"PROPOSED RULE NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2024"									
MS?DRG	Threshold								
001	"$801,163"								
002	"$374,741"								
003	"$526,656"								
004	"$355,125"								
005	"$329,904"								
006	"$192,894"								
007	"$423,698"								
008	"$210,470"								
010	"$170,950"								
011	"$164,916"								
012	"$138,942"								
013	"$99,256"								
014	"$296,488"								
016	"$176,581"								
017	"$102,786"								
018	"$1,423,374"								
019	"$251,855"								
020	"$265,672"								
021	"$200,226"								
022	"$126,372"								
023	"$179,143"								
024	"$136,224"								
025	"$147,526"								
026	"$109,409"								
027	"$95,525"								
028	"$177,800"								
029	"$116,395"								
030	"$87,983"								
031	"$124,626"								
032	"$81,158"								
033	"$73,589"								
034	"$136,332"								
035	"$89,093"								
036	"$77,899"								
037	"$118,080"								
038	"$73,581"								
039	"$60,794"								
040	"$122,160"								
041	"$94,421"								
042	"$80,697"								
052	"$64,936"								
053	"$45,768"								
054	"$56,330"								
055	"$49,753"								
056	"$65,894"								
057	"$49,395"								
058	"$62,514"								
059	"$51,383"								
060	"$46,953"								
061	"$117,800"								
062	"$93,335"								
063	"$84,351"								
064	"$71,082"								
065	"$53,294"								
066	"$42,955"								
067	"$63,167"								
068	"$51,641"								
069	"$49,507"								
070	"$62,177"								
071	"$49,604"								
072	"$42,603"								
073	"$56,774"								
074	"$48,982"								
075	"$68,428"								
076	"$49,853"								
077	"$64,589"								
078	"$53,718"								
079	"$44,690"								
080	"$69,250"								
081	"$44,488"								
082	"$76,517"								
083	"$57,900"								
084	"$47,479"								
085	"$76,930"								
086	"$57,167"								
087	"$46,968"								
088	"$65,992"								
089	"$56,970"								
090	"$46,642"								
091	"$61,554"								
092	"$48,526"								
093	"$42,333"								
094	"$105,100"								
095	"$88,370"								
096	"$85,399"								
097	"$113,883"								
098	"$74,710"								
099	"$61,402"								
100	"$67,046"								
101	"$46,441"								
102	"$54,359"								
103	"$46,723"								
113	"$82,854"								
114	"$56,869"								
115	"$65,255"								
116	"$69,698"								
117	"$52,052"								
121	"$46,518"								
122	"$29,089"								
123	"$48,108"								
124	"$54,761"								
125	"$43,383"								
135	"$88,115"								
136	"$62,040"								
137	"$58,329"								
138	"$48,207"								
139	"$59,040"								
140	"$138,731"								
141	"$90,020"								
142	"$74,838"								
143	"$103,080"								
144	"$73,453"								
145	"$58,533"								
146	"$68,060"								
147	"$51,141"								
148	"$43,250"								
149	"$43,465"								
150	"$51,760"								
151	"$34,808"								
152	"$51,537"								
153	"$35,542"								
154	"$58,194"								
155	"$45,746"								
156	"$34,948"								
157	"$60,298"								
158	"$45,483"								
159	"$37,497"								
163	"$151,082"								
164	"$98,510"								
165	"$82,040"								
166	"$114,990"								
167	"$77,513"								
168	"$65,375"								
175	"$57,860"								
176	"$42,020"								
177	"$63,269"								
178	"$47,250"								
179	"$36,814"								
180	"$65,585"								
181	"$52,162"								
182	"$47,286"								
183	"$60,386"								
184	"$51,070"								
185	"$40,245"								
186	"$59,746"								
187	"$49,587"								
188	"$37,674"								
189	"$52,194"								
190	"$48,934"								
191	"$41,346"								
192	"$31,987"								
193	"$54,922"								
194	"$41,627"								
195	"$33,150"								
196	"$61,327"								
197	"$46,977"								
198	"$37,266"								
199	"$64,020"								
200	"$49,549"								
201	"$35,309"								
202	"$44,454"								
203	"$32,799"								
204	"$43,244"								
205	"$61,241"								
206	"$45,049"								
207	"$201,362"								
208	"$90,935"								
215	"$319,187"								
216	"$319,745"								
217	"$229,490"								
218	"$213,541"								
219	"$265,033"								
220	"$194,225"								
221	"$164,882"								
222	"$263,051"								
223	"$197,190"								
224	"$245,279"								
225	"$192,597"								
226	"$214,515"								
227	"$174,371"								
228	"$167,315"								
229	"$124,408"								
231	"$312,148"								
232	"$231,304"								
233	"$264,608"								
234	"$197,040"								
235	"$205,555"								
236	"$157,668"								
239	"$125,613"								
240	"$86,620"								
241	"$59,551"								
242	"$122,690"								
243	"$95,009"								
244	"$83,043"								
245	"$159,925"								
246	"$130,073"								
247	"$99,750"								
248	"$127,975"								
249	"$94,960"								
250	"$106,533"								
251	"$85,183"								
252	"$110,348"								
253	"$100,680"								
254	"$77,798"								
255	"$83,501"								
256	"$62,680"								
257	"$45,746"								
258	"$100,678"								
259	"$85,032"								
260	"$116,007"								
261	"$79,700"								
262	"$73,881"								
263	"$88,261"								
264	"$94,442"								
265	"$114,748"								
266	"$210,765"								
267	"$171,350"								
268	"$217,864"								
269	"$142,017"								
270	"$164,129"								
271	"$124,391"								
272	"$96,265"								
273	"$150,057"								
274	"$125,917"								
280	"$61,733"								
281	"$49,532"								
282	"$44,442"								
283	"$66,797"								
284	"$40,271"								
285	"$31,534"								
286	"$83,427"								
287	"$61,762"								
288	"$81,792"								
289	"$62,379"								
290	"$49,399"								
291	"$51,383"								
292	"$39,608"								
293	"$28,045"								
294	"$49,461"								
295	"$40,023"								
296	"$64,995"								
297	"$35,392"								
298	"$26,008"								
299	"$56,666"								
300	"$45,753"								
301	"$35,391"								
302	"$48,736"								
303	"$36,182"								
304	"$49,579"								
305	"$40,340"								
306	"$53,397"								
307	"$43,939"								
308	"$51,174"								
309	"$37,058"								
310	"$28,941"								
311	"$36,392"								
312	"$44,576"								
313	"$40,258"								
314	"$67,270"								
315	"$46,084"								
316	"$36,746"								
319	"$147,302"								
320	"$98,661"								
326	"$149,615"								
327	"$95,157"								
328	"$73,001"								
329	"$142,886"								
330	"$93,841"								
331	"$74,701"								
332	"$130,513"								
333	"$86,763"								
334	"$74,182"								
335	"$120,684"								
336	"$85,010"								
337	"$71,042"								
338	"$98,332"								
339	"$73,581"								
340	"$61,525"								
341	"$88,658"								
342	"$69,071"								
343	"$58,923"								
344	"$88,141"								
345	"$66,901"								
346	"$59,508"								
347	"$85,821"								
348	"$61,675"								
349	"$51,629"								
350	"$91,045"								
351	"$68,510"								
352	"$58,751"								
353	"$102,279"								
354	"$75,171"								
355	"$64,443"								
356	"$131,513"								
357	"$87,467"								
358	"$65,506"								
368	"$65,527"								
369	"$51,271"								
370	"$40,613"								
371	"$60,565"								
372	"$47,090"								
373	"$35,591"								
374	"$68,941"								
375	"$53,312"								
376	"$45,030"								
377	"$66,430"								
378	"$49,314"								
379	"$34,391"								
380	"$70,012"								
381	"$52,066"								
382	"$42,257"								
383	"$59,668"								
384	"$50,156"								
385	"$61,524"								
386	"$48,262"								
387	"$36,132"								
388	"$56,895"								
389	"$40,190"								
390	"$29,841"								
391	"$54,361"								
392	"$41,464"								
393	"$60,119"								
394	"$46,555"								
395	"$34,950"								
405	"$168,097"								
406	"$110,039"								
407	"$90,711"								
408	"$120,469"								
409	"$86,518"								
410	"$75,622"								
411	"$111,367"								
412	"$96,402"								
413	"$75,885"								
414	"$117,836"								
415	"$83,468"								
416	"$64,918"								
417	"$95,972"								
418	"$77,948"								
419	"$67,185"								
420	"$109,299"								
421	"$76,793"								
422	"$67,473"								
423	"$126,684"								
424	"$90,072"								
425	"$66,114"								
432	"$68,176"								
433	"$49,669"								
434	"$33,591"								
435	"$67,926"								
436	"$52,147"								
437	"$45,873"								
438	"$62,026"								
439	"$45,095"								
440	"$33,779"								
441	"$65,257"								
442	"$45,914"								
443	"$34,202"								
444	"$65,789"								
445	"$53,367"								
446	"$46,097"								
453	"$269,529"								
454	"$185,897"								
455	"$154,067"								
456	"$257,660"								
457	"$191,145"								
458	"$152,320"								
459	"$196,832"								
460	"$125,967"								
461	"$178,134"								
462	"$108,794"								
463	"$134,339"								
464	"$95,405"								
465	"$75,575"								
466	"$157,266"								
467	"$119,299"								
468	"$98,069"								
469	"$108,752"								
470	"$77,318"								
471	"$166,613"								
472	"$111,163"								
473	"$96,729"								
474	"$116,392"								
475	"$78,334"								
476	"$56,104"								
477	"$110,472"								
478	"$88,688"								
479	"$73,621"								
480	"$104,902"								
481	"$84,490"								
482	"$71,245"								
483	"$90,202"								
485	"$113,529"								
486	"$83,366"								
487	"$69,314"								
488	"$80,875"								
489	"$60,974"								
492	"$117,585"								
493	"$91,085"								
494	"$77,500"								
495	"$118,574"								
496	"$79,856"								
497	"$64,720"								
498	"$90,636"								
499	"$59,066"								
500	"$97,317"								
501	"$69,929"								
502	"$61,084"								
503	"$87,803"								
504	"$68,860"								
505	"$68,860"								
506	"$61,560"								
507	"$72,616"								
508	"$64,167"								
509	"$53,213"								
510	"$103,160"								
511	"$83,274"								
512	"$71,433"								
513	"$65,137"								
514	"$52,196"								
515	"$107,214"								
516	"$81,654"								
517	"$67,839"								
518	"$122,939"								
519	"$80,767"								
520	"$67,269"								
521	"$108,717"								
522	"$88,245"								
533	"$53,332"								
534	"$36,143"								
535	"$51,974"								
536	"$36,540"								
537	"$45,709"								
538	"$33,652"								
539	"$63,188"								
540	"$51,174"								
541	"$37,447"								
542	"$63,109"								
543	"$49,023"								
544	"$37,503"								
545	"$72,061"								
546	"$50,187"								
547	"$43,431"								
548	"$66,225"								
549	"$50,902"								
550	"$45,371"								
551	"$62,165"								
552	"$47,776"								
553	"$51,669"								
554	"$36,395"								
555	"$53,278"								
556	"$40,106"								
557	"$56,739"								
558	"$41,080"								
559	"$58,427"								
560	"$44,804"								
561	"$33,313"								
562	"$56,339"								
563	"$40,954"								
564	"$59,622"								
565	"$47,710"								
566	"$37,588"								
570	"$84,299"								
571	"$61,748"								
572	"$53,115"								
573	"$141,716"								
574	"$101,023"								
575	"$69,877"								
576	"$154,137"								
577	"$94,039"								
578	"$71,423"								
579	"$92,435"								
580	"$67,200"								
581	"$61,939"								
582	"$77,497"								
583	"$66,433"								
584	"$81,551"								
585	"$78,314"								
592	"$56,610"								
593	"$45,338"								
594	"$31,936"								
595	"$61,783"								
596	"$45,122"								
597	"$63,903"								
598	"$48,527"								
599	"$38,854"								
600	"$44,877"								
601	"$31,566"								
602	"$54,161"								
603	"$37,561"								
604	"$60,188"								
605	"$46,300"								
606	"$54,967"								
607	"$37,113"								
614	"$92,915"								
615	"$72,948"								
616	"$111,943"								
617	"$72,500"								
618	"$53,645"								
619	"$98,144"								
620	"$72,924"								
621	"$68,954"								
622	"$95,724"								
623	"$66,250"								
624	"$46,743"								
625	"$101,229"								
626	"$75,778"								
627	"$65,170"								
628	"$109,948"								
629	"$79,017"								
630	"$68,253"								
637	"$55,275"								
638	"$40,736"								
639	"$29,786"								
640	"$50,764"								
641	"$36,861"								
642	"$51,157"								
643	"$60,768"								
644	"$46,904"								
645	"$35,971"								
650	"$165,775"								
651	"$138,997"								
652	"$129,089"								
653	"$166,592"								
654	"$110,922"								
655	"$92,107"								
656	"$114,592"								
657	"$82,547"								
658	"$74,578"								
659	"$88,279"								
660	"$63,397"								
661	"$56,011"								
662	"$97,968"								
663	"$64,919"								
664	"$54,580"								
665	"$103,694"								
666	"$70,254"								
667	"$51,721"								
668	"$98,020"								
669	"$67,431"								
670	"$51,783"								
671	"$70,805"								
672	"$55,847"								
673	"$104,973"								
674	"$83,848"								
675	"$71,438"								
682	"$56,116"								
683	"$41,935"								
684	"$30,173"								
686	"$62,013"								
687	"$48,203"								
688	"$43,769"								
689	"$49,310"								
690	"$37,760"								
693	"$56,199"								
694	"$42,142"								
695	"$48,795"								
696	"$32,831"								
697	"$46,920"								
698	"$57,958"								
699	"$45,606"								
700	"$35,132"								
707	"$85,908"								
708	"$74,386"								
709	"$78,588"								
710	"$60,606"								
711	"$79,592"								
712	"$58,121"								
713	"$62,142"								
714	"$50,869"								
715	"$83,047"								
716	"$63,362"								
717	"$71,136"								
718	"$59,465"								
722	"$61,411"								
723	"$49,619"								
724	"$39,475"								
725	"$51,628"								
726	"$36,546"								
727	"$55,803"								
728	"$38,841"								
729	"$46,423"								
730	"$34,841"								
734	"$87,459"								
735	"$67,308"								
736	"$139,136"								
737	"$86,903"								
738	"$68,704"								
739	"$130,964"								
740	"$80,867"								
741	"$67,066"								
742	"$75,680"								
743	"$59,179"								
744	"$70,929"								
745	"$52,221"								
746	"$65,210"								
747	"$52,204"								
748	"$62,336"								
749	"$93,419"								
750	"$63,525"								
754	"$62,349"								
755	"$48,659"								
756	"$46,526"								
757	"$55,369"								
758	"$45,586"								
759	"$29,908"								
760	"$45,987"								
761	"$32,080"								
768	"$41,597"								
769	"$51,237"								
770	"$43,219"								
776	"$27,623"								
779	"$44,444"								
783	"$61,578"								
784	"$45,331"								
785	"$39,114"								
786	"$55,654"								
787	"$43,072"								
788	"$36,847"								
793	"$55,715"								
794	"$19,143"								
796	"$50,418"								
797	"$39,759"								
798	"$39,759"								
799	"$160,650"								
800	"$98,323"								
801	"$78,338"								
802	"$115,749"								
803	"$77,525"								
804	"$62,994"								
805	"$35,168"								
806	"$23,727"								
807	"$21,264"								
808	"$70,943"								
809	"$51,636"								
810	"$45,208"								
811	"$56,719"								
812	"$43,089"								
813	"$57,429"								
814	"$65,029"								
815	"$48,239"								
816	"$39,408"								
817	"$77,702"								
818	"$59,453"								
819	"$39,053"								
820	"$167,195"								
821	"$84,550"								
822	"$61,987"								
823	"$137,844"								
824	"$88,988"								
825	"$63,459"								
826	"$157,444"								
827	"$95,093"								
828	"$76,903"								
829	"$98,545"								
830	"$69,866"								
831	"$43,554"								
832	"$26,345"								
833	"$21,033"								
834	"$130,538"								
835	"$65,951"								
836	"$50,655"								
837	"$121,248"								
838	"$65,273"								
839	"$52,859"								
840	"$88,210"								
841	"$60,657"								
842	"$48,541"								
843	"$68,550"								
844	"$51,905"								
845	"$44,457"								
846	"$72,012"								
847	"$50,792"								
848	"$36,047"								
849	"$74,535"								
853	"$143,020"								
854	"$79,561"								
855	"$67,386"								
856	"$122,523"								
857	"$74,661"								
858	"$59,619"								
862	"$63,490"								
863	"$44,986"								
864	"$42,709"								
865	"$57,130"								
866	"$42,452"								
867	"$66,592"								
868	"$46,533"								
869	"$35,896"								
870	"$207,820"								
871	"$69,357"								
872	"$48,955"								
876	"$87,408"								
880	"$43,936"								
881	"$28,450"								
882	"$34,058"								
883	"$40,331"								
884	"$49,728"								
885	"$38,984"								
886	"$41,415"								
887	"$48,220"								
894	"$25,180"								
895	"$42,597"								
896	"$60,708"								
897	"$35,745"								
901	"$117,272"								
902	"$70,399"								
903	"$55,522"								
904	"$106,993"								
905	"$65,447"								
906	"$69,330"								
907	"$116,306"								
908	"$76,277"								
909	"$60,209"								
913	"$59,741"								
914	"$45,740"								
915	"$63,881"								
916	"$30,951"								
917	"$57,212"								
918	"$37,002"								
919	"$62,255"								
920	"$47,066"								
921	"$36,226"								
922	"$57,574"								
923	"$41,970"								
927	"$497,100"								
928	"$157,647"								
929	"$92,955"								
933	"$78,609"								
934	"$54,505"								
935	"$55,894"								
939	"$100,840"								
940	"$80,929"								
941	"$73,134"								
945	"$62,879"								
946	"$58,033"								
947	"$48,780"								
948	"$37,718"								
949	"$43,261"								
950	"$26,324"								
951	"$25,345"								
955	"$215,841"								
956	"$117,671"								
957	"$225,495"								
958	"$143,872"								
959	"$97,014"								
963	"$90,886"								
964	"$61,249"								
965	"$47,134"								
969	"$198,199"								
970	"$91,323"								
974	"$87,136"								
975	"$55,855"								
976	"$44,647"								
977	"$52,833"								
981	"$134,441"								
982	"$88,492"								
983	"$69,719"								
987	"$104,429"								
988	"$68,892"								
989	"$54,749"								
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 proposing to calculate 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 proposed in section II. of the proposed rule, we have averaged the thresholds based on the data of these two sets of weights."									
