"ALTERNATIVES CONSIDERED FY 2023 PROPOSED RULE NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2024"									
MS?DRG	Threshold								
001	"$805,461"								
002	"$374,745"								
003	"$531,707"								
004	"$382,421"								
005	"$331,188"								
006	"$192,898"								
007	"$425,113"								
008	"$211,091"								
010	"$172,157"								
011	"$164,840"								
012	"$138,946"								
013	"$99,260"								
014	"$296,534"								
016	"$176,805"								
017	"$102,790"								
018	"$1,423,378"								
019	"$252,399"								
020	"$266,019"								
021	"$200,230"								
022	"$126,376"								
023	"$179,493"								
024	"$136,228"								
025	"$147,771"								
026	"$109,413"								
027	"$95,529"								
028	"$178,245"								
029	"$116,399"								
030	"$87,987"								
031	"$124,599"								
032	"$81,162"								
033	"$73,593"								
034	"$136,377"								
035	"$89,097"								
036	"$77,903"								
037	"$118,190"								
038	"$73,585"								
039	"$60,797"								
040	"$122,492"								
041	"$94,425"								
042	"$80,700"								
052	"$65,194"								
053	"$45,772"								
054	"$56,395"								
055	"$49,757"								
056	"$65,936"								
057	"$49,399"								
058	"$62,091"								
059	"$51,386"								
060	"$46,957"								
061	"$117,709"								
062	"$93,339"								
063	"$84,355"								
064	"$71,108"								
065	"$53,297"								
066	"$42,955"								
067	"$62,812"								
068	"$51,645"								
069	"$49,606"								
070	"$62,087"								
071	"$49,608"								
072	"$42,603"								
073	"$56,843"								
074	"$48,986"								
075	"$68,600"								
076	"$49,853"								
077	"$64,539"								
078	"$53,722"								
079	"$44,690"								
080	"$69,122"								
081	"$44,492"								
082	"$76,220"								
083	"$57,904"								
084	"$47,483"								
085	"$76,753"								
086	"$57,171"								
087	"$46,972"								
088	"$65,962"								
089	"$56,974"								
090	"$46,646"								
091	"$61,514"								
092	"$48,530"								
093	"$42,333"								
094	"$105,875"								
095	"$88,374"								
096	"$85,403"								
097	"$114,169"								
098	"$74,714"								
099	"$61,406"								
100	"$66,953"								
101	"$46,445"								
102	"$54,112"								
103	"$46,723"								
113	"$82,737"								
114	"$56,873"								
115	"$65,375"								
116	"$69,938"								
117	"$52,055"								
121	"$46,625"								
122	"$29,089"								
123	"$48,105"								
124	"$54,634"								
125	"$43,383"								
135	"$88,217"								
136	"$62,043"								
137	"$58,380"								
138	"$48,207"								
139	"$59,044"								
140	"$138,863"								
141	"$90,024"								
142	"$74,842"								
143	"$103,208"								
144	"$73,457"								
145	"$58,537"								
146	"$68,113"								
147	"$51,144"								
148	"$43,250"								
149	"$43,475"								
150	"$51,548"								
151	"$34,808"								
152	"$51,435"								
153	"$35,537"								
154	"$58,315"								
155	"$45,750"								
156	"$34,948"								
157	"$60,237"								
158	"$45,487"								
159	"$37,497"								
163	"$151,748"								
164	"$98,514"								
165	"$82,044"								
166	"$116,579"								
167	"$77,524"								
168	"$65,377"								
175	"$57,817"								
176	"$42,020"								
177	"$62,935"								
178	"$45,068"								
179	"$35,445"								
180	"$65,600"								
181	"$52,166"								
182	"$47,290"								
183	"$60,382"								
184	"$51,074"								
185	"$40,245"								
186	"$59,796"								
187	"$49,591"								
188	"$37,674"								
189	"$52,229"								
190	"$48,951"								
191	"$41,344"								
192	"$31,985"								
193	"$54,951"								
194	"$41,623"								
195	"$33,148"								
196	"$61,387"								
197	"$46,981"								
198	"$37,266"								
199	"$64,074"								
200	"$49,553"								
201	"$35,309"								
202	"$44,471"								
203	"$32,799"								
204	"$43,248"								
205	"$61,397"								
206	"$45,053"								
207	"$221,663"								
208	"$94,468"								
215	"$319,374"								
216	"$320,087"								
217	"$229,494"								
218	"$213,545"								
219	"$265,315"								
220	"$194,229"								
221	"$164,886"								
222	"$263,571"								
223	"$197,194"								
224	"$245,312"								
225	"$192,601"								
226	"$214,744"								
227	"$174,375"								
228	"$167,439"								
229	"$124,412"								
231	"$312,271"								
232	"$231,308"								
233	"$264,892"								
234	"$197,044"								
235	"$205,782"								
236	"$157,671"								
239	"$125,948"								
240	"$86,624"								
241	"$59,555"								
242	"$122,605"								
243	"$95,013"								
244	"$83,047"								
245	"$159,913"								
246	"$130,101"								
247	"$99,754"								
248	"$128,190"								
249	"$94,964"								
250	"$106,416"								
251	"$85,187"								
252	"$110,680"								
253	"$100,684"								
254	"$77,802"								
255	"$83,660"								
256	"$62,684"								
257	"$45,746"								
258	"$100,485"								
259	"$85,036"								
260	"$116,142"								
261	"$79,704"								
262	"$73,885"								
263	"$88,342"								
264	"$94,661"								
265	"$114,771"								
266	"$210,901"								
267	"$171,354"								
268	"$217,883"								
269	"$142,021"								
270	"$164,324"								
271	"$124,395"								
272	"$96,269"								
273	"$150,258"								
274	"$125,920"								
280	"$61,710"								
281	"$49,535"								
282	"$44,441"								
283	"$67,090"								
284	"$40,271"								
285	"$31,534"								
286	"$83,488"								
287	"$61,766"								
288	"$81,789"								
289	"$62,383"								
290	"$49,403"								
291	"$51,429"								
292	"$39,606"								
293	"$28,042"								
294	"$49,378"								
295	"$40,027"								
296	"$64,759"								
297	"$35,392"								
298	"$26,008"								
299	"$56,692"								
300	"$45,756"								
301	"$35,387"								
302	"$48,450"								
303	"$36,182"								
304	"$49,590"								
305	"$40,340"								
306	"$53,425"								
307	"$43,943"								
308	"$51,039"								
309	"$37,056"								
310	"$28,941"								
311	"$36,405"								
312	"$44,632"								
313	"$40,271"								
314	"$67,370"								
315	"$46,088"								
316	"$36,746"								
319	"$147,704"								
320	"$98,665"								
326	"$149,831"								
327	"$95,161"								
328	"$73,005"								
329	"$143,115"								
330	"$93,845"								
331	"$74,705"								
332	"$130,103"								
333	"$86,767"								
334	"$74,185"								
335	"$120,680"								
336	"$85,014"								
337	"$71,046"								
338	"$98,096"								
339	"$73,585"								
340	"$61,529"								
341	"$87,840"								
342	"$69,075"								
343	"$58,927"								
344	"$88,056"								
345	"$66,904"								
346	"$59,512"								
347	"$85,663"								
348	"$61,679"								
349	"$51,633"								
350	"$90,816"								
351	"$68,514"								
352	"$58,755"								
353	"$102,242"								
354	"$75,175"								
355	"$64,447"								
356	"$131,810"								
357	"$87,471"								
358	"$65,510"								
368	"$65,544"								
369	"$51,275"								
370	"$40,613"								
371	"$60,626"								
372	"$47,090"								
373	"$35,591"								
374	"$68,950"								
375	"$53,316"								
376	"$45,034"								
377	"$66,204"								
378	"$49,317"								
379	"$34,391"								
380	"$70,166"								
381	"$52,069"								
382	"$42,257"								
383	"$59,435"								
384	"$50,160"								
385	"$61,330"								
386	"$48,264"								
387	"$36,127"								
388	"$56,774"								
389	"$40,191"								
390	"$29,841"								
391	"$54,302"								
392	"$41,464"								
393	"$60,062"								
394	"$46,559"								
395	"$34,950"								
405	"$168,414"								
406	"$110,043"								
407	"$90,714"								
408	"$120,523"								
409	"$86,522"								
410	"$75,626"								
411	"$111,325"								
412	"$96,406"								
413	"$75,889"								
414	"$118,030"								
415	"$83,471"								
416	"$64,922"								
417	"$95,920"								
418	"$77,952"								
419	"$67,189"								
420	"$109,640"								
421	"$76,797"								
422	"$67,477"								
423	"$127,069"								
424	"$90,076"								
425	"$66,118"								
432	"$68,313"								
433	"$49,673"								
434	"$33,591"								
435	"$67,979"								
436	"$52,151"								
437	"$45,877"								
438	"$61,793"								
439	"$45,095"								
440	"$33,777"								
441	"$65,246"								
442	"$45,912"								
443	"$34,202"								
444	"$65,512"								
445	"$53,370"								
446	"$46,097"								
453	"$269,298"								
454	"$185,901"								
455	"$154,071"								
456	"$257,809"								
457	"$191,149"								
458	"$152,324"								
459	"$197,161"								
460	"$125,971"								
461	"$178,138"								
462	"$108,797"								
463	"$134,587"								
464	"$95,409"								
465	"$75,579"								
466	"$157,353"								
467	"$119,303"								
468	"$98,073"								
469	"$108,855"								
470	"$77,322"								
471	"$166,973"								
472	"$111,166"								
473	"$96,733"								
474	"$117,010"								
475	"$78,338"								
476	"$56,108"								
477	"$110,515"								
478	"$88,692"								
479	"$73,625"								
480	"$104,898"								
481	"$84,494"								
482	"$71,249"								
483	"$90,223"								
485	"$113,271"								
486	"$83,370"								
487	"$69,318"								
488	"$80,961"								
489	"$60,978"								
492	"$117,261"								
493	"$91,089"								
494	"$77,504"								
495	"$118,230"								
496	"$79,859"								
497	"$64,724"								
498	"$90,858"								
499	"$59,070"								
500	"$97,618"								
501	"$69,933"								
502	"$61,088"								
503	"$87,597"								
504	"$68,864"								
505	"$68,864"								
506	"$61,489"								
507	"$72,742"								
508	"$64,171"								
509	"$53,217"								
510	"$103,014"								
511	"$83,278"								
512	"$71,436"								
513	"$65,196"								
514	"$52,200"								
515	"$107,358"								
516	"$81,658"								
517	"$67,843"								
518	"$123,121"								
519	"$80,771"								
520	"$67,273"								
521	"$108,913"								
522	"$88,249"								
533	"$53,217"								
534	"$36,143"								
535	"$51,908"								
536	"$36,539"								
537	"$45,630"								
538	"$33,652"								
539	"$63,399"								
540	"$51,177"								
541	"$37,447"								
542	"$63,133"								
543	"$49,027"								
544	"$37,503"								
545	"$71,956"								
546	"$50,191"								
547	"$43,431"								
548	"$66,204"								
549	"$50,906"								
550	"$45,375"								
551	"$62,124"								
552	"$47,780"								
553	"$51,517"								
554	"$36,395"								
555	"$53,181"								
556	"$40,106"								
557	"$56,824"								
558	"$41,080"								
559	"$58,566"								
560	"$44,804"								
561	"$33,313"								
562	"$56,341"								
563	"$40,954"								
564	"$59,665"								
565	"$47,714"								
566	"$37,588"								
570	"$84,489"								
571	"$61,752"								
572	"$53,119"								
573	"$141,961"								
574	"$101,027"								
575	"$69,880"								
576	"$154,257"								
577	"$94,043"								
578	"$71,427"								
579	"$92,570"								
580	"$67,204"								
581	"$61,943"								
582	"$77,440"								
583	"$66,437"								
584	"$81,463"								
585	"$78,318"								
592	"$56,613"								
593	"$45,342"								
594	"$31,936"								
595	"$61,994"								
596	"$45,120"								
597	"$64,010"								
598	"$48,531"								
599	"$38,854"								
600	"$44,932"								
601	"$31,566"								
602	"$54,172"								
603	"$37,559"								
604	"$60,148"								
605	"$46,304"								
606	"$54,946"								
607	"$37,113"								
614	"$93,115"								
615	"$72,952"								
616	"$111,779"								
617	"$72,504"								
618	"$53,649"								
619	"$98,304"								
620	"$72,928"								
621	"$68,958"								
622	"$95,733"								
623	"$66,254"								
624	"$46,747"								
625	"$101,310"								
626	"$75,782"								
627	"$65,174"								
628	"$110,237"								
629	"$79,021"								
630	"$68,257"								
637	"$55,148"								
638	"$40,734"								
639	"$29,786"								
640	"$50,710"								
641	"$36,860"								
642	"$51,187"								
643	"$60,646"								
644	"$46,906"								
645	"$35,971"								
650	"$165,974"								
651	"$139,001"								
652	"$129,127"								
653	"$166,888"								
654	"$110,926"								
655	"$92,111"								
656	"$114,870"								
657	"$82,550"								
658	"$74,582"								
659	"$88,064"								
660	"$63,400"								
661	"$56,015"								
662	"$97,509"								
663	"$64,923"								
664	"$54,584"								
665	"$103,331"								
666	"$70,258"								
667	"$51,721"								
668	"$97,972"								
669	"$67,435"								
670	"$51,783"								
671	"$71,102"								
672	"$55,851"								
673	"$105,389"								
674	"$83,852"								
675	"$71,442"								
682	"$55,973"								
683	"$41,935"								
684	"$30,173"								
686	"$61,864"								
687	"$48,207"								
688	"$43,773"								
689	"$49,330"								
690	"$37,756"								
693	"$55,768"								
694	"$42,142"								
695	"$48,583"								
696	"$32,831"								
697	"$46,955"								
698	"$58,036"								
699	"$45,610"								
700	"$35,132"								
707	"$85,937"								
708	"$74,390"								
709	"$78,809"								
710	"$60,610"								
711	"$79,798"								
712	"$58,125"								
713	"$62,285"								
714	"$50,872"								
715	"$83,106"								
716	"$63,366"								
717	"$71,173"								
718	"$59,468"								
722	"$61,468"								
723	"$49,623"								
724	"$39,478"								
725	"$51,705"								
726	"$36,546"								
727	"$55,850"								
728	"$38,841"								
729	"$46,542"								
730	"$34,841"								
734	"$87,449"								
735	"$67,312"								
736	"$139,129"								
737	"$86,906"								
738	"$68,708"								
739	"$130,958"								
740	"$80,871"								
741	"$67,070"								
742	"$75,718"								
743	"$59,183"								
744	"$71,092"								
745	"$52,225"								
746	"$65,285"								
747	"$52,208"								
748	"$62,340"								
749	"$93,471"								
750	"$63,529"								
754	"$62,405"								
755	"$48,663"								
756	"$46,530"								
757	"$55,498"								
758	"$45,586"								
759	"$29,885"								
760	"$46,140"								
761	"$32,080"								
768	"$41,216"								
769	"$51,241"								
770	"$43,433"								
776	"$27,904"								
779	"$44,448"								
783	"$62,246"								
784	"$45,331"								
785	"$39,114"								
786	"$55,934"								
787	"$43,069"								
788	"$36,847"								
793	"$55,715"								
794	"$19,143"								
796	"$50,418"								
797	"$39,759"								
798	"$39,759"								
799	"$160,630"								
800	"$98,327"								
801	"$78,342"								
802	"$115,972"								
803	"$77,529"								
804	"$62,998"								
805	"$35,486"								
806	"$23,727"								
807	"$21,264"								
808	"$70,833"								
809	"$51,640"								
810	"$45,212"								
811	"$56,589"								
812	"$43,088"								
813	"$57,561"								
814	"$65,133"								
815	"$48,243"								
816	"$39,380"								
817	"$77,855"								
818	"$59,457"								
819	"$39,053"								
820	"$167,268"								
821	"$84,554"								
822	"$61,991"								
823	"$137,887"								
824	"$88,992"								
825	"$63,463"								
826	"$157,406"								
827	"$95,097"								
828	"$76,906"								
829	"$98,571"								
830	"$69,870"								
831	"$43,560"								
832	"$26,345"								
833	"$21,033"								
834	"$130,486"								
835	"$65,954"								
836	"$50,659"								
837	"$121,635"								
838	"$65,277"								
839	"$52,863"								
840	"$88,141"								
841	"$60,661"								
842	"$48,545"								
843	"$68,518"								
844	"$51,909"								
845	"$44,461"								
846	"$71,995"								
847	"$50,795"								
848	"$36,047"								
849	"$74,490"								
853	"$144,005"								
854	"$79,564"								
855	"$67,390"								
856	"$122,701"								
857	"$74,665"								
858	"$59,623"								
862	"$63,631"								
863	"$44,990"								
864	"$42,735"								
865	"$57,011"								
866	"$42,452"								
867	"$66,769"								
868	"$46,537"								
869	"$35,896"								
870	"$218,500"								
871	"$70,377"								
872	"$48,958"								
876	"$87,963"								
880	"$43,930"								
881	"$28,578"								
882	"$34,053"								
883	"$40,335"								
884	"$49,891"								
885	"$39,120"								
886	"$41,582"								
887	"$48,504"								
894	"$25,261"								
895	"$42,615"								
896	"$60,467"								
897	"$35,745"								
901	"$117,474"								
902	"$70,403"								
903	"$55,526"								
904	"$107,361"								
905	"$65,451"								
906	"$69,443"								
907	"$116,628"								
908	"$76,281"								
909	"$60,212"								
913	"$59,417"								
914	"$45,740"								
915	"$63,654"								
916	"$30,951"								
917	"$57,232"								
918	"$37,002"								
919	"$62,327"								
920	"$47,069"								
921	"$36,226"								
922	"$57,588"								
923	"$41,970"								
927	"$494,703"								
928	"$158,257"								
929	"$92,959"								
933	"$78,613"								
934	"$54,683"								
935	"$56,051"								
939	"$101,337"								
940	"$80,933"								
941	"$73,138"								
945	"$62,622"								
946	"$58,037"								
947	"$48,659"								
948	"$37,716"								
949	"$43,295"								
950	"$26,324"								
951	"$25,308"								
955	"$215,956"								
956	"$117,924"								
957	"$225,221"								
958	"$143,876"								
959	"$97,018"								
963	"$90,787"								
964	"$61,253"								
965	"$47,138"								
969	"$198,401"								
970	"$91,326"								
974	"$87,483"								
975	"$55,616"								
976	"$44,855"								
977	"$53,060"								
981	"$136,680"								
982	"$88,499"								
983	"$69,713"								
987	"$105,530"								
988	"$68,910"								
989	"$54,737"								
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)									
"2As discussed in section I.O. of Appendix A of the FY 2023 IPPS/LTCH proposed rule, we considered an alternative approach of using the FY 2021 data we would ordinarily use without  modifications to our usual ratesetting methodology."									
