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DRG codes and how much you can claim using the CBD

You can claim for whichever is the smaller amount:

  • the cost of your healthcare abroad
  • the cost of the same healthcare in the public system in Ireland

For example, if the healthcare abroad costs €2,000 and in Ireland it costs €1,500, you will receive €1,500.

Calculating the cost in the public health system in Ireland

We use diagnosis-related group (DRG) codes to calculate payments for treatment under the Cross Border Directive (CBD) Scheme.

DRG codes apply to payments for inpatient and day case care patients.

  • inpatient care is when you stay overnight in a hospital
  • day case care is when you are admitted to hospital but do not stay overnight

Outpatient care is planned healthcare that does not involve an admission or overnight hospital stay.

Outpatient healthcare claims

Inpatient and day case patients can use DRG codes to check how much a treatment might cost in Ireland’s public health system.

DRG codes and prices

When you are an inpatient or day case patient in an Irish public hospital, the HSE assigns a DRG code to your case. We do this when you are discharged.

We select one DRG code that covers your case.

This includes:

  • your diagnosis
  • your full medical information
  • the procedures you had - this can be one or more procedures
  • all the health care services you received during your admission

Each DRG code has a price for either inpatient or day case care. We calculate your payment based on the setting (inpatient or day case care) where you would have had the procedure in Ireland.

We review and update these prices every year. Prices can go up or down based on changes in clinical practice.

Check the most common DRG codes and prices

We have published a guide to the most common procedures patients have using the CBD scheme.

The guide includes the:

  • most common procedures patients get
  • most likely DRG code for the procedure
  • prices for inpatient or day case care, whichever is standard in Ireland

Use this guide to estimate how much you might be repaid.

Guide to common DRG codes and prices (PDF, 595 KB, 11 pages)

Full DRG price lists

If you can’t find a procedure in the guide you can check the full price lists.

For older claims check past price lists.

Choosing a different DRG code

Sometimes a healthcare provider abroad might select a different DRG code to the one in the guide. They can only do this after they have completed your treatment and have all the medical information.

The medical notes from your episode of care must support this choice.

Review of DRG codes

We sometimes send applications to the Healthcare Pricing Office (HPO) for an independent review to check the DRG code. If the wrong code or no code is provided, the correct code will be assigned. The correct code will determine the maximum amount of money the patient can receive toward the cost of their healthcare.

Outpatient healthcare claims

Outpatient care is usually when you have a hospital appointment for a consultation. Sometimes you may have a diagnostic test, minor procedure or treatment. You are not admitted to hospital and you do not stay overnight.

These are the maximum claims for one or more outpatient appointments, including treatment, on the same day in a hospital abroad.

The maximum claim for appointments from 1 May 2023 is €194.

The maximum claim for appointments between 1 March 2021 to 30 April 2023 is €178.

There are different types of outpatient appointments such as x-rays, CT scans, biopsy or MRI scans. If you have more than 1 outpatient appointment on the same day, the maximum you can claim is €194.

DRG code changes for clinicians

Cataract surgery

The code we expect for most cataract treatments is:

  • DRG C16Z LENS INTERVENTIONS

The codes for the most complex cataract treatments are:

  • DRG C15A GLAUCOMA/CMPLX CATARACT INTERV, MAJC
  • DRG C15B GLAUCOMA/CMPLX CATARACT INTERV, MINC

Injections to joints

The code DRG 140Z INFUSION FOR MUSCLSKLT DIS, SD is no longer in use. This was used to cover all injections and infusions for musculoskeletal disorders until 2024.

There are now 5 DRG codes for injections to joints. They are ‌based on the reason for the injection. View the codes and their criteria in the guide to common DRG codes and costs (PDF, 595 KB, 11 pages).

Hip replacement

The code we expect for unilateral hip replacement is:

  • DRG I33B HIP REPLACE, NON-TRAUMA, MINC

The code to use for trauma cases is:

  • DRG I03B HIP REPLACEMENT, TRAUMA, MINC

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