-A_T2_Injury 0.1685 

45 N-A_T2_Poisoning 0.2102 

46 N-A_T2_All other MDB groups 0.1458 

48 N-A_T3_Circulatory system and Endocrine, nutritional and metabolic illness 0.1317 



 
For Official Use Only-I2-A2   76 
 

URG  
V1.4 Description 

Price 
Weights 

50 N-A_T3_Injury 0.1140 

51 N-A_T3_Genitourinary illness 0.1324 

52 N-A_T3_Gastrointestinal system and Digestive system illness 0.1285 

53 N-A_T3_Neurological illness 0.1393 

55 N-A_T3_Respiratory system illness 0.1149 

56 N-A_T3_Musculoskeletal/connective tissue illness 0.1197 

57 N-A_T3_All other MDB groups 0.1023 

58 N-A_T4_Injury 0.0782 

60 N-A_T4_Urological system illness 0.0969 

61 N-A_T4_Circulatory system / Endocrine, nutritional and metabolic illness 0.0977 

62 N-A_T4_Gastrointestinal system and Digestive system illness 0.0948 

63 N-A_T4_Musculoskeletal/connective tissue illness 0.0886 

65 N-A_T4_Illness of the ENT 0.0689 

66 N-A_T4_Illness of the Eyes 0.0615 

67 N-A_T4_Other presentation block 0.0718 

68 N-A_T4_All other MDB groups 0.0839 

69 N-A_T5_Poisoning/Toxic effects of drugs 0.0599 

70 N-A_T5_Injury 0.0599 

71 N-A_T5_Other presentation block 0.0485 

72 N-A_T5_All other MDB groups 0.0627 

73 Did Not Wait 0.0406 

74 Transfer presentation_1, 2 0.3402 

75 Died in emergency department triage 1 0.2739 

76 Adm_Return visit, planned w any Triage 0.1185 

77 N-A Return visit, planned   Triage 1, 2 0.1359 

78 N-A Return visit, planned   Triage 3-5 0.0581 

79 Adm_T1_Psychiatric illness 0.3775 

80 Adm_T2_System infection/parasites 0.2515 

81 Adm_T2_Urological system illness 0.2215 

82 Adm_T2_Psychiatric illness 0.2386 

83 Adm_T3_Illness of eyes, ear, nose, throat 0.1439 

84 Adm_T3_Hepatobiliary system illness 0.2017 

85 Adm_T3_Psychiatric illness 0.1840 

86 Adm_T4_Circulatory system illness and Endocrine, nutritional and metabolic illness 0.1516 

87 Adm_T4_Illness of eyes, ear nose and throat 0.1147 

88 Adm_T4_Blood/immune system illness/system infection/parasites 0.1498 

89 Adm_T4_Gynaecological and Male reproductive system illness 0.1285 

90 Adm_T4_Psychiatric illness 0.1436 

91 Adm_T5_All other MDB groups 2 0.1124 

92 Adm_T5_Injury 0.0952 

93 Adm_T5_Gastrointestinal system and Digestive system illness 0.1171 

94 Adm_T5_Psychiatric illness 0.1118 

95 N-A_T2_Respiratory system illness 0.1658 



 
For Official Use Only-I2-A2   77 
 

URG  
V1.4 Description 

Price 
Weights 

96 N-A_T2_Urological system illness 0.1807 

97 N-A_T2_Gastrointestinal system and Digestive system illness 0.1668 

98 N-A_T2_Neurological illness 0.1942 

99 N-A_T2_Blood/immune system illness/system infection/parasites 0.1612 

100 N-A_T2_Psychiatric illness 0.1806 

101 N-A_T3_Poisoning 0.1327 

102 N-A_T3_Toxic effects of drugs 0.1460 

103 N-A_T3_Illness of eyes 0.0854 

104 N-A_T3_Blood/immune system illness/system infection/parasites 0.1081 

105 N-A_T3_Psychiatric illness 0.1358 

106 N-A_T4_Poisoning 0.0803 

107 N-A_T4_Toxic effects of drugs 0.0997 

108 N-A_T4_Respiratory system illness 0.0853 

109 N-A_T4_Blood/Immune system illness/System infection/parasites 0.0793 

110 N-A_T4_Obstetric and Newborn/Neonate 0.0848 

111 N-A_T4_Gynecological/Male reproductive system illness 0.0930 

112 N-A_T4_Psychiatric illness 0.0959 

113 N-A_T5_Circulatory system illness/Endocrine, nutritional and metabolic diseases 0.0688 

114 N-A_T5_Gastrointestinal system and Digestive system illness 0.0663 

115 N-A_T5_Illness of the eyes, ear, nose and throat 0.0497 

116 N-A_T5_Illness of the skin, subcutaneous tissue, breast/Musculoskeletal/Connective tissue illness 0.0625 

117 N-A_T5_Blood/immune system illness/system infection/parasites 0.0575 

118 N-A_T5_Obstetric illness/Newborn/Neonate 0.0469 

119 N-A_T5_Genitourinary system illness 0.0635 

120 N-A_T5_Psychiatric illness 0.0677 

121 Transfer presentation_3 0.2691 

122 Transfer presentation_4 0.2153 

123 Transfer presentation_5 0.1330 

124 Died in emergency department triage 2-5 0.2799 

125 Left at own risk_1, 2 0.1717 

126 Left at own risk_3 0.1016 

127 Left at own risk_4 0.0697 

128 Left at own risk_5 0.0519 

 

  



 
For Official Use Only-I2-A2   78 
 

 

5.10 Section 10: Emergency Department   UDG v1.3 
 

This table is from the 2018 19 National Efficient Price Determination published by IHPA. 

 

UDG  V1.3 Description Price Weights 
1 Adm_T1 0.3423 

2 Adm_T2 0.2275 

3 Adm_T3 0.1834 

4 Adm_T4 0.1422 

5 Adm_T5 0.1024 

6 N-A_T1 0.3004 

7 N-A_T2 0.1694 

8 N-A_T3 0.1192 

9 N-A_T4 0.0819 

10 N-A_T5 0.0581 

11 Did Not Wait 0.0406 

12 Dead on Arrival w any Triage w any MDB 0.0464 

13 Transfer presentation 0.2782 

14 Died in emergency department 0.2761 

15 Adm_Return visit, planned w any Triage 0.1185 

16 N-A Return visit, planned   Triage 1, 2, 3 0.1088 

17 N-A Return visit, planned   Triage 4,5 0.0565 

 

 

  



 
For Official Use Only-I2-A2   79 
 

 

5.11 Section 11: List of hospitals by Peer Group 
 

The following hospitals are SA Health types/peer groups that applies to Emergency and Non-admitted 
(except for Country Chemo) 

 

Hosp Code Hosp Name LHN Type Peer Group 
3 Women s and Children s WCHN W&amp;CHN Metro - WCH 

5 Flinders Medical Centre SALHN SALHN Metro - Large 

8 Hampstead CALHN CALHN Metro - Other 

14 The Queen Elizabeth Hospital CALHN CALHN Metro - Large 

19 Royal Adelaide Hospital CALHN CALHN Metro - Large 

20 Gawler CHSA Country - Casemix Other Country Other 

27 Lyell McEwin NALHN NALHN Metro   Large 

30 Modbury NALHN NALHN Metro   Other 

33 Noarlunga SALHN SALHN Metro   Other 

36 Southern Districts War Memorial SALHN Other Metro   Other 

42 St Margaret s CALHN CALHN Metro   Other 

49 Angaston CHSA Country   Casemix Other Country Other 

52 Balaklava CHSA Country   Grant Funded Country GFU 

55 Barmera CHSA Country   Grant Funded Country GFU 

58 Riverland (Berri) CHSA Country   Casemix Large Country Large 

67 Booleroo CHSA Country   Grant Funded Country GFU 

70 Bordertown CHSA Country   Grant Funded Country GFU 

73 Burra CHSA Country   Grant Funded Country GFU 

76 Wudinna CHSA Country   Grant Funded Country GFU 

79 Clare CHSA Country   Casemix Other Country Other 

82 Cleve CHSA Country   Grant Funded Country GFU 

85 Coober Pedy CHSA Country   Grant Funded Country GFU 

88 Cowell CHSA Country   Grant Funded Country GFU 

91 Crystal Brook CHSA Country   Grant Funded Country GFU 

94 Cummins CHSA Country   Grant Funded Country GFU 

97 Elliston CHSA Country   Grant Funded Country GFU 

100 Eudunda CHSA Country   Grant Funded Country GFU 

103 Hawker CHSA Country   Grant Funded Country GFU 

106 Gumeracha CHSA Country   Grant Funded Country GFU 

109 Jamestown CHSA Country   Grant Funded Country GFU 

112 Kangaroo Island CHSA Country   Grant Funded Country GFU 

115 Kapunda CHSA Country   Grant Funded Country GFU 

118 Karoonda CHSA Country   Grant Funded Country GFU 

121 Kimba CHSA Country   Grant Funded Country GFU 

124 Kingston CHSA Country   Grant Funded Country GFU 

127 Lameroo CHSA Country   Grant Funded Country GFU 



 
For Official Use Only-I2-A2   80 
 

Hosp Code Hosp Name LHN Type Peer Group 
130 Laura CHSA Country   Grant Funded Country GFU 

136 Tailem Bend CHSA Country   Grant Funded Country GFU 

139 Loxton CHSA Country   Grant Funded Country GFU 

142 CYP (Maitland) CHSA Country   Grant Funded Country GFU 

145 Mannum CHSA Country   Grant Funded Country GFU 

151 Meningie CHSA Country   Grant Funded Country GFU 

154 Millicent CHSA Country   Casemix Other Country Other 

160 Mt Barker CHSA Country   Casemix Other Country Other 

163 Mt Gambier CHSA Country   Casemix Large Country Large 

166 Mt Pleasant CHSA Country   Grant Funded Country GFU 

169 Ceduna CHSA Country   Grant Funded Country GFU 

172 Murray Bridge CHSA Country   Casemix Other Country Other 

175 Naracoorte CHSA Country   Casemix Other Country Other 

184 Orroroo CHSA Country   Grant Funded Country GFU 

187 Penola CHSA Country   Grant Funded Country GFU 

190 Peterborough CHSA Country   Grant Funded Country GFU 

193 Pinnaroo CHSA Country   Grant Funded Country GFU 

196 Port Augusta CHSA Country   Casemix Large Country Large 

199 Port Broughton CHSA Country   Grant Funded Country GFU 

202 Port Lincoln CHSA Country   Casemix Large Country Large 

205 Port Pirie CHSA Country   Casemix Large Country Large 

208 Quorn CHSA Country   Grant Funded Country GFU 

211 Renmark CHSA Country   Grant Funded Country GFU 

214 Riverton CHSA Country   Grant Funded Country GFU 

217 Roxby Downs CHSA Country   Grant Funded Country GFU 

220 Snowtown CHSA Country   Grant Funded Country GFU 

223 South Coast CHSA Country   Casemix Other Country Other 

226 Southern Yorke CHSA Country   Grant Funded Country GFU 

229 Strathalbyn CHSA Country   Grant Funded Country GFU 

232 Streaky Bay CHSA Country   Grant Funded Country GFU 

235 Tanunda CHSA Country   Casemix Other Country Other 

241 Tumby Bay CHSA Country   Grant Funded Country GFU 

244 Waikerie CHSA Country   Grant Funded Country GFU 

247 Northern Yorke CHSA Country   Casemix Other Country Other 

249 Whyalla CHSA Country   Casemix Large Country Large 

300 Glenside CALHN NA NA 

306 James Nash House NALHN NA NA 

 

 


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