"NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2024"									
MS?DRG	Threshold								
001	"$802,286"								
002	"$373,964"								
003	"$527,350"								
004	"$355,541"								
005	"$330,977"								
006	"$191,636"								
007	"$422,523"								
008	"$209,793"								
010	"$170,894"								
011	"$164,639"								
012	"$138,746"								
013	"$99,543"								
014	"$298,086"								
016	"$176,821"								
017	"$103,034"								
018	"$1,416,925"								
019	"$250,703"								
020	"$265,658"								
021	"$200,391"								
022	"$126,472"								
023	"$179,050"								
024	"$136,241"								
025	"$147,513"								
026	"$109,582"								
027	"$95,842"								
028	"$178,189"								
029	"$116,394"								
030	"$88,357"								
031	"$124,458"								
032	"$81,193"								
033	"$73,674"								
034	"$136,624"								
035	"$89,206"								
036	"$77,970"								
037	"$118,219"								
038	"$73,758"								
039	"$60,996"								
040	"$122,048"								
041	"$94,479"								
042	"$80,466"								
052	"$64,791"								
053	"$45,892"								
054	"$56,498"								
055	"$49,875"								
056	"$66,017"								
057	"$49,552"								
058	"$62,556"								
059	"$51,544"								
060	"$47,234"								
061	"$117,855"								
062	"$93,474"								
063	"$84,378"								
064	"$71,211"								
065	"$53,448"								
066	"$42,951"								
067	"$63,273"								
068	"$51,831"								
069	"$49,466"								
070	"$62,322"								
071	"$49,741"								
072	"$42,569"								
073	"$56,977"								
074	"$49,142"								
075	"$68,426"								
076	"$49,231"								
077	"$64,823"								
078	"$53,895"								
079	"$44,677"								
080	"$69,589"								
081	"$44,667"								
082	"$76,683"								
083	"$58,072"								
084	"$47,647"								
085	"$77,022"								
086	"$57,331"								
087	"$47,116"								
088	"$66,286"								
089	"$57,137"								
090	"$46,955"								
091	"$61,725"								
092	"$48,701"								
093	"$42,282"								
094	"$105,058"								
095	"$88,599"								
096	"$85,388"								
097	"$114,156"								
098	"$74,912"								
099	"$61,606"								
100	"$67,193"								
101	"$46,598"								
102	"$54,442"								
103	"$46,648"								
113	"$83,144"								
114	"$56,924"								
115	"$65,355"								
116	"$70,035"								
117	"$51,855"								
121	"$46,513"								
122	"$29,041"								
123	"$48,054"								
124	"$54,981"								
125	"$43,343"								
135	"$88,594"								
136	"$62,195"								
137	"$58,404"								
138	"$47,745"								
139	"$59,133"								
140	"$138,426"								
141	"$90,265"								
142	"$75,035"								
143	"$103,157"								
144	"$73,556"								
145	"$58,656"								
146	"$68,250"								
147	"$51,388"								
148	"$42,509"								
149	"$43,400"								
150	"$51,850"								
151	"$34,826"								
152	"$51,588"								
153	"$35,476"								
154	"$58,283"								
155	"$45,923"								
156	"$34,945"								
157	"$60,504"								
158	"$45,600"								
159	"$37,466"								
163	"$151,192"								
164	"$98,626"								
165	"$82,108"								
166	"$115,101"								
167	"$77,576"								
168	"$65,589"								
175	"$58,017"								
176	"$41,979"								
177	"$63,435"								
178	"$47,352"								
179	"$36,774"								
180	"$65,731"								
181	"$52,367"								
182	"$47,522"								
183	"$60,609"								
184	"$51,229"								
185	"$40,175"								
186	"$59,939"								
187	"$49,719"								
188	"$37,591"								
189	"$52,354"								
190	"$49,100"								
191	"$41,332"								
192	"$31,998"								
193	"$55,077"								
194	"$41,599"								
195	"$33,162"								
196	"$61,444"								
197	"$47,141"								
198	"$37,238"								
199	"$64,187"								
200	"$49,761"								
201	"$35,215"								
202	"$44,409"								
203	"$32,769"								
204	"$43,243"								
205	"$61,436"								
206	"$45,010"								
207	"$201,543"								
208	"$91,068"								
215	"$319,159"								
216	"$319,706"								
217	"$229,591"								
218	"$213,919"								
219	"$264,950"								
220	"$194,171"								
221	"$164,870"								
222	"$263,064"								
223	"$196,682"								
224	"$245,632"								
225	"$192,291"								
226	"$214,168"								
227	"$174,475"								
228	"$167,083"								
229	"$124,661"								
231	"$312,553"								
232	"$231,294"								
233	"$264,921"								
234	"$197,134"								
235	"$205,400"								
236	"$157,761"								
239	"$125,913"								
240	"$86,791"								
241	"$59,869"								
242	"$122,806"								
243	"$95,095"								
244	"$83,151"								
245	"$160,170"								
246	"$130,235"								
247	"$99,857"								
248	"$127,477"								
249	"$95,035"								
250	"$106,590"								
251	"$85,329"								
252	"$110,485"								
253	"$100,786"								
254	"$77,933"								
255	"$83,575"								
256	"$62,836"								
257	"$45,771"								
258	"$101,064"								
259	"$84,746"								
260	"$116,220"								
261	"$79,815"								
262	"$74,107"								
263	"$87,700"								
264	"$94,593"								
265	"$114,737"								
266	"$210,944"								
267	"$171,432"								
268	"$217,808"								
269	"$142,047"								
270	"$164,172"								
271	"$124,518"								
272	"$96,429"								
273	"$150,061"								
274	"$125,909"								
280	"$61,899"								
281	"$49,680"								
282	"$44,406"								
283	"$66,950"								
284	"$40,190"								
285	"$31,544"								
286	"$83,539"								
287	"$61,897"								
288	"$81,803"								
289	"$62,583"								
290	"$49,537"								
291	"$51,543"								
292	"$39,583"								
293	"$28,075"								
294	"$49,348"								
295	"$40,213"								
296	"$65,137"								
297	"$35,297"								
298	"$26,431"								
299	"$56,818"								
300	"$45,906"								
301	"$35,329"								
302	"$48,852"								
303	"$36,183"								
304	"$49,723"								
305	"$40,286"								
306	"$53,648"								
307	"$44,162"								
308	"$51,345"								
309	"$37,057"								
310	"$28,914"								
311	"$36,371"								
312	"$44,543"								
313	"$40,241"								
314	"$67,480"								
315	"$46,242"								
316	"$36,757"								
319	"$147,491"								
320	"$98,782"								
326	"$149,881"								
327	"$95,204"								
328	"$73,100"								
329	"$142,989"								
330	"$93,945"								
331	"$74,863"								
332	"$129,962"								
333	"$86,692"								
334	"$74,370"								
335	"$120,827"								
336	"$85,100"								
337	"$71,227"								
338	"$98,284"								
339	"$73,787"								
340	"$61,666"								
341	"$88,840"								
342	"$69,205"								
343	"$59,134"								
344	"$88,309"								
345	"$67,003"								
346	"$59,755"								
347	"$85,998"								
348	"$61,789"								
349	"$51,820"								
350	"$91,314"								
351	"$68,608"								
352	"$59,020"								
353	"$102,250"								
354	"$75,288"								
355	"$64,544"								
356	"$131,611"								
357	"$87,620"								
358	"$65,545"								
368	"$65,615"								
369	"$51,402"								
370	"$40,513"								
371	"$60,698"								
372	"$47,037"								
373	"$35,545"								
374	"$69,120"								
375	"$53,469"								
376	"$45,204"								
377	"$66,566"								
378	"$49,313"								
379	"$34,369"								
380	"$70,116"								
381	"$52,191"								
382	"$42,197"								
383	"$59,779"								
384	"$50,293"								
385	"$61,636"								
386	"$48,409"								
387	"$35,994"								
388	"$57,058"								
389	"$40,153"								
390	"$29,818"								
391	"$54,498"								
392	"$41,440"								
393	"$60,265"								
394	"$46,714"								
395	"$34,947"								
405	"$168,184"								
406	"$110,126"								
407	"$90,697"								
408	"$120,693"								
409	"$86,703"								
410	"$75,710"								
411	"$112,571"								
412	"$96,408"								
413	"$76,176"								
414	"$117,986"								
415	"$83,682"								
416	"$64,906"								
417	"$96,163"								
418	"$78,098"								
419	"$67,362"								
420	"$109,788"								
421	"$76,984"								
422	"$67,642"								
423	"$126,685"								
424	"$89,914"								
425	"$66,248"								
432	"$68,287"								
433	"$49,823"								
434	"$33,459"								
435	"$68,093"								
436	"$52,305"								
437	"$46,048"								
438	"$62,195"								
439	"$45,051"								
440	"$33,778"								
441	"$65,391"								
442	"$45,917"								
443	"$34,205"								
444	"$65,960"								
445	"$53,518"								
446	"$46,098"								
453	"$269,329"								
454	"$185,962"								
455	"$154,190"								
456	"$257,808"								
457	"$191,069"								
458	"$151,995"								
459	"$197,098"								
460	"$126,049"								
461	"$178,026"								
462	"$108,963"								
463	"$134,554"								
464	"$95,649"								
465	"$75,650"								
466	"$157,495"								
467	"$119,382"								
468	"$98,150"								
469	"$108,921"								
470	"$77,426"								
471	"$166,710"								
472	"$111,272"								
473	"$96,790"								
474	"$116,690"								
475	"$78,445"								
476	"$56,247"								
477	"$110,573"								
478	"$88,821"								
479	"$73,798"								
480	"$105,026"								
481	"$84,620"								
482	"$71,401"								
483	"$90,296"								
485	"$113,661"								
486	"$83,483"								
487	"$69,580"								
488	"$81,294"								
489	"$61,155"								
492	"$117,867"								
493	"$91,294"								
494	"$77,675"								
495	"$118,765"								
496	"$80,060"								
497	"$64,764"								
498	"$90,939"								
499	"$59,201"								
500	"$97,495"								
501	"$70,114"								
502	"$61,228"								
503	"$88,103"								
504	"$68,936"								
505	"$69,333"								
506	"$61,686"								
507	"$72,738"								
508	"$64,485"								
509	"$53,615"								
510	"$103,299"								
511	"$83,429"								
512	"$71,544"								
513	"$65,296"								
514	"$52,091"								
515	"$107,386"								
516	"$81,824"								
517	"$68,022"								
518	"$123,029"								
519	"$80,886"								
520	"$67,420"								
521	"$108,860"								
522	"$88,384"								
533	"$53,464"								
534	"$36,067"								
535	"$52,090"								
536	"$36,519"								
537	"$45,644"								
538	"$33,771"								
539	"$63,277"								
540	"$51,272"								
541	"$37,428"								
542	"$63,224"								
543	"$49,163"								
544	"$37,504"								
545	"$72,080"								
546	"$50,399"								
547	"$43,362"								
548	"$66,588"								
549	"$51,070"								
550	"$45,527"								
551	"$62,353"								
552	"$47,943"								
553	"$51,738"								
554	"$36,431"								
555	"$53,415"								
556	"$40,057"								
557	"$56,865"								
558	"$41,045"								
559	"$58,539"								
560	"$44,768"								
561	"$33,265"								
562	"$56,505"								
563	"$40,957"								
564	"$59,809"								
565	"$47,885"								
566	"$37,564"								
570	"$84,369"								
571	"$61,860"								
572	"$53,187"								
573	"$142,131"								
574	"$101,460"								
575	"$69,990"								
576	"$153,989"								
577	"$94,095"								
578	"$71,429"								
579	"$92,688"								
580	"$67,322"								
581	"$62,130"								
582	"$77,619"								
583	"$66,251"								
584	"$81,814"								
585	"$78,530"								
592	"$56,726"								
593	"$45,550"								
594	"$31,845"								
595	"$61,908"								
596	"$45,268"								
597	"$63,962"								
598	"$48,795"								
599	"$38,774"								
600	"$45,014"								
601	"$31,544"								
602	"$54,332"								
603	"$37,527"								
604	"$60,347"								
605	"$46,393"								
606	"$55,113"								
607	"$37,081"								
614	"$92,875"								
615	"$73,092"								
616	"$112,178"								
617	"$72,658"								
618	"$53,806"								
619	"$97,696"								
620	"$72,992"								
621	"$69,055"								
622	"$95,972"								
623	"$66,443"								
624	"$46,755"								
625	"$101,253"								
626	"$75,875"								
627	"$65,107"								
628	"$110,149"								
629	"$79,158"								
630	"$68,403"								
637	"$55,452"								
638	"$40,697"								
639	"$29,717"								
640	"$50,912"								
641	"$36,845"								
642	"$51,242"								
643	"$60,915"								
644	"$47,029"								
645	"$36,012"								
650	"$165,655"								
651	"$138,845"								
652	"$128,842"								
653	"$166,603"								
654	"$110,994"								
655	"$92,202"								
656	"$114,616"								
657	"$82,631"								
658	"$74,674"								
659	"$88,349"								
660	"$63,567"								
661	"$56,169"								
662	"$97,895"								
663	"$65,026"								
664	"$54,870"								
665	"$103,764"								
666	"$70,366"								
667	"$51,623"								
668	"$98,038"								
669	"$67,547"								
670	"$51,811"								
671	"$70,979"								
672	"$55,990"								
673	"$105,158"								
674	"$84,003"								
675	"$71,618"								
682	"$56,248"								
683	"$41,898"								
684	"$30,174"								
686	"$62,101"								
687	"$48,262"								
688	"$43,930"								
689	"$49,470"								
690	"$37,744"								
693	"$56,330"								
694	"$42,105"								
695	"$48,966"								
696	"$32,787"								
697	"$47,081"								
698	"$58,111"								
699	"$45,713"								
700	"$35,139"								
707	"$86,116"								
708	"$74,465"								
709	"$78,929"								
710	"$60,755"								
711	"$79,730"								
712	"$57,673"								
713	"$62,297"								
714	"$50,861"								
715	"$82,729"								
716	"$63,517"								
717	"$71,351"								
718	"$59,935"								
722	"$61,563"								
723	"$49,640"								
724	"$39,661"								
725	"$51,790"								
726	"$36,439"								
727	"$55,937"								
728	"$38,829"								
729	"$46,569"								
730	"$35,151"								
734	"$87,592"								
735	"$67,279"								
736	"$139,250"								
737	"$87,107"								
738	"$68,876"								
739	"$131,555"								
740	"$80,947"								
741	"$67,266"								
742	"$75,762"								
743	"$59,321"								
744	"$70,996"								
745	"$52,100"								
746	"$65,292"								
747	"$52,326"								
748	"$62,411"								
749	"$93,401"								
750	"$64,008"								
754	"$62,500"								
755	"$48,740"								
756	"$46,995"								
757	"$55,540"								
758	"$45,601"								
759	"$29,987"								
760	"$46,110"								
761	"$32,041"								
768	"$41,354"								
769	"$51,354"								
770	"$43,110"								
776	"$27,532"								
779	"$45,064"								
783	"$62,224"								
784	"$45,181"								
785	"$39,798"								
786	"$55,860"								
787	"$43,009"								
788	"$36,764"								
793	"$55,492"								
794	"$19,135"								
796	"$50,486"								
797	"$39,728"								
798	"$39,728"								
799	"$160,425"								
800	"$98,058"								
801	"$78,343"								
802	"$116,061"								
803	"$77,745"								
804	"$63,139"								
805	"$35,153"								
806	"$23,671"								
807	"$21,230"								
808	"$71,093"								
809	"$51,761"								
810	"$45,363"								
811	"$56,863"								
812	"$43,042"								
813	"$57,601"								
814	"$65,144"								
815	"$48,363"								
816	"$39,318"								
817	"$77,767"								
818	"$59,624"								
819	"$39,079"								
820	"$167,066"								
821	"$84,858"								
822	"$61,990"								
823	"$138,025"								
824	"$89,200"								
825	"$63,529"								
826	"$157,431"								
827	"$95,132"								
828	"$76,943"								
829	"$98,601"								
830	"$70,018"								
831	"$43,623"								
832	"$26,293"								
833	"$20,966"								
834	"$130,609"								
835	"$66,205"								
836	"$50,791"								
837	"$121,210"								
838	"$65,220"								
839	"$53,051"								
840	"$88,340"								
841	"$60,834"								
842	"$48,925"								
843	"$68,732"								
844	"$52,039"								
845	"$44,592"								
846	"$72,134"								
847	"$50,891"								
848	"$35,850"								
849	"$74,329"								
853	"$143,090"								
854	"$79,705"								
855	"$67,297"								
856	"$122,757"								
857	"$74,806"								
858	"$59,798"								
862	"$63,559"								
863	"$45,131"								
864	"$42,650"								
865	"$57,321"								
866	"$42,375"								
867	"$66,690"								
868	"$46,636"								
869	"$35,727"								
870	"$208,035"								
871	"$69,498"								
872	"$49,112"								
876	"$87,946"								
880	"$44,026"								
881	"$28,455"								
882	"$33,995"								
883	"$40,621"								
884	"$49,904"								
885	"$39,071"								
886	"$41,507"								
887	"$48,363"								
894	"$25,182"								
895	"$42,693"								
896	"$60,844"								
897	"$35,685"								
901	"$117,328"								
902	"$70,742"								
903	"$55,610"								
904	"$107,454"								
905	"$65,577"								
906	"$69,408"								
907	"$116,338"								
908	"$76,398"								
909	"$60,332"								
913	"$59,937"								
914	"$45,647"								
915	"$63,973"								
916	"$30,870"								
917	"$57,385"								
918	"$37,003"								
919	"$62,368"								
920	"$47,198"								
921	"$36,215"								
922	"$57,707"								
923	"$42,047"								
927	"$495,957"								
928	"$157,128"								
929	"$92,986"								
933	"$78,480"								
934	"$54,644"								
935	"$55,941"								
939	"$101,095"								
940	"$80,767"								
941	"$73,152"								
945	"$62,943"								
946	"$58,345"								
947	"$48,954"								
948	"$37,692"								
949	"$43,351"								
950	"$26,221"								
951	"$25,289"								
955	"$216,479"								
956	"$118,402"								
957	"$226,305"								
958	"$144,082"								
959	"$98,840"								
963	"$91,309"								
964	"$61,524"								
965	"$47,299"								
969	"$199,295"								
970	"$91,537"								
974	"$87,344"								
975	"$55,856"								
976	"$44,844"								
977	"$53,214"								
981	"$134,537"								
982	"$88,648"								
983	"$69,934"								
987	"$104,593"								
988	"$69,061"								
989	"$54,973"								
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)									
"2Since we are calculating the relative weights for FY 2023 by calculating two sets of weights (and then averaging the two sets of relative weights), one including and one excluding COVID-19 claims, as discussed in section II. of the final rule, we have averaged the thresholds based on the data of these two sets of weights."									
