Facility Coder

DRG lookup, APC calculator, OPPS payment estimation, and facility-side coding tools — free with API access

DRGs, APCs, OPPS payment — the facility side of coding. Free.

The Facility Coder is RCI’s public tool for hospital and facility coding — covering what Find-a-Code’s paid subscriptions offer for DRGs and APCs. Look up DRG weights, calculate APC payments by CBSA, check OPPS status indicators, and estimate facility reimbursement.

Try it at rcintell.com/tools

What’s included

DRG Lookup & Calculator

Enter a DRG code or search by diagnosis. See the weight, expected length of stay, and estimated payment for any facility.

MS-DRG: 470 | Year: 2026

┌──────────────────────────────────────────────────────────────┐
│  MS-DRG: 470                                                  │
│  Description: Major Hip and Knee Joint Replacement            │
│               or Reattachment of Lower Extremity              │
│               Without MCC                                     │
│  MDC: 08 - Diseases and Disorders of the                     │
│       Musculoskeletal System and Connective Tissue            │
│  Type: Surgical                                               │
│                                                               │
│  Relative Weight:  1.7396                                     │
│  Geometric LOS:    1.8 days                                   │
│  Arithmetic LOS:   2.1 days                                   │
│                                                               │
│  ─── PAYMENT ESTIMATE (CCN: 170001) ─────────────────        │
│                                                               │
│  Base Rate:           $6,421.18                               │
│  Wage Index:          0.8914 (Topeka, KS CBSA 45820)         │
│  Labor Share:         $4,083.22 × 0.8914 = $3,639.78         │
│  Non-Labor Share:     $2,337.96                               │
│  Adjusted Base:       $5,977.74                               │
│  DRG Payment:         $5,977.74 × 1.7396 = $10,399.73       │
│                                                               │
│  Add-ons:                                                     │
│  ├─ DSH adjustment:   +$412.50 (if applicable)               │
│  ├─ IME adjustment:   +$0 (not teaching)                     │
│  └─ Outlier:          N/A                                     │
│                                                               │
│  Estimated Total:     $10,812.23                              │
│                                                               │
│  ☐ Toggle: 2026 ▼  Compare: MS-DRG 469 (with MCC)           │
└──────────────────────────────────────────────────────────────┘

APC Lookup & Calculator

Enter a CPT/HCPCS code. See the APC assignment, status indicator, relative weight, and payment rate for any CBSA.

CPT: 27447 | CBSA: 45820 (Topeka, KS) | Year: 2026

┌──────────────────────────────────────────────────────────────┐
│  CPT: 27447 — Total knee arthroplasty                         │
│  APC: 5115 — Level 5 Musculoskeletal Procedures              │
│  Status Indicator: J1 — Comprehensive APC                    │
│                                                               │
│  APC Relative Weight:  75.8214                                │
│  National Payment Rate: $16,242.38                            │
│                                                               │
│  ─── OPPS PAYMENT (CBSA 45820) ──────────────────────        │
│                                                               │
│  Wage Index:    0.8914                                        │
│  Labor Share:   60% × $16,242.38 = $9,745.43                │
│  Adjusted:      $9,745.43 × 0.8914 = $8,687.09              │
│  Non-Labor:     40% × $16,242.38 = $6,496.95                │
│  OPPS Payment:  $8,687.09 + $6,496.95 = $15,184.04          │
│                                                               │
│  Copay:         $3,796.01 (25%)                               │
│  Medicare Pays: $11,388.03                                    │
│                                                               │
│  Status Indicators:                                           │
│  ├─ J1: Packaged — no separate payment for packaged items    │
│  ├─ Comprehensive APC: ancillary services packaged           │
│  └─ Device offset: applicable                                │
│                                                               │
│  ☐ Toggle: 2026 ▼                                            │
└──────────────────────────────────────────────────────────────┘

OPPS Status Indicators

Every HCPCS code in OPPS has a status indicator that determines how it’s paid:

SI	Payment	Description
A	Separately paid	OPPS rate, not discounted
J1	Comprehensive APC	Packaged services included
N	Packaged	No separate payment
Q1	STV-packaged	Conditionally packaged
S	Separately paid (significant)	Discounted at 50% for multiple
T	Separately paid (significant)	Reduced for multiple procedures
V	Clinic/ED visit	Payment based on HCPCS code
X	Ancillary	Separately paid under OPPS

DRG Grouper Logic

Enter diagnosis and procedure codes. See which MS-DRG the case groups to:

Principal Dx: M17.11 (Primary osteoarthritis, right knee)
Procedure: 0SRC0JZ (Replacement of right knee, cemented)
CC/MCC: None

Groups to: MS-DRG 470
  (Major Hip and Knee Joint Replacement Without MCC)

Alternative groupings:
├─ If CC present:   MS-DRG 469 (weight: 2.0422, +17.4%)
├─ If MCC present:  MS-DRG 468 (weight: 3.1274, +79.8%)
└─ If bilateral:    MS-DRG 470 × 2 (if separate encounters)

Revenue Code + TOB Validation

Validate that revenue codes match the facility type and Type of Bill:

Facility: CCN 170001 (Short-term hospital)
TOB: 0131 (Hospital outpatient)

Valid Revenue Codes:
├─ 0250-0259: Pharmacy ✓
├─ 0300-0309: Laboratory ✓
├─ 0320-0329: Radiology ✓
├─ 0450-0459: Emergency room ✓
├─ 0636: Self-administered drugs ✓
├─ 0761: Treatment/observation room ✓
│
Invalid for this TOB:
├─ 0100-0119: Room & board ✗ (inpatient only)
└─ 0200-0209: ICU ✗ (inpatient only)

How it compares to Find-a-Code

Feature	Find-a-Code	RCI Facility Coder
DRG codes + weights	Yes	Yes, with payment calculator
DRG length of stay	Yes	Yes (geometric + arithmetic)
DRG payment calculator	Yes (per provider)	Yes (per CCN with wage index)
APC codes + weights	Yes	Yes, with CBSA-specific payment
APC payment calculator	Yes (per CBSA)	Yes, with copay/Medicare split
Status indicators	Yes	Yes, with payment implications
DRG grouper	No	Yes — enter Dx + Px, get DRG
Revenue code validation	No	Yes — linked to TOB + facility
API access	No	Full REST API
MCP server	No	Yes — AI agent access
Price	Paid subscription	Free (public tool)
		API: pay-as-you-go

API access

# DRG lookup
curl "https://api-dev.rcintell.com/v1/facility/drg/470?year=2026" \
  -H "X-API-Key: kp_test_..."

# DRG payment estimate for a facility
curl "https://api-dev.rcintell.com/v1/facility/drg/470/payment?ccn=170001" \
  -H "X-API-Key: kp_test_..."

# APC lookup
curl "https://api-dev.rcintell.com/v1/facility/apc?cpt=27447&year=2026" \
  -H "X-API-Key: kp_test_..."

# APC payment by CBSA
curl "https://api-dev.rcintell.com/v1/facility/apc/payment?cpt=27447&cbsa=45820" \
  -H "X-API-Key: kp_test_..."

# DRG grouper
curl -X POST "https://api-dev.rcintell.com/v1/facility/drg/group" \
  -H "X-API-Key: kp_test_..." \
  -d '{
    "principal_dx": "M17.11",
    "procedures": ["0SRC0JZ"],
    "secondary_dx": []
  }'

# Revenue code validation
curl "https://api-dev.rcintell.com/v1/facility/revenue-codes?tob=0131&ccn=170001" \
  -H "X-API-Key: kp_test_..."

Data sources

Data	Source	Update frequency
MS-DRG weights	CMS IPPS Final Rule	Annually (Oct 1)
Wage indices	CMS Wage Index Files	Annually
APC weights/rates	CMS OPPS Final Rule	Annually (Jan 1) + quarterly
Status indicators	CMS OPPS Addendum B	Annually + quarterly
CBSA definitions	OMB / CMS	As released

Free to use

The Facility Coder is free at rcintell.com/tools. No account required. API access requires a free API key.