"NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2022-PROPOSED RULE"				
MS?DRG	Number of Cases	Threshold		
001	2164	"$747,106"		
002	143	"$441,189"		
003	14383	"$449,655"		
004	12627	"$279,158"		
005	1242	"$289,576"		
006	515	"$171,748"		
007	586	"$361,693"		
008	339	"$185,384"		
010	28	"$128,992"		
011	1881	"$140,891"		
012	1859	"$123,766"		
013	541	"$87,742"		
014	1069	"$314,175"		
016	2114	"$180,949"		
017	113	"$131,131"		
018	116	"$1,237,393"		
019	86	"$217,133"		
020	1727	"$287,474"		
021	443	"$207,253"		
022	140	"$137,269"		
023	12776	"$163,319"		
024	4592	"$124,542"		
025	21876	"$133,530"		
026	9509	"$98,969"		
027	10451	"$86,759"		
028	2240	"$157,096"		
029	3827	"$101,449"		
030	1423	"$80,411"		
031	974	"$115,861"		
032	2227	"$77,256"		
033	2785	"$67,644"		
034	1361	"$120,662"		
035	3650	"$83,358"		
036	5130	"$70,513"		
037	3523	"$104,787"		
038	11589	"$68,105"		
039	21942	"$55,545"		
040	3861	"$112,559"		
041	6386	"$84,871"		
042	2394	"$73,097"		
052	1038	"$60,302"		
053	225	"$46,564"		
054	12595	"$51,474"		
055	3905	"$45,906"		
056	11916	"$59,388"		
057	29883	"$45,238"		
058	812	"$58,456"		
059	2769	"$47,144"		
060	2310	"$42,719"		
061	5500	"$106,678"		
062	10510	"$87,570"		
063	2204	"$80,866"		
064	77653	"$63,747"		
065	107461	"$49,158"		
066	31531	"$39,216"		
067	989	"$58,651"		
068	4396	"$46,695"		
069	37227	"$43,651"		
070	18361	"$56,029"		
071	18329	"$44,553"		
072	3699	"$38,859"		
073	7377	"$51,535"		
074	16090	"$45,097"		
075	642	"$59,758"		
076	164	"$45,646"		
077	2105	"$58,936"		
078	2938	"$47,598"		
079	529	"$40,000"		
080	829	"$62,826"		
081	577	"$35,477"		
082	6943	"$70,140"		
083	10001	"$52,671"		
084	4852	"$43,255"		
085	8152	"$68,652"		
086	15953	"$51,630"		
087	8102	"$41,783"		
088	617	"$58,689"		
089	1915	"$49,286"		
090	618	"$45,076"		
091	16124	"$55,902"		
092	22682	"$43,964"		
093	7372	"$38,922"		
094	1456	"$97,823"		
095	1354	"$77,811"		
096	434	"$78,843"		
097	2038	"$102,643"		
098	1565	"$68,648"		
099	494	"$56,748"		
100	25394	"$60,520"		
101	40916	"$41,921"		
102	1212	"$48,643"		
103	9470	"$41,401"		
113	470	"$76,608"		
114	131	"$59,638"		
115	708	"$59,069"		
116	375	"$63,294"		
117	160	"$49,276"		
121	576	"$42,752"		
122	171	"$24,441"		
123	3088	"$41,692"		
124	1005	"$50,335"		
125	3332	"$38,824"		
135	284	"$76,223"		
136	95	"$57,284"		
137	959	"$53,741"		
138	386	"$40,748"		
139	336	"$52,962"		
140	649	"$121,301"		
141	2485	"$81,672"		
142	1370	"$67,113"		
143	755	"$91,658"		
144	1591	"$65,573"		
145	1083	"$53,569"		
146	1090	"$60,100"		
147	914	"$46,958"		
148	228	"$37,809"		
149	15199	"$37,914"		
150	1066	"$47,128"		
151	2488	"$31,071"		
152	3057	"$44,467"		
153	7400	"$32,134"		
154	2020	"$53,925"		
155	3907	"$40,971"		
156	1463	"$31,135"		
157	1970	"$54,332"		
158	3391	"$39,541"		
159	843	"$30,842"		
163	10848	"$140,561"		
164	15756	"$91,538"		
165	8195	"$74,454"		
166	10087	"$104,858"		
167	6379	"$68,530"		
168	2331	"$58,962"		
175	31452	"$56,895"		
176	29040	"$41,220"		
177	76795	"$60,437"		
178	30363	"$47,673"		
179	5041	"$37,252"		
180	18874	"$61,355"		
181	9684	"$48,270"		
182	608	"$41,101"		
183	5104	"$56,294"		
184	10622	"$46,536"		
185	2872	"$36,300"		
186	10126	"$55,169"		
187	6444	"$45,543"		
188	1176	"$34,319"		
189	145164	"$48,920"		
190	128888	"$46,517"		
191	65167	"$38,413"		
192	23134	"$30,947"		
193	149665	"$50,803"		
194	102218	"$38,049"		
195	23542	"$29,941"		
196	9286	"$57,353"		
197	2938	"$44,531"		
198	724	"$34,912"		
199	6427	"$60,468"		
200	9822	"$45,705"		
201	1813	"$31,490"		
202	41128	"$42,341"		
203	8255	"$31,350"		
204	7633	"$38,499"		
205	9627	"$55,059"		
206	9406	"$40,300"		
207	18328	"$160,221"		
208	54734	"$83,106"		
215	7702	"$276,352"		
216	5574	"$310,181"		
217	1879	"$211,408"		
218	207	"$177,086"		
219	15531	"$237,395"		
220	15028	"$175,615"		
221	2405	"$146,553"		
222	1846	"$259,265"		
223	475	"$201,489"		
224	2315	"$230,939"		
225	1627	"$188,736"		
226	4831	"$200,105"		
227	4567	"$163,699"		
228	4409	"$187,320"		
229	5235	"$133,454"		
231	969	"$287,597"		
232	693	"$210,041"		
233	12125	"$245,443"		
234	13871	"$184,882"		
235	11473	"$188,187"		
236	19630	"$143,276"		
239	9868	"$116,113"		
240	7775	"$79,902"		
241	702	"$58,011"		
242	18894	"$116,225"		
243	25130	"$90,530"		
244	14433	"$79,104"		
245	1862	"$163,091"		
246	50867	"$122,389"		
247	86006	"$93,871"		
248	2405	"$122,573"		
249	3072	"$90,092"		
250	4425	"$99,936"		
251	5154	"$80,239"		
252	33196	"$100,159"		
253	23910	"$91,609"		
254	10517	"$70,789"		
255	2291	"$76,862"		
256	2098	"$59,231"		
257	139	"$47,140"		
258	547	"$102,988"		
259	897	"$77,246"		
260	2657	"$109,098"		
261	3629	"$74,345"		
262	1357	"$68,987"		
263	266	"$75,872"		
264	10374	"$86,772"		
265	576	"$98,894"		
266	20622	"$202,452"		
267	29676	"$165,135"		
268	3649	"$198,817"		
269	16274	"$129,698"		
270	18873	"$151,452"		
271	14485	"$115,331"		
272	5300	"$90,892"		
273	7530	"$134,600"		
274	26442	"$116,332"		
280	90935	"$57,341"		
281	48192	"$45,616"		
282	20487	"$40,428"		
283	10237	"$60,637"		
284	1084	"$37,395"		
285	272	"$26,121"		
286	44548	"$79,309"		
287	57040	"$58,417"		
288	1374	"$75,428"		
289	715	"$56,438"		
290	60	"$43,679"		
291	393258	"$49,196"		
292	84559	"$37,069"		
293	21818	"$28,625"		
294	286	"$47,543"		
295	27	"$36,953"		
296	3836	"$59,353"		
297	400	"$35,987"		
298	158	"$25,755"		
299	19529	"$52,071"		
300	28498	"$42,598"		
301	7598	"$32,416"		
302	3662	"$44,998"		
303	12062	"$32,398"		
304	16649	"$45,756"		
305	30448	"$35,994"		
306	4249	"$50,163"		
307	3295	"$39,001"		
308	69641	"$47,953"		
309	86317	"$34,065"		
310	55528	"$26,420"		
311	5273	"$33,698"		
312	67877	"$39,889"		
313	38223	"$36,636"		
314	43229	"$62,361"		
315	19996	"$42,746"		
316	3397	"$35,703"		
319	1605	"$136,177"		
320	589	"$86,092"		
326	10439	"$140,664"		
327	10331	"$87,285"		
328	7790	"$67,014"		
329	35523	"$134,141"		
330	50475	"$87,366"		
331	27548	"$68,459"		
332	182	"$113,958"		
333	645	"$77,378"		
334	676	"$64,419"		
335	5267	"$115,609"		
336	9309	"$81,006"		
337	4438	"$66,247"		
338	378	"$96,530"		
339	1078	"$73,491"		
340	824	"$59,111"		
341	1104	"$85,506"		
342	3596	"$65,120"		
343	3647	"$56,209"		
344	1068	"$84,403"		
345	2118	"$60,773"		
346	1064	"$55,073"		
347	865	"$76,442"		
348	2120	"$55,492"		
349	1110	"$46,330"		
350	1386	"$84,963"		
351	3460	"$63,312"		
352	2492	"$53,077"		
353	2741	"$95,002"		
354	7228	"$68,657"		
355	5292	"$58,420"		
356	6965	"$119,595"		
357	5619	"$80,040"		
358	1308	"$58,552"		
368	3054	"$64,798"		
369	3794	"$48,251"		
370	450	"$36,499"		
371	16682	"$56,028"		
372	25015	"$42,966"		
373	5638	"$33,264"		
374	11637	"$63,364"		
375	12755	"$49,158"		
376	1113	"$42,586"		
377	68578	"$61,128"		
378	126794	"$44,863"		
379	14769	"$30,778"		
380	5874	"$63,819"		
381	7602	"$48,332"		
382	1505	"$38,055"		
383	1059	"$54,292"		
384	3675	"$45,682"		
385	2900	"$56,447"		
386	7797	"$44,604"		
387	3411	"$33,702"		
388	18849	"$53,000"		
389	49164	"$37,167"		
390	29281	"$28,092"		
391	41987	"$49,466"		
392	136515	"$37,051"		
393	26037	"$55,755"		
394	38467	"$42,636"		
395	8850	"$31,977"		
405	3957	"$154,508"		
406	4988	"$98,600"		
407	1635	"$80,470"		
408	953	"$111,711"		
409	1009	"$78,898"		
410	316	"$66,321"		
411	160	"$116,426"		
412	231	"$86,011"		
413	147	"$71,267"		
414	1829	"$111,361"		
415	2636	"$76,784"		
416	1319	"$60,274"		
417	13122	"$89,196"		
418	22247	"$72,462"		
419	14149	"$61,901"		
420	719	"$102,658"		
421	785	"$71,776"		
422	177	"$60,398"		
423	1104	"$118,830"		
424	580	"$80,468"		
425	112	"$64,148"		
432	16634	"$62,021"		
433	11924	"$45,367"		
434	668	"$29,229"		
435	13744	"$61,896"		
436	7498	"$48,338"		
437	677	"$43,447"		
438	13890	"$56,398"		
439	24419	"$40,031"		
440	12225	"$30,958"		
441	20503	"$59,111"		
442	17879	"$40,985"		
443	2645	"$32,017"		
444	12827	"$60,012"		
445	18576	"$48,845"		
446	7181	"$42,274"		
453	3876	"$244,272"		
454	21327	"$166,144"		
455	21863	"$137,988"		
456	1390	"$239,125"		
457	3732	"$179,597"		
458	1248	"$137,437"		
459	3762	"$176,863"		
460	48642	"$116,567"		
461	262	"$163,305"		
462	6035	"$102,388"		
463	5210	"$121,981"		
464	8165	"$86,294"		
465	2542	"$65,856"		
466	5387	"$142,217"		
467	24226	"$107,207"		
468	18769	"$89,185"		
469	12264	"$97,284"		
470	357837	"$70,957"		
471	3521	"$148,438"		
472	16225	"$100,479"		
473	11785	"$87,419"		
474	3570	"$105,398"		
475	3620	"$70,732"		
476	707	"$50,970"		
477	3528	"$98,304"		
478	6784	"$82,119"		
479	1589	"$68,366"		
480	28673	"$96,784"		
481	79670	"$76,836"		
482	21289	"$65,120"		
483	67812	"$83,439"		
485	1522	"$105,972"		
486	3115	"$77,453"		
487	974	"$65,174"		
488	2623	"$67,914"		
489	2630	"$55,888"		
492	6264	"$106,298"		
493	19675	"$81,459"		
494	12118	"$69,906"		
495	499	"$106,174"		
496	1877	"$71,046"		
497	1220	"$58,273"		
498	1113	"$80,891"		
499	211	"$52,499"		
500	2832	"$89,759"		
501	6102	"$63,229"		
502	3026	"$54,824"		
503	1066	"$81,191"		
504	3018	"$63,611"		
505	1132	"$63,611"		
506	465	"$57,585"		
507	438	"$70,576"		
508	159	"$58,009"		
509	48	"$61,735"		
510	1062	"$90,177"		
511	3466	"$74,877"		
512	2131	"$64,570"		
513	1823	"$59,258"		
514	535	"$47,025"		
515	4811	"$97,341"		
516	14020	"$73,396"		
517	12623	"$59,539"		
518	2678	"$108,364"		
519	8418	"$72,719"		
520	6474	"$59,995"		
521	14942	"$100,255"		
522	50178	"$80,943"		
533	953	"$48,429"		
534	2717	"$31,291"		
535	7895	"$46,735"		
536	23875	"$32,286"		
537	900	"$39,660"		
538	326	"$30,901"		
539	3110	"$56,826"		
540	3316	"$46,885"		
541	568	"$34,116"		
542	7573	"$57,295"		
543	14566	"$44,335"		
544	3895	"$33,536"		
545	3715	"$65,842"		
546	4126	"$46,470"		
547	1272	"$36,616"		
548	645	"$62,393"		
549	1295	"$47,505"		
550	367	"$37,307"		
551	13326	"$56,569"		
552	53143	"$42,882"		
553	2434	"$46,770"		
554	11942	"$32,538"		
555	2293	"$50,184"		
556	9088	"$36,243"		
557	3555	"$52,209"		
558	10196	"$36,758"		
559	3036	"$55,535"		
560	5551	"$40,211"		
561	2604	"$31,226"		
562	6782	"$51,136"		
563	25492	"$36,988"		
564	5042	"$54,808"		
565	8468	"$43,806"		
566	2035	"$34,423"		
570	3093	"$75,526"		
571	6301	"$56,667"		
572	1384	"$47,517"		
573	781	"$118,755"		
574	1431	"$84,581"		
575	220	"$59,566"		
576	448	"$128,425"		
577	1604	"$82,968"		
578	881	"$63,146"		
579	4925	"$80,341"		
580	11208	"$58,119"		
581	4159	"$52,137"		
582	682	"$64,662"		
583	652	"$59,683"		
584	700	"$67,031"		
585	733	"$65,912"		
592	3032	"$50,918"		
593	4583	"$41,266"		
594	550	"$30,336"		
595	1038	"$56,960"		
596	2676	"$39,047"		
597	1478	"$56,315"		
598	1465	"$46,664"		
599	58	"$28,909"		
600	807	"$39,940"		
601	327	"$27,378"		
602	25650	"$49,589"		
603	95927	"$33,038"		
604	3356	"$54,292"		
605	13540	"$41,356"		
606	1856	"$48,581"		
607	5791	"$33,360"		
614	2156	"$85,407"		
615	1167	"$68,713"		
616	3037	"$107,123"		
617	15061	"$68,015"		
618	104	"$52,515"		
619	952	"$91,019"		
620	3703	"$68,651"		
621	11702	"$63,943"		
622	2045	"$88,263"		
623	6007	"$61,393"		
624	227	"$45,901"		
625	833	"$93,782"		
626	1194	"$69,246"		
627	1334	"$56,837"		
628	3397	"$103,174"		
629	5498	"$74,289"		
630	228	"$58,380"		
637	33726	"$50,465"		
638	53606	"$36,883"		
639	8732	"$27,681"		
640	76096	"$46,095"		
641	85324	"$32,959"		
642	1979	"$45,875"		
643	11194	"$56,241"		
644	13304	"$43,174"		
645	4323	"$33,843"		
650	2550	"$146,140"		
651	1143	"$130,237"		
652	9079	"$118,415"		
653	1663	"$148,142"		
654	4062	"$101,590"		
655	1530	"$79,838"		
656	3006	"$105,254"		
657	7430	"$75,963"		
658	5817	"$67,784"		
659	9319	"$81,695"		
660	19347	"$58,862"		
661	12873	"$51,657"		
662	689	"$85,099"		
663	1515	"$60,349"		
664	572	"$50,774"		
665	660	"$93,897"		
666	1525	"$64,670"		
667	486	"$46,559"		
668	2196	"$87,346"		
669	5546	"$60,912"		
670	1688	"$47,194"		
671	388	"$63,774"		
672	199	"$51,926"		
673	15665	"$95,503"		
674	7268	"$77,898"		
675	471	"$65,848"		
682	103122	"$51,459"		
683	126516	"$37,800"		
684	14483	"$28,200"		
686	1668	"$58,801"		
687	2507	"$44,723"		
688	287	"$36,125"		
689	79672	"$45,108"		
690	128152	"$34,507"		
693	1283	"$49,719"		
694	6437	"$35,761"		
695	1278	"$44,550"		
696	5906	"$30,071"		
697	446	"$43,892"		
698	67921	"$53,585"		
699	36601	"$41,945"		
700	3391	"$32,508"		
707	3391	"$76,189"		
708	6052	"$67,451"		
709	467	"$72,274"		
710	214	"$61,014"		
711	442	"$74,483"		
712	106	"$48,993"		
713	4754	"$57,556"		
714	1531	"$43,805"		
715	416	"$76,112"		
716	88	"$59,163"		
717	1686	"$65,245"		
718	491	"$54,713"		
722	806	"$56,555"		
723	1445	"$45,557"		
724	76	"$30,946"		
725	753	"$47,579"		
726	2914	"$32,764"		
727	1410	"$51,531"		
728	3859	"$34,549"		
729	616	"$42,052"		
730	97	"$25,143"		
734	800	"$82,171"		
735	466	"$63,953"		
736	601	"$129,610"		
737	2537	"$79,271"		
738	558	"$65,413"		
739	565	"$116,190"		
740	2278	"$73,285"		
741	1635	"$60,653"		
742	4082	"$67,348"		
743	5392	"$53,233"		
744	1415	"$64,324"		
745	205	"$50,383"		
746	1406	"$58,664"		
747	1370	"$46,166"		
748	1327	"$56,469"		
749	783	"$85,314"		
750	108	"$60,358"		
754	1789	"$58,639"		
755	2482	"$45,560"		
756	205	"$38,321"		
757	841	"$53,365"		
758	1306	"$41,665"		
759	376	"$31,706"		
760	1559	"$40,393"		
761	274	"$29,056"		
768	174	"$38,864"		
769	113	"$51,305"		
770	59	"$41,092"		
776	501	"$31,975"		
779	51	"$41,024"		
783	194	"$56,774"		
784	532	"$41,179"		
785	410	"$35,252"		
786	661	"$51,732"		
787	1637	"$39,037"		
788	1663	"$33,534"		
789	1	"$10,251"		
793	1	"$23,156"		
794	1	"$56,000"		
796	31	"$40,192"		
797	80	"$33,499"		
798	115	"$30,893"		
799	454	"$146,997"		
800	298	"$95,656"		
801	132	"$68,402"		
802	562	"$97,283"		
803	820	"$70,190"		
804	455	"$59,521"		
805	496	"$32,934"		
806	1913	"$22,964"		
807	3329	"$19,695"		
808	8224	"$64,987"		
809	13788	"$47,070"		
810	1631	"$41,174"		
811	29064	"$51,352"		
812	52434	"$38,174"		
813	17818	"$51,824"		
814	1537	"$59,037"		
815	2372	"$44,252"		
816	589	"$33,692"		
817	63	"$71,288"		
818	72	"$52,498"		
819	38	"$47,332"		
820	1098	"$158,186"		
821	1111	"$78,648"		
822	913	"$58,614"		
823	2347	"$128,286"		
824	2302	"$82,768"		
825	654	"$60,299"		
826	740	"$140,299"		
827	1366	"$88,094"		
828	767	"$69,559"		
829	1760	"$92,778"		
830	331	"$62,728"		
831	745	"$39,908"		
832	1126	"$26,297"		
833	506	"$18,627"		
834	4510	"$124,371"		
835	2210	"$59,633"		
836	445	"$43,138"		
837	1891	"$115,651"		
838	1263	"$62,586"		
839	862	"$50,112"		
840	8655	"$80,844"		
841	6930	"$55,873"		
842	1341	"$45,130"		
843	2198	"$61,671"		
844	1903	"$48,201"		
845	275	"$41,594"		
846	3159	"$70,884"		
847	11952	"$49,834"		
848	228	"$40,787"		
849	342	"$67,773"		
853	84796	"$131,454"		
854	25423	"$73,712"		
855	233	"$58,944"		
856	9205	"$111,172"		
857	9858	"$67,032"		
858	1131	"$53,231"		
862	12286	"$58,640"		
863	10498	"$39,662"		
864	9379	"$39,984"		
865	3078	"$50,177"		
866	6349	"$36,510"		
867	2601	"$63,264"		
868	1913	"$42,750"		
869	378	"$33,128"		
870	32360	"$180,887"		
871	607367	"$62,029"		
872	154398	"$44,740"		
876	666	"$81,855"		
880	7322	"$39,463"		
881	3975	"$24,992"		
882	1936	"$28,783"		
883	1195	"$36,865"		
884	20170	"$44,755"		
885	68029	"$33,959"		
886	296	"$36,207"		
887	385	"$41,988"		
894	4259	"$21,569"		
895	3489	"$39,203"		
896	9527	"$55,735"		
897	30068	"$31,339"		
901	1175	"$106,064"		
902	2050	"$64,731"		
903	571	"$48,585"		
904	1035	"$97,806"		
905	251	"$59,335"		
906	573	"$61,769"		
907	10278	"$107,115"		
908	9073	"$69,448"		
909	2979	"$55,664"		
913	763	"$56,568"		
914	2435	"$41,725"		
915	2479	"$57,446"		
916	3921	"$28,451"		
917	28626	"$52,435"		
918	15829	"$33,907"		
919	14830	"$57,878"		
920	13592	"$43,116"		
921	2723	"$31,209"		
922	1690	"$54,194"		
923	1949	"$37,834"		
927	162	"$477,371"		
928	1086	"$142,794"		
929	254	"$85,148"		
933	119	"$63,191"		
934	492	"$50,206"		
935	1745	"$49,307"		
939	659	"$94,189"		
940	1439	"$73,793"		
941	734	"$66,399"		
945	2147	"$55,394"		
946	675	"$54,253"		
947	8788	"$45,234"		
948	28164	"$34,722"		
949	1183	"$39,767"		
950	235	"$26,858"		
951	2993	"$21,872"		
955	462	"$183,785"		
956	6169	"$106,833"		
957	2229	"$210,281"		
958	1792	"$130,949"		
959	125	"$91,690"		
963	3013	"$83,436"		
964	4540	"$56,679"		
965	735	"$43,739"		
969	356	"$158,259"		
970	92	"$85,807"		
974	4293	"$75,705"		
975	2050	"$50,148"		
976	351	"$41,405"		
977	1192	47958		
981	26293	122565		
982	13784	81726		
983	2645	63559		
987	8914	94780		
988	8136	62853		
989	1216	50923		
1Geometric mean plus the lesser of .75 of the national adjusted operating standardized payment amount (increased to reflect the difference between costs and charges) or .75 of one standard deviation of mean charges by medicare severity diagnosis related group (ms drg)				
2Cases taken from the FY 2019 MedPAR file; MS-DRGs are from GROUPER Version38.0.				
