G-DRG guideG-DRG codes explained, from the first letter to the last

What a G-DRG is

G-DRG stands for Ghana Diagnosis-Related Groupings. Since May 2008, the NHIS has paid for services by G-DRG, a fixed price for a whole episode of care, while medicines are paid separately, item by item, against the NHIS Medicines List.

The August 2026 schedule, Version 7 (25 September 2026) prices 729 G-DRG codes across 30 tariff blocks. A block is one combination of ownership, facility level and, for primary hospitals, catering status.

How a code is built

Take OPDC06A, General OPD for a patient aged 12 or over:

• OPDC: the Major Diagnostic Category (MDC), here outpatient care.
• 06: the sequence number within that category.
• A: the age band. A is 12 years and over; C is under 12.

The age band follows the patient’s age on the day of service, not the ward they were in. Getting it wrong is the single most common avoidable deduction.

Investigations are the exception. In INVE codes, a trailing D or E, or a three-digit number, is a sequence marker added as the list grew. It is not an age band, and investigation codes apply at any age.

The 15 Major Diagnostic Categories

Code counts are from the August 2026 schedule, Version 7 (25 September 2026).

Bundled and unbundled services

A G-DRG is a bundle: it covers the routine care in the episode, so those items must not be claimed again on the same claim. Two kinds of item can sometimes be claimed on top:

• Unbundled consultation (OPDC11).
• Investigations (INVE codes), but only at the levels where the 2026 bundling rules allow it. At most levels an investigation done in-house is part of the OPD or IPD tariff. See investigations by level.

NHIA also classes each G-DRG as procedure or non-procedure. A procedure G-DRG covers the operative episode and needs an operative note to support it.

Why the same code pays different amounts

The tariff for a code depends on three things about your facility:

• Ownership: public, mission (CHAG), quasi-government or private.
• Level: from CHPS compound to tertiary hospital, plus stand-alone diagnostic, eye and dental centres.
• Catering status, for primary hospitals only: whether the facility feeds its inpatients.

General OPD for an adult (OPDC06A), for example, pays GH¢24.90 at a public health centre, GH¢46.81 at a private clinic, GH¢82.05 at a public secondary hospital and GH¢94.18 at a public tertiary hospital. Look up any code in our NHIS tariff lookup.

Tariffs change: price by date of service

NHIA revises the schedule during the year, and revised the August 2026 schedule several times. The current file is the August 2026 schedule, Version 7 (25 September 2026). A claim must be priced from the schedule in force on the day the service was given, so keep each edition with its effective date rather than overwriting old prices.