"PROPOSED NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2023"											
MS?DRG	Number of Cases	Threshold									
001	2236	"$751,298"									
002	122	"$411,730"									
003	14344	"$455,890"									
004	12890	"$280,942"									
005	1236	"$289,583"									
006	507	"$172,151"									
007	595	"$361,718"									
008	347	"$186,398"									
010	29	"$128,711"									
011	1885	"$141,641"									
012	1863	"$124,230"									
013	545	"$88,691"									
014	1100	"$256,145"									
016	2127	"$181,658"									
017	114	"$132,501"									
018	145	"$1,255,014"									
019	86	"$218,512"									
020	1732	"$289,084"									
021	444	"$208,740"									
022	144	"$139,112"									
023	12867	"$164,339"									
024	4624	"$125,398"									
025	21980	"$134,412"									
026	9547	"$99,853"									
027	10496	"$87,577"									
028	2247	"$157,835"									
029	3863	"$102,205"									
030	1432	"$81,333"									
031	976	"$116,545"									
032	2235	"$77,936"									
033	2794	"$68,443"									
034	1372	"$121,561"									
035	3671	"$84,164"									
036	5158	"$71,296"									
037	3530	"$105,669"									
038	11624	"$68,852"									
039	22007	"$56,233"									
040	3759	"$111,991"									
041	6382	"$85,514"									
042	2413	"$73,817"									
052	1043	"$61,180"									
053	229	"$47,224"									
054	12661	"$52,165"									
055	3929	"$46,582"									
056	11985	"$60,181"									
057	29962	"$45,956"									
058	814	"$59,298"									
059	2783	"$47,869"									
060	2316	"$42,800"									
061	5519	"$107,432"									
062	10541	"$88,256"									
063	2206	"$81,590"									
064	77952	"$64,502"									
065	107759	"$49,856"									
066	31635	"$39,272"									
067	992	"$59,369"									
068	4402	"$47,359"									
069	37299	"$43,699"									
070	18437	"$56,792"									
071	18411	"$44,614"									
072	3717	"$38,847"									
073	7409	"$52,259"									
074	16136	"$45,757"									
075	646	"$60,449"									
076	165	"$45,873"									
077	2111	"$59,542"									
078	2942	"$47,649"									
079	531	"$40,132"									
080	834	"$63,677"									
081	579	"$35,442"									
082	6985	"$71,044"									
083	10064	"$53,421"									
084	4884	"$43,381"									
085	8182	"$69,544"									
086	16037	"$52,360"									
087	8139	"$41,894"									
088	622	"$59,169"									
089	1937	"$50,103"									
090	625	"$44,967"									
091	16182	"$56,595"									
092	22759	"$44,096"									
093	7399	"$39,006"									
094	1466	"$98,868"									
095	1362	"$78,459"									
096	436	"$79,476"									
097	2051	"$103,160"									
098	1573	"$69,444"									
099	494	"$57,693"									
100	25493	"$61,250"									
101	41073	"$42,015"									
102	1217	"$49,255"									
103	9533	"$41,381"									
113	475	"$77,359"									
114	132	"$60,509"									
115	713	"$59,692"									
116	384	"$65,078"									
117	162	"$50,310"									
121	580	"$43,408"									
122	173	"$24,573"									
123	3100	"$41,770"									
124	1008	"$51,014"									
125	3349	"$38,834"									
135	286	"$76,911"									
136	94	"$58,087"									
137	743	"$54,617"									
138	329	"$41,691"									
139	340	"$53,766"									
140	649	"$122,074"									
141	2483	"$82,140"									
142	1360	"$67,820"									
143	767	"$92,986"									
144	1615	"$66,557"									
145	1102	"$54,519"									
146	1110	"$61,200"									
147	932	"$47,715"									
148	230	"$37,540"									
149	15220	"$37,979"									
150	1070	"$47,943"									
151	2492	"$31,169"									
152	3064	"$45,174"									
153	7421	"$32,190"									
154	2033	"$54,622"									
155	3935	"$41,046"									
156	1470	"$31,223"									
157	2025	"$55,264"									
158	3563	"$40,145"									
159	900	"$31,316"									
163	11074	"$142,333"									
164	15838	"$92,618"									
165	8162	"$75,343"									
166	9958	"$104,431"									
167	6418	"$68,676"									
168	2407	"$59,608"									
175	31550	"$57,602"									
176	29115	"$41,263"									
177	77113	"$61,169"									
178	30456	"$48,373"									
179	5059	"$37,401"									
180	18942	"$62,068"									
181	9697	"$48,915"									
182	611	"$41,624"									
183	5038	"$57,053"									
184	10769	"$47,245"									
185	2907	"$36,439"									
186	10142	"$55,820"									
187	6456	"$46,039"									
188	1177	"$34,344"									
189	145612	"$49,622"									
190	129191	"$47,213"									
191	65309	"$38,462"									
192	23188	"$30,992"									
193	150013	"$51,508"									
194	102472	"$38,101"									
195	23580	"$29,992"									
196	9324	"$58,034"									
197	2950	"$44,548"									
198	724	"$34,884"									
199	6476	"$61,206"									
200	9961	"$46,503"									
201	1822	"$31,510"									
202	41215	"$42,390"									
203	8281	"$31,404"									
204	7662	"$38,576"									
205	9679	"$55,742"									
206	9441	"$40,409"									
207	18418	"$161,332"									
208	54947	"$83,849"									
215	4408	"$300,784"									
216	7517	"$302,062"									
217	2610	"$213,361"									
218	479	"$203,558"									
219	15807	"$238,379"									
220	15223	"$176,714"									
221	2484	"$148,157"									
222	2079	"$248,319"									
223	404	"$195,013"									
224	2118	"$235,244"									
225	1628	"$189,262"									
226	5316	"$199,410"									
227	4196	"$163,471"									
228	2747	"$159,547"									
229	3513	"$118,079"									
231	1060	"$293,918"									
232	720	"$212,586"									
233	13055	"$249,184"									
234	14507	"$186,497"									
235	12479	"$192,205"									
236	20884	"$145,281"									
239	9937	"$116,881"									
240	7796	"$80,595"									
241	702	"$58,703"									
242	19295	"$117,153"									
243	24916	"$91,054"									
244	14443	"$79,840"									
245	1888	"$164,149"									
246	51592	"$123,132"									
247	85709	"$94,568"									
248	2435	"$122,971"									
249	3068	"$90,852"									
250	4471	"$100,693"									
251	5131	"$80,980"									
252	33467	"$100,985"									
253	23991	"$92,358"									
254	10594	"$71,616"									
255	2312	"$77,615"									
256	2099	"$59,819"									
257	139	"$47,048"									
258	592	"$102,385"									
259	857	"$77,315"									
260	2706	"$109,259"									
261	3618	"$75,217"									
262	1353	"$69,711"									
263	262	"$76,543"									
264	10415	"$87,554"									
265	580	"$99,380"									
266	20609	"$202,529"									
267	29682	"$165,709"									
268	3672	"$200,021"									
269	16295	"$130,517"									
270	19003	"$152,284"									
271	14510	"$116,064"									
272	5319	"$91,617"									
273	7699	"$135,014"									
274	26451	"$117,153"									
280	94152	"$57,505"									
281	46141	"$46,445"									
282	19803	"$40,750"									
283	10318	"$61,341"									
284	1055	"$37,106"									
285	266	"$25,822"									
286	50165	"$78,310"									
287	51781	"$58,481"									
288	1376	"$76,152"									
289	715	"$57,160"									
290	60	"$44,446"									
291	466351	"$48,253"									
292	28945	"$36,019"									
293	5789	"$26,511"									
294	285	"$48,331"									
295	27	"$36,987"									
296	3854	"$59,908"									
297	405	"$35,962"									
298	159	"$25,885"									
299	19589	"$52,704"									
300	28606	"$42,806"									
301	7618	"$32,401"									
302	3678	"$45,675"									
303	12094	"$32,503"									
304	16720	"$46,450"									
305	30523	"$36,057"									
306	4265	"$50,933"									
307	3301	"$39,226"									
308	69815	"$48,650"									
309	86560	"$34,114"									
310	55671	"$26,462"									
311	5291	"$33,820"									
312	68109	"$39,969"									
313	38356	"$36,669"									
314	43399	"$63,061"									
315	20058	"$42,698"									
316	3356	"$34,757"									
319	1632	"$136,918"									
320	574	"$85,631"									
326	9799	"$140,792"									
327	10094	"$87,666"									
328	7763	"$67,833"									
329	35959	"$135,526"									
330	50747	"$88,201"									
331	27648	"$69,206"									
332	180	"$115,038"									
333	647	"$78,252"									
334	677	"$65,121"									
335	5347	"$116,705"									
336	9388	"$81,890"									
337	4454	"$67,039"									
338	726	"$95,590"									
339	2368	"$70,732"									
340	1997	"$58,836"									
341	766	"$83,440"									
342	2323	"$64,670"									
343	2492	"$56,296"									
344	1075	"$85,635"									
345	2126	"$61,514"									
346	1068	"$55,766"									
347	870	"$77,090"									
348	2133	"$56,205"									
349	1115	"$46,345"									
350	1386	"$85,558"									
351	3468	"$64,048"									
352	2492	"$53,805"									
353	2752	"$95,942"									
354	7265	"$69,401"									
355	5305	"$59,158"									
356	7052	"$120,731"									
357	5629	"$81,135"									
358	1294	"$59,303"									
368	3065	"$65,554"									
369	3811	"$48,951"									
370	451	"$36,816"									
371	16742	"$56,765"									
372	25090	"$43,066"									
373	5673	"$33,295"									
374	11740	"$64,145"									
375	12827	"$49,912"									
376	1128	"$43,415"									
377	68806	"$61,845"									
378	127106	"$44,917"									
379	14792	"$30,821"									
380	5897	"$64,561"									
381	7630	"$48,691"									
382	1510	"$38,052"									
383	1065	"$54,903"									
384	3694	"$45,751"									
385	2910	"$57,136"									
386	7824	"$44,965"									
387	3435	"$33,826"									
388	18923	"$53,711"									
389	49335	"$37,218"									
390	29333	"$28,119"									
391	42188	"$50,228"									
392	136981	"$37,117"									
393	26201	"$56,550"									
394	38680	"$42,737"									
395	8911	"$32,117"									
405	3984	"$155,692"									
406	4994	"$99,467"									
407	1645	"$81,209"									
408	956	"$112,306"									
409	1010	"$79,635"									
410	319	"$67,261"									
411	159	"$118,366"									
412	231	"$86,682"									
413	148	"$72,449"									
414	1823	"$112,248"									
415	2642	"$77,468"									
416	1326	"$60,979"									
417	13112	"$89,958"									
418	22330	"$73,203"									
419	14225	"$62,614"									
420	725	"$103,510"									
421	790	"$72,640"									
422	178	"$60,931"									
423	1106	"$119,692"									
424	584	"$81,228"									
425	114	"$64,818"									
432	16686	"$62,681"									
433	11978	"$46,036"									
434	675	"$29,201"									
435	13806	"$62,548"									
436	7532	"$49,015"									
437	680	"$44,167"									
438	13935	"$57,137"									
439	24514	"$40,118"									
440	12268	"$31,012"									
441	20563	"$59,735"									
442	17934	"$40,959"									
443	2661	"$32,048"									
444	12847	"$60,743"									
445	18621	"$49,547"									
446	7200	"$42,330"									
453	3904	"$245,264"									
454	21434	"$166,865"									
455	21993	"$138,616"									
456	1397	"$239,755"									
457	3754	"$180,703"									
458	1251	"$138,197"									
459	3775	"$177,985"									
460	48814	"$117,365"									
461	264	"$164,449"									
462	6090	"$103,063"									
463	5234	"$122,939"									
464	8196	"$87,083"									
465	2564	"$66,636"									
466	5389	"$143,096"									
467	24331	"$108,014"									
468	18834	"$89,979"									
469	12309	"$98,086"									
470	359227	"$71,698"									
471	3534	"$149,418"									
472	16324	"$101,216"									
473	11837	"$88,133"									
474	3585	"$106,196"									
475	3644	"$71,513"									
476	712	"$51,225"									
477	3539	"$99,037"									
478	6813	"$82,733"									
479	1597	"$69,078"									
480	28808	"$97,592"									
481	79935	"$77,599"									
482	21367	"$65,841"									
483	68063	"$84,146"									
485	1526	"$106,807"									
486	3131	"$78,261"									
487	979	"$65,855"									
488	2641	"$68,791"									
489	2653	"$56,598"									
492	6314	"$107,116"									
493	19806	"$82,282"									
494	12198	"$70,664"									
495	500	"$106,965"									
496	1889	"$71,691"									
497	1224	"$58,851"									
498	1121	"$81,570"									
499	211	"$53,198"									
500	2669	"$91,278"									
501	5772	"$64,446"									
502	2999	"$55,599"									
503	1090	"$82,353"									
504	3066	"$64,379"									
505	1137	"$64,379"									
506	476	"$58,285"									
507	449	"$72,076"									
508	161	"$59,181"									
509	48	"$62,619"									
510	1081	"$91,455"									
511	3517	"$75,673"									
512	2162	"$65,267"									
513	1772	"$60,512"									
514	530	"$47,660"									
515	4844	"$98,203"									
516	14113	"$74,158"									
517	12677	"$60,264"									
518	2684	"$109,195"									
519	8454	"$73,503"									
520	6509	"$60,715"									
521	14987	"$101,094"									
522	50307	"$81,699"									
533	961	"$48,961"									
534	2733	"$31,357"									
535	7919	"$47,405"									
536	23959	"$32,340"									
537	905	"$39,703"									
538	329	"$30,921"									
539	3138	"$57,574"									
540	3368	"$47,570"									
541	570	"$34,089"									
542	7610	"$57,991"									
543	14612	"$44,408"									
544	3913	"$33,570"									
545	3739	"$66,773"									
546	4137	"$47,186"									
547	1277	"$36,621"									
548	657	"$63,502"									
549	1328	"$48,436"									
550	367	"$37,005"									
551	13420	"$57,301"									
552	53388	"$42,964"									
553	2443	"$47,469"									
554	11997	"$32,628"									
555	2294	"$50,879"									
556	9102	"$36,326"									
557	3585	"$52,961"									
558	10343	"$36,896"									
559	3062	"$56,265"									
560	5582	"$40,274"									
561	2625	"$31,321"									
562	6828	"$51,877"									
563	25607	"$37,084"									
564	5112	"$55,694"									
565	8584	"$44,029"									
566	2081	"$34,498"									
570	3103	"$76,277"									
571	6326	"$57,408"									
572	1393	"$48,347"									
573	788	"$120,210"									
574	1433	"$85,339"									
575	222	"$60,163"									
576	450	"$130,191"									
577	1590	"$83,530"									
578	849	"$62,973"									
579	4221	"$85,440"									
580	8970	"$62,120"									
581	3242	"$57,221"									
582	682	"$65,392"									
583	659	"$60,505"									
584	715	"$68,052"									
585	746	"$66,968"									
592	3058	"$51,643"									
593	4609	"$41,420"									
594	553	"$30,272"									
595	1041	"$57,765"									
596	2682	"$39,202"									
597	1492	"$57,031"									
598	1470	"$47,382"									
599	59	"$28,518"									
600	820	"$39,965"									
601	330	"$27,472"									
602	26454	"$50,561"									
603	99491	"$33,533"									
604	3326	"$54,736"									
605	13403	"$41,162"									
606	1871	"$49,298"									
607	5853	"$33,495"									
614	2161	"$86,199"									
615	1172	"$69,483"									
616	3054	"$107,863"									
617	15119	"$68,720"									
618	104	"$53,169"									
619	956	"$91,898"									
620	3732	"$69,429"									
621	11815	"$64,686"									
622	2063	"$89,345"									
623	6036	"$62,095"									
624	229	"$46,640"									
625	837	"$94,304"									
626	1195	"$70,046"									
627	1334	"$57,671"									
628	3360	"$103,777"									
629	5501	"$75,160"									
630	227	"$59,109"									
637	33900	"$51,191"									
638	54070	"$37,022"									
639	8785	"$27,690"									
640	76424	"$46,813"									
641	85536	"$33,015"									
642	1984	"$46,556"									
643	11228	"$56,978"									
644	13351	"$43,221"									
645	4342	"$33,898"									
650	2555	"$147,322"									
651	1155	"$131,024"									
652	9191	"$119,098"									
653	1668	"$149,206"									
654	4079	"$102,420"									
655	1537	"$80,668"									
656	3013	"$105,920"									
657	7455	"$76,723"									
658	5840	"$68,473"									
659	9278	"$82,359"									
660	19336	"$59,535"									
661	12848	"$52,344"									
662	695	"$86,487"									
663	1523	"$61,041"									
664	571	"$51,521"									
665	660	"$95,192"									
666	1530	"$65,350"									
667	487	"$46,594"									
668	2026	"$88,636"									
669	5061	"$62,130"									
670	1295	"$46,468"									
671	389	"$64,587"									
672	202	"$52,322"									
673	15766	"$96,278"									
674	7334	"$78,702"									
675	474	"$66,638"									
682	103530	"$52,160"									
683	126956	"$37,846"									
684	14524	"$28,261"									
686	1679	"$59,506"									
687	2519	"$45,443"									
688	288	"$36,124"									
689	79903	"$45,318"									
690	128735	"$34,604"									
693	1387	"$51,954"									
694	7215	"$38,019"									
695	1287	"$45,279"									
696	5933	"$30,190"									
697	449	"$44,426"									
698	68304	"$54,320"									
699	36807	"$42,041"									
700	3411	"$32,744"									
707	3415	"$76,945"									
708	6088	"$68,189"									
709	469	"$73,105"									
710	216	"$61,967"									
711	443	"$75,178"									
712	107	"$49,637"									
713	4768	"$58,284"									
714	1534	"$43,849"									
715	418	"$76,667"									
716	88	"$59,896"									
717	1691	"$65,931"									
718	492	"$55,382"									
722	810	"$57,261"									
723	1453	"$46,177"									
724	78	"$30,342"									
725	759	"$48,325"									
726	2923	"$32,834"									
727	1417	"$52,276"									
728	3886	"$34,699"									
729	618	"$42,619"									
730	97	"$25,291"									
734	804	"$82,919"									
735	470	"$64,731"									
736	606	"$130,275"									
737	2547	"$80,042"									
738	561	"$65,998"									
739	569	"$117,136"									
740	2283	"$74,074"									
741	1645	"$61,441"									
742	4104	"$68,065"									
743	5423	"$53,914"									
744	1423	"$65,145"									
745	205	"$51,188"									
746	1408	"$59,383"									
747	1371	"$46,371"									
748	1332	"$57,294"									
749	783	"$85,942"									
750	108	"$61,064"									
754	1795	"$59,419"									
755	2491	"$46,248"									
756	205	"$39,260"									
757	842	"$54,076"									
758	1317	"$41,783"									
759	379	"$31,678"									
760	1563	"$40,310"									
761	275	"$29,193"									
768	174	"$38,881"									
769	112	"$50,861"									
770	59	"$41,215"									
776	511	"$32,300"									
779	51	"$42,488"									
783	197	"$56,986"									
784	536	"$41,128"									
785	412	"$35,418"									
786	671	"$52,767"									
787	1650	"$39,030"									
788	1679	"$33,580"									
789	2	"$51,509"									
793	1	"$23,367"									
794	1	"$58,507"									
796	31	"$40,893"									
797	81	"$33,423"									
798	115	"$30,847"									
799	455	"$147,769"									
800	300	"$96,827"									
801	131	"$68,460"									
802	563	"$98,327"									
803	822	"$70,886"									
804	457	"$60,132"									
805	507	"$33,030"									
806	1929	"$22,944"									
807	3367	"$19,747"									
808	8270	"$65,808"									
809	13851	"$47,784"									
810	1632	"$41,507"									
811	29167	"$52,043"									
812	52619	"$38,224"									
813	17828	"$52,540"									
814	1545	"$59,869"									
815	2381	"$44,944"									
816	600	"$33,628"									
817	65	"$72,701"									
818	72	"$53,200"									
819	37	"$47,529"									
820	1102	"$159,173"									
821	1111	"$79,447"									
822	915	"$59,298"									
823	2350	"$129,357"									
824	2305	"$83,465"									
825	657	"$61,011"									
826	744	"$141,497"									
827	1372	"$88,950"									
828	768	"$70,193"									
829	1763	"$93,472"									
830	335	"$63,550"									
831	748	"$40,632"									
832	1150	"$26,213"									
833	499	"$18,907"									
834	4533	"$125,570"									
835	2223	"$60,465"									
836	445	"$43,876"									
837	1899	"$116,801"									
838	1275	"$63,314"									
839	866	"$51,049"									
840	8700	"$81,637"									
841	6963	"$56,584"									
842	1349	"$45,783"									
843	2216	"$62,416"									
844	1921	"$48,860"									
845	275	"$42,212"									
846	3176	"$71,427"									
847	12012	"$50,549"									
848	228	"$41,721"									
849	345	"$68,521"									
853	84072	"$132,906"									
854	24365	"$75,335"									
855	224	"$60,598"									
856	8813	"$114,386"									
857	9031	"$69,320"									
858	1044	"$54,148"									
862	12786	"$59,846"									
863	11499	"$41,300"									
864	9419	"$40,068"									
865	3079	"$50,872"									
866	6368	"$36,583"									
867	2622	"$64,090"									
868	1944	"$43,604"									
869	379	"$32,831"									
870	32544	"$181,931"									
871	610295	"$62,783"									
872	156094	"$44,967"									
876	671	"$82,559"									
880	7348	"$39,515"									
881	4002	"$25,019"									
882	1957	"$28,772"									
883	1206	"$37,641"									
884	20220	"$45,470"									
885	68602	"$34,051"									
886	297	"$36,865"									
887	387	"$42,614"									
894	4278	"$21,563"									
895	3514	"$39,887"									
896	9566	"$56,467"									
897	30258	"$31,399"									
901	1187	"$107,182"									
902	2055	"$65,525"									
903	572	"$49,318"									
904	1036	"$98,797"									
905	253	"$60,067"									
906	571	"$62,610"									
907	10344	"$107,254"									
908	9089	"$70,565"									
909	2981	"$56,246"									
913	759	"$57,306"									
914	2420	"$41,641"									
915	2488	"$58,160"									
916	3927	"$28,493"									
917	28779	"$53,143"									
918	15931	"$33,949"									
919	14878	"$58,705"									
920	13688	"$43,816"									
921	2751	"$31,558"									
922	1696	"$54,893"									
923	1967	"$38,043"									
927	161	"$484,435"									
928	1091	"$143,819"									
929	261	"$87,522"									
933	119	"$64,018"									
934	498	"$50,950"									
935	1751	"$50,187"									
939	643	"$95,276"									
940	1414	"$74,320"									
941	738	"$67,121"									
945	2162	"$56,041"									
946	679	"$54,877"									
947	8834	"$45,917"									
948	28278	"$34,774"									
949	1185	"$39,815"									
950	235	"$26,365"									
951	3040	"$21,950"									
955	473	"$185,944"									
956	6229	"$108,201"									
957	2322	"$213,078"									
958	1844	"$132,292"									
959	130	"$92,924"									
963	3071	"$84,424"									
964	4626	"$57,566"									
965	744	"$43,752"									
969	409	"$154,596"									
970	86	"$88,981"									
974	4294	"$76,424"									
975	2066	"$50,854"									
976	354	"$41,560"									
977	1195	"$48,848"									
981	26388	"$123,322"									
982	13731	"$82,387"									
983	2652	"$64,054"									
987	9017	"$96,082"									
988	7862	"$64,342"									
989	1239	"$51,810"									
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 Version39.0.											
