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Chapter 4.5. Division of Workers' Compensation
SUBCHAPTER 1. ADMINISTRATIVE DIRECTOR -ADMINISTRATIVE RULES
Article 5.3. Official Medical Fee Schedule -- Services Rendered after January 1, 2004
SUBCHAPTER 1. ADMINISTRATIVE DIRECTOR -ADMINISTRATIVE RULES
Article 5.3. Official Medical Fee Schedule -- Services Rendered after January 1, 2004
§9789.25. Federal Regulations, Federal Register Notices, and Payment Impact File by Date of Discharge.
Discharges Occurring on or After 1/1/2004 | Discharges Occurring on or After 11/29/2004 | Discharges Occurring on or After 12/1/2005 | Discharges Occurring on or After 12/1/2006 | |
|---|---|---|---|---|
Title 42, Code of Federal Regulations, § 412.2 | Effective October 1, 2003 | |||
Title 42, Code of Federal Regulations, § 412.23(e) | Effective date October 1, 2002 and revised as of October 1, 2003 | |||
Title 42, Code of Federal Regulations, § 412.23(f) | Effective October 1, 2002 and revised as of October 1, 2003 | |||
Title 42, Code of Federal Regulations, Section 412.64 | Effective October 1, 2004 | |||
Title 42, Code of Federal Regulations, Section 412.87 | Effective September 7, 2001 and revised as of October 1, 2003 | Amended; effective October 1, 2004 | ||
Title 42, Code of Federal Regulations, Section 412.88 | Effective September 7, 2001 and amended August 1, 2002 and August 1, 2003 and revised as of October 1, 2003 | Amended; effective October 1, 2004 | ||
Title 42, Code of Federal Regulations, § 412.92(a) | Effective October 1, 2002 and revised as of October 1, 2003 | Amended; effective October 1, 2005 | ||
Title 42, Code of Federal Regulations, § 412.92(d) | Effective October 1, 2002 and revised as of October 1, 2003 | Amended; effective October 1, 2005 | ||
Title 42, Code of Federal Regulations, Section 412.316(b) | Effective November 11, 2003, large urban add-on is an additional 3% | Amended; effective October 1, 2004, large urban add-on is an additional 3% | Amended; effective October 1, 2004, large urban add-on is an additional 3% | Amended; effective October 1, 2006, large urban add-on is an additional 3% |
Discharges Occurring on or After 1/1/2008 | Discharges Occurring on or After 12/1/2008 | Discharges Occurring on or After 12/1/2009 | Discharges Occurring on or After 3/01/2011 | |
|---|---|---|---|---|
Title 42, Code of Federal Regulations, § 412.2 | Amended; effective October 1, 2010 | |||
Title 42, Code of Federal Regulations, § 412.23(e) | Amended; effective October 1, 2009 | Amended; effective October 1, 2010 | ||
Title 42, Code of Federal Regulations, § 412.23(f) | ||||
Title 42, Code of Federal Regulations, Section 412.64 | ||||
Title 42, Code of Federal Regulations, Section 412.87 | Amended; effective October 1, 2008 | Amended; effective October 1, 2009 | ||
Title 42, Code of Federal Regulations, Section 412.88 | Amended; effective October 1, 2007 | |||
Title 42, Code of Federal Regulations, Section 412.92(a) | ||||
Title 42, Code of Federal Regulations, Section 412.92(d) | Amended; effective October 1, 2008 | |||
Title 42, Code of Federal Regulations, Section 412.316(b) | Amended; effective October 1, 2007, large urban add-on is eliminated |
Discharges Occurring on or After 12/01/2011 | Discharges Occurring on or After 03/15/2013 | Discharges Occurring on or After 03/05/2015 | Discharges Occurring on or After 03/05/2015 (These 2015 factors are updated by AD Order dated 02/05/2015, and supersedes 2014 factors adopted under the OMFS rulemaking filed with the Secretary of State on 02/04/2015) | |
|---|---|---|---|---|
Title 42, Code of Federal Regulations, § 412.2 | Amended; effective October 1, 2010 | |||
Title 42, Code of Federal Regulations, § 412.23(e) | Amended; effective October 1, 2011 | Amended; effective October 1, 2014 | ||
Title 42, Code of Federal Regulations, § 412.23(f) | Effective October 1, 2002 and revised as of October 1, 2003 | |||
Title 42, Code of Federal Regulations, § 412.64 | Amended; effective October 1, 2011 | Amended | Amended | Amended; effective October 1, 2014 |
Title 42, Code of Federal Regulations, Section 412.87 | Amended; effective October 1, 2009 | |||
Title 42, Code of Federal Regulations, Section 412.88 | Amended; effective October 1, 2007 | |||
Title 42, Code of Federal Regulations, Section 412.92(a) | Amended; effective October 1, 2005 | |||
Title 42, Code of Federal Regulations, Section 412.92(d) | Amended; effective October 1, 2008 | |||
Title 42, Code of Federal Regulations, Section 412.106 | Amended; effective October 1, 2013 | Amended; effective October 1, 2014 | ||
Title 42, Code of Federal Regulations, Section 412.316(b) | Amended; effective October 1, 2007 |
Discharges Occurring on or After 3/01/2016 | Discharges Occurring on or After 01/01/2017 | Discharges Occurring on or After 12/01/2017 | Discharges Occurring On or After 12/01/2018 | |
|---|---|---|---|---|
Title 42, Code of Federal Regulations, § 412.2 | Amended; effective October 1, 2010 | Amended; effective October 1, 2010 | Amended; effective October 1, 2010 | Amended; effective October 1, 2010 |
Title 42, Code of Federal Regulations, § 412.23(e) | Amended; effective October 1, 2015 | Amended; effective October 1, 2015 | Amended; effective October 1, 2017 | Amended; effective October 1, 2018 |
Title 42, Code of Federal Regulations, § 412.23(f) | Effective October 1, 2002 and revised as of October 1, 2003 | Effective October 1, 2002 and revised as of October 1, 2003 | Effective October 1, 2002 and revised as of October 1, 2003 | Effective October 1, 2002 and revised as of October 1, 2003 |
Title 42, Code of Federal Regulations, § 412.64 | Amended; effective October 1, 2015 | Amended; effective October 1, 2016 | Amended; effective October 1, 2017 | Amended; effective October 1, 2018 |
Title 42, Code of Federal Regulations, Section 412.87 | Amended; effective October 1, 2009 | Amended; effective October 1, 2009 | Amended; effective October 1, 2017 | Amended; effective October 1, 2017 |
Title 42, Code of Federal Regulations, Section 412.88 | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 |
Title 42, Code of Federal Regulations, Section 412.92(a) | Amended; effective October 1, 2005 | Amended; effective October 1, 2005 | Amended; effective October 1, 2005 | Amended; effective October 1, 2018 |
Title 42, Code of Federal Regulations, Section 412.92(d) | Amended; effective October 1, 2008 | Amended; effective October 1, 2008 | Amended; effective October 1, 2008 | Amended; effective October 1, 2018 |
Title 42, Code of Federal Regulations, Section 412.106 | Amended; effective October 1, 2015 | Amended; effective October 1, 2016 | Amended; effective October 1, 2017 | Amended; effective October 1, 2018 |
Title 42, Code of Federal Regulations, Section 412.316(b) | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 |
Discharges Occurring On or After 11/01/2019 | Discharges Occurring On or After 12/01/2020 | Discharges Occurring On or After 03/15/2021 | Discharges Occurring On or After 12/01/2021 | |
|---|---|---|---|---|
Title 42, Code of Federal Regulations, § 412.2 | Amended; effective October 1, 2010 | Amended; effective October 1, 2010 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 |
Title 42, Code of Federal Regulations, § 412.23(e) | Amended; effective October 1, 2015 | Amended; effective October 1, 2015 | Amended; effective October 1, 2015 | Amended; effective October 1, 2015 |
Title 42, Code of Federal Regulations, § 412.23(f) | Effective October 1, 2002 and revised as of October 1, 2003 | Effective October 1, 2002 and revised as of October 1, 2003 | Effective October 1, 2002 and revised as of October 1, 2003 | Effective October 1, 2002 and revised as of October 1, 2003 |
Title 42, Code of Federal Regulations, Section 412.64 | Amended effective October 1, 2019 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 | Amended; effective October 1, 2021 |
Title 42, Code of Federal Regulations, § 412.87 | Amended effective October 1, 2019 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 |
Title 42, Code of Federal Regulations, Section 412.88 | Amended effective October 1, 2019 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 |
Title 42, Code of Federal Regulations, Section 412.92(a) | Amended effective October 1, 2005 | Amended; effective October 1, 2005 | Amended; effective October 1, 2005 | Amended; effective October 1, 2005 |
Title 42, Code of Federal Regulations, Section 412.92(d) | Amended effective October 1, 2008 | Amended; effective October 1, 2008 | Amended; effective October 1, 2008 | |
Title 42, Code of Federal Regulations, Section 412.106 | Amended effective October 1, 2019 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 | Amended; effective October 1, 2021 |
Title 42, Code of Federal Regulations, Section 412.316(b) | Amended effective October 1, 2007 | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 |
Discharges Occurring On or After 12/01/2022 | Discharges Occurring On or After 11/01/2023 | |||
|---|---|---|---|---|
Title 42, Code of Federal Regulations, § 412.2 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 | ||
Title 42, Code of Federal Regulations, § 412.23(e) | Amended; effective October 1, 2015 | Amended; effective October 1, 2015 | ||
Title 42, Code of Federal Regulations, § 412.23(f) | Effective October 1, 2002 and revised as of October 1, 2003 | Effective October 1, 2002 and revised as of October 1, 2003 | ||
Title 42, Code of Federal Regulations, § 412.64 | Amended; effective October 1, 2022 | Amended; effective October 1, 2022 | ||
Title 42, Code of Federal Regulations, Section 412.87 | Amended; effective October 1, 2020 | Amended; effective October 1, 2023 | ||
Title 42, Code of Federal Regulations, Section 412.88 | Amended; effective October 1, 2020 | Amended; effective October 1, 2020 | ||
Title 42, Code of Federal Regulations, Section 412.92(a) | Amended; effective October 1, 2005 | Amended; effective October 1, 2005 | ||
Title 42, Code of Federal Regulations, Section 412.92(d) | Amended; effective October 1, 2008 | Amended; effective October 1, 2008 | ||
Title 42, Code of Federal Regulations, Section 412.106 | Amended effective October 1, 2022 | Amended effective October 1, 2023 | ||
Title 42, Code of Federal Regulations, Section 412.316(b) | Amended; effective October 1, 2007 | Amended; effective October 1, 2007 |
Discharges Occurring on or After 1/1/2004 | Discharges Occurring on or After 11/29/2004 | Discharges Occurring on or After 7/1/2005 | Discharges Occurring on or After 12/1/2005 | |
|---|---|---|---|---|
Applicable FR Notices | (A) August 1, 2003 (CMS-1470-F; 68 FR 45346) final rule (B) October 6, 2003 (CMS-1470-CN; 68 FR 57732) correction notice | (A) August 11, 2004 (CMS-1428-F; 69 FR 48916) final rule (B) October 7, 2004 (CMS-1428-CN2; 69 FR 60242) correction notice (C) 69 FR 78526 (CMS-1428-F2) correction notice | (A) August 11, 2004 (CMS-1428-F; 69 FR 48916) final rule (B) October 7, 2004 (CMS-1428-CN2; 69 FR 60242) correction notice (C) 69 FR 78526 (CMS-1428-F2) correction notice | (A) August 12, 2005 (CMS-1500-F; 70 FR 47278) final rule (B) September 30, 2005 70 FR 57161 (CMS-1500-CN) correction notice |
Capital wage index | Tables 4A-4C beginning on (A) page 57736 | Tables 4A1--4C2 beginning on (C) page 78619 | Tables 4A-4C beginning on (A) page 47580 as corrected by Tables 4A-4C beginning on (B) page 57163 | |
Capital market basket | Not applicable | 0.7% ((A) page 49285) | 0.8% ((A) page 47500) | |
Capital standard federal payment rate | $414.18 ((B) page 57735, Table 1D) | $416.73 ($413.83 x 1.007) | $420.06 ($416.73 x 1.008) | |
Complex Spinal Surgery DRGs | 496, 497, 498, 519, 520, 531, 532 | 496, 497, 498, 519, 520, 531, 532, 546 (page 47308 of (A)) | ||
Fixed Loss Outlier Threshold | $31,000 ((A) page 45477) | $25,800 ((A) page 49278) | $23,600 ((A) page 47494) | |
National Standard Operating Rate | $3,136.39 ((B) page 57735, Table 1A) | $4,569.83 ($4,423.84 x 1.033) | $4,738.91 ($4,569.83 x 1.037) | |
Operating Wage Index | Tables 4A-4C beginning on (A) page 57736; PIF: Operating Wage Index location (WIGRN) | Tables 4A1-4C2 beginning on (C) page 78619; PIF: Final Wage Index location (WIGRN) | Tables 4A-4C beginning on (A) page 47580 as corrected by Tables 4A-4C beginning on (B) page 57163; PIF: Post Reclass Wage Index location | |
Labor-Related Portion | Table 1A beginning on B page 57735 | For wage indexes greater than 1.0, the labor-related portion is 71.066% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 49070 | For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 47393 | |
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs | DRGs 12, 14, 24, 25, 89, 90, 113, 121, 122, 130, 131, 236, 239, 243, 263, 264, 277, 278, 296, 297, 320, 321, 429, 462, 483, or 468 (A) beginning at page 45413 | DRGs 12, 14, 24, 25, 88, 89, 90, 113, 121, 122, 127, 130, 131, 236, 239, 277, 278, 294, 296, 297, 320, 321, 395, 429, 468, 541 or 542 (B) beginning at page 60246 | DRGs designated with a “yes” in “FY06 Final Rule Post-acute Care DRG” column in Table 5 (A) beginning at page 47617 and (B) beginning at page 57163 | |
Post-acute care transfer qualifying DRGs | DRGs 209, 210 or 211 (A) beginning at page 45413 | DRGs 7, 8, 210, 211, 233, 234, 471, 497, 498, 544, 545, 549, or 550 (A) beginning at page 47617 and (B) beginning at page 57163 |
Discharges Occurring on or After 12/1/2006 | Discharges Occurring on or After 3/1/2007 | Discharges Occurring on or After 1/1/2008 | Discharges Occurring on or After 12/1/2008 | |
|---|---|---|---|---|
Applicable FR Notices | (A) August 18, 2006 (CMS-1488-F; 71 FR 47870) (B) October 11, 2006 (CMS-1488-N; 71 FR 59886) additional notice | (A) August 18, 2006 (CMS-1488-F; 71 FR 47870) (B) October 11, 2006 (CMS-1488-N; 71 FR 59886) additional notice (C) January 5, 2007 (CMS-1488-CN2; 72 fr 569) correction notice | (A) August 22, 2007 (CMS-1533-FC; 72 FR 47130) final rule (B) October 10, 2007 72 FR 57634 (CMS-1533-CN2) correction notice | (A) August 19, 2008 (CMS-1390-F; 73 FR 48434) final rule (B) October 3, 2008 73 FR 57888 (CMS-1390-N) correction notice |
Capital wage index | Tables 4A-1 - 4C-1 (for discharges before 4/1/2007) and Tables 4A-2-4C2 (for discharges occurring on or after 4/1/2007) beginning on (B) page 59975 | Tables 4A-4C beginning on (B) page 57698 | Tables 4A-4C beginning on (B) page 57956 | |
Capital market basket | 1.10% ((A) page 48163) | 1.3% ((A) page 47426) | 1.4% ((A) page 48776) | |
Capital standard federal payment rate | $424.68 ($420.06 x 1.0110) | $430.20 ($424.68 x 1.013) | $436.22 ($430.20 x 1.014) | |
Complex Spinal Surgery DRGs | 028, 029, 030, 453, 454, 455, 456, 457, 458, 459, 460, 471, 472, 473 | |||
Fixed Loss Outlier Threshold | $24,485 ((A) page 59890) | $22,185 ((A) Page 66887) | $20,045 ((A) page 57891) | |
National Standard Operating Rate | $4,900.03 ($4,738.91 x 1.034) | $5,061.73 ($4,900.03 x 1.033) | $5,243.95 ($5,061.73 x 1.036) | |
Operating Wage Index | Tables 4A-1 - 4C-1 (for discharges before 4/1/2007) and Tables 4A-2-4C2 (for discharges occurring on or after 4/1/2007) beginning on (B) page 59975; PIF: Post Reclass Wage Index_a (for first half FY 2007) and Post Reclass Wage Index_b (for second half FY 2007) | Tables 4A-4C beginning on (B) page 57698; PIF: Post Reclass Wage Index location | Tables 4A-4C beginning on (B) page 57956; PIF: Post Reclass Wage Index location | |
Labor-Related Portion | For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 48029 | For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 47344 | For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 48592 | |
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs | DRGs designated with a “yes” in the “FY 07 Final Rule Post-acute Care DRG” column in Table 5 (B) beginning at page 60013 | DRGs designated with a “yes” in the “FY 07 Final Rule Post-acute Care DRG” column in Table 5 (B) beginning at page 60013 and (C) beginning at page 573 | Medicare-Severity DRGs designated with a “yes” in the “FY08 Final Rule Post-Acute DRG” column in Table 5 (A) beginning at page 47539 and (B) at page 57727 | Medicare-Severity DRGs designated with a “yes” in the “FY09 Final Rule Post-Acute DRG” column in Table 5 (A) beginning at page 48899 |
Post-acute care transfer qualifying DRGs | DRGs 7, 8, 210, 211, 233, 234, 471, 497, 498, 545, 549, or 550 (B) beginning at page 60013 | DRGs 7, 8, 210, 211, 233, 234, 471, 497, 498, 544, 545, 549, or 550 (B) beginning at page 60013 and (C) beginning at page 573 | Medicare- Severity DRGs designated with a “yes” in the “FY08 Final Rule Special Pay DRG” column in Table 5 (A) beginning at page 47539 and (B) at page 57727 | Medicare-Severity DRGs designated with a “yes” in the “FY09 Final Rule Special Pay DRG” column in Table 5 (A) beginning at page 48899 |
Discharges Occurring on or After 12/1/2009 | Discharges Occurring on or After 3/01/2011 | Discharges Occurring on or After 12/01/2011 | Discharges Occurring on or After 1/1/2013 but Before 1/1/2014 | |
|---|---|---|---|---|
Applicable FR Notices | (A)August 27, 2009 (CMS-1406-F; FR 43754) final rule (B) October 7, 2009 (CMS-1406-CN; 74 FR 51496) correction notice | (A) August 16, 2010 (CMS-1498-F; FR 50042) final Rule (B) October 1, 2011 (CMS-1498-F; 75 FR 60640) correction | (A) August 18, 2011 (CMS-1518-F; FR 51476) final Rule (B) September 26, 2011 (CMS-1518-CN3; 76 FR 59263) correction | |
Capital wage index | Tables 4A-4C beginning on page (A) 44085 as corrected by Tables 4A-4C beginning on (B) page 51505 for certain areas | Tables 4A-C Beginning on page (A) 50511 | Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01overview.asp | |
Capital market basket | 1.2% ((B) page 51498) | 1.2%, (A) page 50442 | 1.5%, (A) page 51806 | |
Capital standard federal payment rate | $441.46 ($436.22 x 1.012) | $446.75 ($441.46 X 1.012) | $453.46 (446.75 X 1.015) | |
Complex Spinal Surgery DRGs | 028, 029, 030, 453 454, 455, 456 | |||
Fixed Loss Outlier Threshold | $23,140 ((A) page 44011) | $23,075, (A) page 50441 | $22,385, (A) page 51795 | |
National Standard Operating Rate | $5,354.08 ($5,243.95 x 1.021) | $5,493.28 ($5,354.08 x 1.026) | $5,658.08 ($5,493.28 x 1.03) | |
Operating Wage Index | Tables 4A-4C beginning on page (A) 44085 as corrected by Tables 4A-4C beginning on (B) page 51505 for certain areas; PIF: Post Reclass Wage Index location | Tables 4A-C Beginning on page (A) 50511; PIF: FY 2011 Wage Index location | Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2012 Wage Index location | |
Labor-Related Portion | For wage indexes greater than 1.0, the labor-related portion is 68.802% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 43856 | For wage indexes greater than 1.0, the labor-related portion is 68.8% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 50422 | For wage indexes greater than 1.0, the labor-related portion is 68.8% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 51786 | |
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2010 Final Rule Post-Acute DRG” column in Table 5 (A) beginning at page 44126 | Medicare-Severity DRGs designated with a “yes” in the “FY 2011 Final Rule Post-Acute DRG” Column in Table 5 (A) beginning at page 50547 | Medicare-Severity DRGs designated with a “yes” in the “FY 2012 Final Rule Post-Acute DRG” Column in Table 5 https://www.cms.gov/AcuteInpatientPPS/ | |
Post-acute care transfer qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY2010 Final Rule Special Pay DRG” column in Table 5 (A) beginning at page 44126 | Medicare-Severity DRGs designated with a “yes” in the “FY 2011 Final Rule Special Pay DRG” column in Table 5 (A) Beginning at page 50547 | Medicare-Severity DRGs designated with a “yes” in the “FY 2012 Final Rule Special Pay DRG” column in Table 5 https://www.cms.gov/AcuteInpatientPPS/ |
Discharges Occurring on or After 3/15/2013 | Discharges Occurring on or After 03/05/2015 | Discharges Occurring on or After 03/05/2015 | Discharges Occurring on or After 03/01/2016 | |
|---|---|---|---|---|
(These 2015 factors are updated by AD Order dated 02/05/2015, and supersedes 2014 factors adopted under the OMFS rulemaking filed with the Secretary of State on 02/04/2015) | ||||
Applicable FR Notices | (A) August 31, 2012 (CMS-1588-F; 77 FR 53258) final rule (B) October 3, 2012 (CMS-1588-CN2; 77 FR 60315; correction notice) (C) October 29, 2012 (CMS-1588-CN3; 77 FR 65495; correction notice) | (A) August 19, 2013 (CMS-1599-F; 78 FR 50496) Final Rule (B) October 3, 2013 (CMS-1599-CN2; 78 FR 61197; corrections) (C) October 3, 2013 (CMS-1599-IFC; 78 FR 61191; interim final rule) (D) January 2, 2014 (CMS-1599-CN3; 79 FR 61; corrections) (E) January 10, 2014 (CMS-1599-CN4; 79 FR 1741; corrections) (F) March 18, 2014 (CMS-1599-IFC2; 79 FR 15022; Interim final rule | (A) August 22, 2014 (CMS-1607-F; 79 FR 49854) Final Rule (B) October 3, 2014 (CMS-1607-CN; 79 FR 59675; Corrections) | (A) August 17, 2015 (CMS-1632-F and IFC; 80 FR 49326; Final Rule) (B) October 5, 2015 (CMS-1632-CN; 80 FR 60055; Correction) |
Capital wage index | Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp | Tables 4A -- 4C-CN2 at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp | Tables 4A-1 Through 4C-2CN at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Note: Table 3 contains information by CBSA and information from the following tables that have been provided in previous fiscal years: Tables 3A, 3B, 4A, 4B, 4C, 4D, and 4F. | ||||
Capital market basket | 1.2% (A) page 53703 | 1.2% (A) page 50507 | 1.5% (A) page 50390 | 1.3% (A) page 49795 |
Capital standard federal payment rate | $458.90 ($453.46 x 1.012) | $464.41 ($458.90 x 1.012) | $471.37 ($464.41 x 1.015) | $477.50 ($471.37 x 1.013) |
Complex Spinal Surgery DRGs | N/A | N/A | ||
Fixed Loss Outlier Threshold | $21,821 ((A) page 53696) | $21,748 ((A) page 50983) | $24,626 (B) page 59680 | $22,539 (B) page 60058 |
National Standard Operating Rate | $5,805.19 ($5,658.08 x 1.026) | $5,950.32 ($5,805.19 x 1.025) | $6,122.88 ($5,950.32 x 1.029) | $6,269.83 ($6,122.88 x 1.024) |
Operating Wage Index | Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2013 Wage Index location | Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2014 Wage Index location | Tables 4A-1 Through 4C-2CN at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Note: Table 3 contains information by CBSA and information from the following tables that have been provided in previous fiscal years: Tables 3A, 3B, 4A, 4B, 4C, 4D, and 4F. | ||||
Labor-Related Portion | For wage indexes greater than 1.0, the labor-related portion is 68.8% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 53685 | For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 50972 | For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 49991 | For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 49505 |
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2013 Final Rule Post-Acute DRG” Column in Table 5 https://www.cms.gov/AcuteInpatientPPS/ | Medicare-Severity DRGs designated with a “yes” in the “FY 2014 FR Post-Acute DRG” Column in Table 5 https://www.cms.gov/AcuteInpatientPPS/ | Medicare-Severity DRGs designated with a “yes” in the “FINAL Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp | Medicare-Severity DRGs designated with a “yes” in the “FY 2016 Final Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutePPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp |
Post-acute care transfer qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2013 Final Rule Special Pay DRG” column in Table 5 https://www.cms.gov/AcuteInpatientPPS/ | Medicare-Severity DRGs designated with a “yes” in the “FY 2014 FR Special Pay DRG” column in Table 5 https://www.cms.gov/AcuteInpatientPPS/ | Medicare-Severity DRGs designated with a “yes” in the “FY 2015 NPRM Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp | Medicare-Severity DRGs designated with a “yes” in the “FY 2016 Final Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp |
Uncompensated Care Adjustment | 0.943 (A) page 50634 | 0.7619 (A) page 50014 | 0.6369 (A) page 49522 |
Discharges Occurring on or After 01/01/2017 | Discharges Occurring on or After 12/01/2017 | Discharges Occurring On or After 12/01/2018 | Discharges Occurring On or After 11/01/2019 | |
|---|---|---|---|---|
Applicable FR Notices | (A) August 22, 2016 (CMS-1655-F; 81 FR 56762) final rule (B) October 5, 2016 (CMS-1655-F; 81 FR 68947; final rule; correction) | (A) August 14, 2017 (CMS-1677-F; 82 FR 37990 (B) October 4, 2017 (CMS-1677-CN; 82 FR 46138; Final rule; correction) | (A) August 17, 2018 (CMS-1694-F; 83 FR 41144) (B) October 3, 2018 (CMS-1694-CN2; 83 FR 49836; Correction) | (A) August 16, 2019 (CMS-1716-F; 84 FR 42044 (B) October 8, 2019 (CMS-1716-CN2; 84 FR 53603; correction) |
Capital wage index | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 (CN), at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Capital market basket | 1.2% (A) page 57295 | 1.3% (A) page 38174 | 1.4% (A) page 41730 | 1.5% (A) page 42640 |
Capital standard federal payment rate | $483.23 ($477.50 x 1.012) | $489.51 ($483.23 x 1.013). | $496.36 ($489.51 x 1.014) | $503.81 ($496.36 x 1.015) |
Complex Spinal Surgery DRGs | N/A | N/A | N/A | N/A |
Fixed Loss Outlier Threshold | $23,573 ((B) page 68952) | $26,537 ((B) page 46143) | $25,743 ((B) page 49844) | $26.552 ((B) page 53609) |
National Standard Operating Rate | $6,439.11 ($6,269.83 x 1.027) | $6,612.97 ($6,439.11 x 1.027) | $6,804.75 ($6,612.97 x 1.029) | $7,008.89 ($6,804.75 x 1.030) |
Operating Wage Index | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 (CN) at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Labor-Related Portion | For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 57276 | For wage indexes greater than 1.0, the labor-related portion is 68.3% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 38157 | For wage indexes greater than 1.0, the labor-related portion is 68.3% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 41713 | For wage indexes greater than 1.0, the labor-related portion is 68.3% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 42325 |
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2017 FINAL Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp | Medicare-Severity DRGs designated with a “yes” in the “FY 2018 Final Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp | Medicare-Severity DRGs designated with a “yes” in the “FY 2019 FINAL Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Medicare-Severity DRGs designated with a “yes” in the “FY 2020 FINAL Post-Acute DRG” Column in Table 5, (Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Post-acute care transfer qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2017 FINAL Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp | Medicare-Severity DRGs designated with a “yes” in the FY 2018 Final Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp | Medicare-Severity DRGs designated with a “yes” in the “FY 2019 FINAL Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Medicare-Severity DRGs designated with a “yes” in the “FY 2020 FINAL Special Pay DRG” column in Table 5, (Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Uncompensated Care Adjustment | 0.5536 (A) page 56950 | 0.5801 (A) page 38200 | 0.6751 (A) page 41409 | 0.6714 (A) page 42358 |
DRG weights for Covid-19 related discharges in accordance with Section 3710 of the CARES Act and MLN Matters Special Edition Article SE20015, dated April 15, 2020. | N/A | N/A | N/A | For discharges on or after January 27, 2020: The weighting factor of the assigned Diagnosis-Related Group (DRG) is increased by 20 percent for an individual diagnosed with COVID-19 discharged during the COVID-19 Public Health Emergency (PHE) period. Discharges of an individual diagnosed with COVID-19 will be identified by the presence of the following International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes: |
• B97.29 (Other coronavirus as the cause of diseases classified else where for discharges occurring on or after January 27, 2020, and on or before March 31, 2020. | ||||
• U07.1 (COVID-19) for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 public health emergency period. | ||||
Providers may refer to the following ICD-10-CM coding guidance for coding encounters related to COVID-19: | ||||
• For discharges on or after April 1, 2020, the ICD-10-CM Official Coding and Reporting Guidelines are at https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf | ||||
• For discharges prior to April 1, 2020, the ICD-10-CM Official Coding Guideline - Supplement is at: https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-CodingGudance-Interim-Advice-coronavirus-feb-20-2020.pdf |
Discharges Occurring On or After 12/01/2020 | Discharges Occurring On or After 3/15/2021 | Discharges Occurring On or After 12/01/2021 | Discharges Occurring On or After 12/01/2022 | |
|---|---|---|---|---|
Applicable FR Notices | September 18, 2020 (CMS-1735-F; 85 FR 58432) | (A) September 18, 2020 (CMS-1735-F; 85 FR 58432 final rule) (B) December 7, 2020 (CMS-1735-CN; 85 FR 78748; correction notice) | (A) August 13, 2021 (CMS-1752-F; 86 FR 44774 final rule) (B) October 20, 2021 (CMS-1752-F2; 86 FR 58019; correcting amendment) | (A) August 10, 2022 (CMS-1771-F; 87 FR 48780 final rule) (B) November 4, 2022 (CMS-1771-F2; 87 FR 66558; correcting amendment) (C) December 13, 2022 (CMS-1771-CN; 87 FR 76109) |
Capital wage index | Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page | CN Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS | CA Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Reg | Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page |
Capital market basket | 1.1% (A) page 59048 | 1.1% (A) page 59048 | 1.1% (A) page 45554 | 2.5% (A) page 49437 |
Capital standard federal payment rate | $509.35 ($503.81 x 1.011) | $509.35 ($503.81 x 1.011) | $514.95 ($509.35 x 1.011) | $527.82 ($514.95 x 1.025) |
Complex Spinal Surgery DRGs | N/A | N/A | N/A | N/A |
Fixed Loss Outlier Threshold | $30,006 (A) page 59039 | $29,064 (B) page 78754 | $30,988 (A) page 45543 | $38,788 (B) page 66563 and (C) page 76111 |
National Standard Operating Rate | $7,177.10 ($7,008.89 x 1.024) | $7,177.10 ($7,008.89 x 1.024) | $7,370.88 ($7177.10 x 1.027) | $7,673.09 ($7,370.99 x 1.041) |
Operating Wage Index | Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page | CN Table 3 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS | CA Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page | Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page |
Labor-Related Portion | For wage indexes greater than 1.0, the labor-related portion is 68.3% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 58793 | For wage indexes greater than 1.0, the labor-related portion is 68.3% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 59028 | For wage indexes greater than 1.0, the labor-related portion is 67.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 45194 | For wage indexes greater than 1.0, the labor-related portion is 67.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% page (A) 49431 |
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2021 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page | Medicare-Severity DRGs designated with a “yes” in the “FY 2021 CN Post-Acute DRG” column in CN Table 5 Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS | Medicare-Severity DRGs designated with a “yes” in the “FY 2022 Final Post-Acute DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Reg | Medicare-Severity DRGs designated with a “yes” in the “FY 2023 Final Post-Acute DRG” column in Table 5. https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page |
Post-acute care transfer qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2021 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page | Medicare-Severity DRGs designated with a “yes” in the “FY 2021 CN Special Pay DRG” column in CN Table 5 Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS | Medicare-Severity DRGs designated with a “yes” in the “FY 2022 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Reg | Medicare-Severity DRGs designated with a “yes” in the “FY 2023 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page |
Uncompensated Care Adjustment | 0.6786 (A) page 58813 | 0.7286 (A) page 58814 | 0.6857 (A) page 45232 | 0.6571 (A) page 49033 |
Discharges Occurring On or After 11/01/2023 | ||||
|---|---|---|---|---|
Applicable FR Notices | August 28, 2023 (CMS-1785-F; 88 FR 58640) | |||
Capital wage index | Table 3 at https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page | |||
Capital market basket | 2.9% page 59364 | |||
Capital standard federal payment rate | $543.13 ($527.82 x 1.029) | |||
Complex Spinal Surgery DRGs | N/A | |||
Fixed Loss Outlier Threshold | $42,750 page 59353 | |||
National Standard Operating Rate | $7,926.30 ($7,673.09 x 1.033) | |||
Operating Wage Index | Table 3 at https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page | |||
Labor-Related Portion | For wage indexes greater than 1.0, the labor-related portion is 67.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% page 59357 | |||
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2024 Post-Acute DRG” column in Table 5 https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page | |||
Post-acute care transfer qualifying DRGs | Medicare-Severity DRGs designated with a “yes” in the “FY 2024 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page | |||
Uncompensated Care Adjustment | 0.6947 page 59379 |
Discharges Occurring on or After 1/1/2004 | Discharges Occurring on or After 11/29/2004 | Discharges Occurring on or After 12/1/2005 | Discharges Occurring on or After 12/1/2006 | |
|---|---|---|---|---|
Applicable Payment Impact File (PIF) | FY2004 Final Rule Impact File | FY2005 Final Rule Impact File | FY2006 Final Rule Impact File | FY2007 Final Rule Impact File |
Capital geographic adjustment factor | PIF: Capital Wage Index | PIF: POST RECLASS GAF | PIF: WICGRN | PIF: Post Reclass GAF_a (for first half FY 2007) and Post Reclass GAF_b (for capital second half FY 2007) |
Large Urban Add-on | PIF: Post-Reclassification Urban/Rural location | PIF: Standardized payment location | PIF:URSPA | PIF:URSPA |
Capital Disproportionate Share Adjustment Factor | PIF: Capital Disproportionate Share Adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) Adjustment location (CAPITAL DSH ADJ.) | PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG) |
Capital Indirect Medical Education Adjustment Factor | PIF: Capital IME Adjustment location (TCHCP) | PIF: IME adjustment factor for capital PPS location (IME ADJUSTMENT-CAPITAL) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) |
Operating Wage Index | Tables 4A-4C beginning on (A) page 57736; PIF: Operating Wage Index location (WIGRN) | Tables 4A1-4C2 beginning on (C) page 78619; PIF: Final Wage Index location (WIGRN) | Tables 4A-4C beginning on (A) page 47580 as corrected by Tables 4A-4C beginning on (B) page 57163; PIF: Post Reclass Wage Index location | Tables 4A-1 - 4C-1 (for discharges before 4/1/2007) and Tables 4A-2-4C2 (for discharges occurring on or after 4/1/2007) beginning on (b) page 59975; PIF: Post Reclass Wage Index_a (for first half FY 2007) and Post Reclass Wage Index_b (for second hall FY 2007) |
Operating Disproportionate Share Adjustment Factor | PIF: Operating DSH Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (OPERATING DSH ADJ.) | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) |
Operating Indirect Medical Education Adjustment | PIF: Operating IME Adjustment location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (IME ADJUSTMENT OPERATING) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) |
Sole Community Hospital -- Hospital Specific Rate | PIF: Hospital -- Specific Rate location (HSPPUB) | PIF: Sole Community Hospital Cost/Case 1982/1987 and Sole Community Hospital Cost/Case 1996 locations | PIF: 82/87 Hospital Specific Rate Updated to FY 2006 (OLDHSPPS) and 1996 Hospital Specific Rate Updated to FY 2006 (HSP96) locations | PIF: 82/87/96 Hospital Specific Rate Updated to FY 2007 for SCH Providers location (HSP Rate) |
Cost-to-Charge Ratio | PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR) | PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR) | PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR) | PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR) |
Discharges Occurring on or After 1/1/2008 | Discharges Occurring on or After 12/1/2008 | Discharges Occurring on or After 12/1/2009 | Discharges Occurring on or After 3/01/2011 | |
|---|---|---|---|---|
Applicable Payment Impact File (PIF) | FY2008 Final Rule | FY2009 Final Rule | FY2010 Correction Notice | FY 2011 Final Rule |
Capital Geographic Adjustment Factor | Post Reclass GAF | Post Reclass GAF | Post Reclass GAF | FY 2011 GAF |
Capital Disproportionate Share Adjustment Factor | PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG) |
Capital Indirect Medical Education Adjustment Factor | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) |
Operating Wage Index | Tables 4A-4C beginning on (B) page 57698; PIF: Post Reclass Wage Index location | Tables 4A-4C beginning on (B) page 57956; PIF: Post Reclass Wage Index location | Tables 4A-4C beginning on page (A) 44085 as corrected by Tables 4A-4C beginning on (B) page 51505 for certain areas; PIF: Post Reclass Wage Index location | Tables 4A-C Beginning on page (A) 50511; PIF: FY 2011 Wage Index location |
Operating Disproportionate Share Adjustment Factor | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) |
Operating Indirect Medical Education Adjustment | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) |
Sole Community Hospital -- Hospital Specific Rate | PIF: 82/87/96 Hospital Specific Rate Updated to FY 2008 for SCH Providers location (HSP Rate) | PIF: 82/87/96 Hospital Specific Payment (HSP) Rate Updated to FY 2009 for SCH Providers location (HSP Rate) | PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY 2010 for SCH Providers location (FY10HSP Rate) | PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2011 for SCH Providers location (FY11 HSP Rate) |
Cost-to-Charge Ratio | PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) |
Discharges Occurring on or After 12/01/2011 | Discharges Occurring on or After 03/15/2013 | Discharges Occurring on or After 03/05/2015 | Discharges Occurring on or After 03/05/2015 (These 2015 factors are updated by AD Order dated 02/05/2015, and supersedes 2014 factors adopted under the OMFS rulemaking filed with the Secretary of State on 02/04/2015) | |
|---|---|---|---|---|
Applicable Payment Impact File (PIF) | FY 2012 Final Rule-IPPS Impact File | FY 13 FR Impact File--updated October 2012 | FY 2014 Impact file--updated January 2014 to reflect changes from the September 2013 correction notice and interim final rule with comment | FY 15 Impact File (August 22, 2014 Final Rule and October 3, 2014 Correction Notice) |
Capital Geographic Adjustment Factor | FY 2012 GAF | FY 2013 GAF | FY 2014 GAF--Updated September 2013 | FY 2015 GAF--Updated October 2014 |
Capital Disproportionate Share Adjustment Factor | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG) |
Capital Indirect Medical Education Adjustment Factor | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) |
Operating Wage Index | Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2012 Wage Index location | Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2013 Wage Index location | Tables 4A-C--CN2 at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2014 Wage Index location | Tables 4A-1 Through 4C-2CN at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Operating Disproportionate Share Adjustment Factor | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share Hospital (DSH) Adjustment Factor location (DSHOPG) | PIF: Operating Disproportionate Share Hospital (DSH) Adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3133 of the Affordable Care Act. Factor location (DSHOPG) |
Operating Indirect Medical Education Adjustment | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) |
Sole Community Hospital--Hospital Specific Rate | PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2012 for SCH Providers location (FY12 HSP Rate) | PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2013 for SCH Providers location (FY13 HSP Rate) | PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2014 for SCH and MDH Providers with the -0.2% adjustment for presumptive inpatient hospital status policy. Location (FY14 HSP Rate) | PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2015 for SCH and MDH Providers. Location (FY14 HSP Rate) |
Cost-to-Charge Ratio | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) |
Discharges Occurring on or After 03/01/2016 | Discharges Occurring on or After 01/01/2017 | Discharges Occurring on or After 12/01/2017 | Discharges Occurring On or After 12/01/2018 | |
|---|---|---|---|---|
Applicable Payment Impact File (PIF) | FY 16 Impact File (August 17, 2015 Final Rule and October 5, 2015 Correction Notice) | FY 17 Impact File (August 22, 2016 Final Rule and October 5, 2016 Correction Notice) | FY 18 Impact File (August 14, 2017 Final Rule and October 4, 2017 Correction Notice) | FY 19 Impact File (August 17, 2018 Final Rule and October 3, 2018 Correction Notice) |
Capital Geographic Adjustment Factor | FY 2016 GAF--Updated October 2015 | FY 2017 GAF--Updated October 2016 | FY 2018 GAF--Updated October 2017 | FY 2019 GAF--Updated October 2018 |
Capital Disproportionate Share Adjustment Factor | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG) | PIF: FY 2018 Capital Disproportionate Share (DSH) adjustment location (DSHCPG) | PIF: FY 2019 Capital Disproportionate Share Share (DSH) adjustment (DSHCPP) |
Capital Indirect Medical Education Adjustment Factor | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) |
Operating Wage Index | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html Note: Table 3 contains information by CBSA and information from the following tables that have been provided in previous fiscal years: Tables 3A, 3B, 4A, 4B, 4C, 4D, and 4F. | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html |
Operating Disproportionate Share Adjustment Factor | PIF: Operating Disproportionate Share Hospital (DSH) Adjustment. Reflects a 75% reduction to the DSH adjustment required under section 3133 of the Affordable Care Act. Factor location (DSHOPG) | PIF: Operating Disproportionate Share Hospital (DSH) Adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3133 of the Affordable Care Act. Factor location (DSHOPG) | PIF: Estimated FY 2018 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) | PIF: Estimated FY 2019 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) |
Operating Indirect Medical Education Adjustment | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating PPS location (TCHOP) | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) |
Sole Community Hospital--Hospital Specific Rate | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2016 for SCH and MDH providers. HSP Rate is based on the March 2015 update of the Provider Specific File (PSF). Location (HSP Rate) | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2017 for SCH and MDH providers. HSP Rate is based on the March 2016 update of the Provider Specific File (PSF). Location (HSP Rate) | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2018 for SCH providers. HSP Rate is based on the March 2017 update of the Provider Specific File (PSF). Location (HSP Rate) | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2019 for SCH providers. HSP Rate is based on the March 2018 update of the Provider Specific File (PSF). Location (HSP Rate) |
Cost-to-Charge Ratio | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) |
Discharges Occurring On or After 11/01/2019 | Discharges Occurring On or After 12/01/2020 | Discharges Occurring On or After 03/15/2021 | Discharges Occurring On or After 12/01/2021 | |
|---|---|---|---|---|
Applicable Payment Impact File (PIF) | FY 20 Impact File (Final Rule and Correction Notice) | FY 21 Impact File (Final Rule) | FY 21 Impact File (Final Rule and Correction Notice) | FY 22 Impact File (Final Rule and Correcting Amendment) |
Capital Geographic Adjustment Factor | FY 2020 GAF--Updated October 2019 | FY 2012 GAF--Updated October 2020 | FY 2021 GAF--Updated October 2020 | FY 2022 GAF--Updated October 2021 |
Capital Disproportionate Share Adjustment Factor | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP) |
Capital Indirect Medical Education Adjustment Factor | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) |
Operating Wage Index | Table 3 (CN) at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html | Table 3 at https://www.cms.gov/medicare/acute-inpatientpps/fy-2021-ipps-final-rule-home-page | Table 3 (CN) at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS | Table 3 at https://www.cms.gov/medicare/acute-inpatientpps/fy-2022-ipps-final-rule-home-page#Reg |
Operating Disproportionate Share Adjustment Factor | PIF: Estimated FY 2020 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) | PIF: Estimated FY 2021 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) | PIF: Estimated FY 2021 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) | PIF: Estimated FY 2022 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) |
Operating Indirect Medical Education Adjustment | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) |
Sole Community Hospital--Hospital Specific Rate | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2020 for SCH providers. HSP Rate is based on the March 2019 update of the Provider Specific File (PSF). Location (HSP Rate) | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2021 for SCH providers. HSP Rate is based on the March 2020 update of the Provider Specific File (PSF) Location (HSP Rate) | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2021 for SCH providers. HSP Rate is based on the March 2020 update of the Provider Specific File (PSF). Location (HSP Rate) | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2022 for SCH providers. HSP Rate is based on the March 2020 update of the Provider Specific File (PSF). Location (HSP Rate) |
Cost-to-Charge Ratio | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Change Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) |
Discharges Occurring On or After 12/01/2022 | Discharges Occurring On or After 11/01/2023 | |||
|---|---|---|---|---|
Applicable Payment Impact File (PIF) | FY 2023 Impact File (Final Rule) | FY 2024 Impact File (Final Rule) | ||
Capital Geographic Adjustment Factor | FY 2023 GAF-Updated October 2022 | FY 2024 GAF-Updated October 2023 | ||
Capital Disproportionate Share Adjustment Factor | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP) | PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP) | ||
Capital Indirect Medical Education Adjustment Factor | PIF: IME adjustment factor for capital PPS location (TCHCP) | PIF: IME adjustment factor for capital PPS location (TCHCP) | ||
Operating Wage Index | Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page | Table 3 at https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2024-ipps-final-rule-home-page | ||
Operating Disproportionate Share Adjustment Factor | PIF: Estimated FY 2023 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) | PIF: Estimated FY 2024 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP) | ||
Operating Indirect Medical Education Adjustment | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) | PIF: IME Adjustment Factor for Operating IPPS location (TCHOP) | ||
Sole Community Hospital -- Hospital Specific Rate | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2023 for SCH providers. HSP Rate is based on the March 2022 update of the Provider Specific File (PSF). Location (HSP Rate) | PIF: Hospital Specific Payment (HSP) Rate updated to FY 2024 for SCH providers. HSP Rate is based on the March 2023 update of the Provider Specific File (PSF). Location (HSP Rate) | ||
Cost-to-Charge Ratio | PIF: Operating Cost-to-Charge Ratio location (Operating CCR and Capital Cost-to-Charge location (Capital CCR) | PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR) |
Credits
Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 5307.1, Labor Code.
History
1. New section filed 12-27-2012; operative 1-1-2013 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2012, No. 52).
2. Amendment filed 3-13-2013; operative 3-15-2013. Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2013, No. 11).
3. Amendment filed 2-4-2015; operative 3-5-2015. Submitted to OAL for printing only pursuant to Government Code section 11340.9 (Register 2015, No. 6).
4. Amendment filed 2-25-2015; operative 3-5-2015 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2015, No. 9).
5. Amendment filed 3-14-2016; operative 3-1-2016 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2016, No. 12).
6. Editorial correction of subsection (b) (Register 2016, No. 49).
7. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 1-19-2017; operative 1-1-2017 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 3).
8. Amendment filed 11-28-2017; operative 12-1-2017 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 48).
9. Editorial correction of formatting (Register 2018, No. 15).
10. Nonsubstantive action without change filed 4-27-2018 pursuant to section 100, title 1, California Code of Regulations to correct errors in 11-28-2017 filing (Register 2018, No. 17).
11. Editorial correction of subsections (b)(1) and (c)(1) (Register 2018, No. 48).
12. Amendment filed 11-26-2018; operative 12-1-2018 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2018, No. 48).
13. Amendment filed 10-16-2019; operative 11-1-2019 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2019, No. 42).
14. Amendment of subsections (b)(1) and (c)(1) filed 12-12-2019; operative 11-1-2019 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2019, No. 50).
15. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 12-23-2020; operative 12-1-2020 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2020, No. 52).
16. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 4-12-2021; operative 3-15-2021 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2021, No. 16).
17. Editorial correction of subsections (a)(1), (b)(1) and (c)(1) (Register 2021, No. 49).
18. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 12-1-2021; operative 12-1-2021 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2021, No. 49).
19. Amendment of subsections (a)(1), (b)(1) and (c)(1) and amendment of Note filed 12-29-2022; operative 12-1-2022 pursuant to Labor Code section 5307.1(g)(2). Exempt from the APA pursuant to Labor Code section 5307.1(g)(2) and submitted to OAL for filing and printing only pursuant to Government Code section 11343.8 (Register 2022, No. 52).
20. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 2-13-2024; operative 2-13-2024 pursuant to Labor Code section 5307.1(g)(2). Exempt from the APA pursuant to Labor Code section 5307.1(g)(2) and submitted to OAL for filing and printing only pursuant to Government Code section 11343.8 (Register 2024, No. 7).
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