10.25.A. - The DETOUR System Codes - FY 2024																		
																		
Note:  The applicant provided the following codes and/or MS-DRGs that were used in performing a cost analysis for the Charges section of the new technology add-on payment application.																		
																		
Analysis 1 Identified MS-DRGs 1																		
253																		
254																		
252																		
271																		
270																		
240																		
272																		
239																		
853																		
854																		
269																		
616																		
003																		
038																		
039																		
215																		
216																		
220																		
228																		
233																		
234																		
241																		
242																		
243																		
246																		
247																		
268																		
356																		
418																		
463																		
464																		
470																		
474																		
475																		
477																		
478																		
480																		
481																		
488																		
492																		
500																		
504																		
570																		
573																		
580																		
617																		
622																		
623																		
628																		
629																		
673																		
856																		
857																		
902																		
904																		
907																		
908																		
928																		
939																		
940																		
957																		
981																		
982																		
																		
"1 For the MS-DRG desciptions, refer to Table 5 associated with the applicable fiscal year IPPS/LTCH PPS proposed rule."																		
