NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1 FOR APPLICATIONS FOR FY 2026 - INTERIM FINAL ACTION									
MS?DRG	Threshold								
001	"$895,084"								
002	"$373,392"								
003	"$595,879"								
004	"$375,773"								
005	"$345,594"								
006	"$211,983"								
007	"$476,337"								
008	"$225,771"								
010	"$251,310"								
011	"$178,994"								
012	"$156,975"								
013	"$105,070"								
014	"$368,637"								
016	"$182,588"								
017	"$182,588"								
018	"$1,554,026"								
019	"$301,779"								
020	"$261,641"								
021	"$178,997"								
022	"$108,478"								
023	"$192,640"								
024	"$144,562"								
025	"$158,024"								
026	"$120,069"								
027	"$104,702"								
028	"$196,901"								
029	"$125,426"								
030	"$94,209"								
031	"$139,813"								
032	"$90,729"								
033	"$78,513"								
034	"$142,804"								
035	"$98,253"								
036	"$84,348"								
037	"$125,139"								
038	"$79,170"								
039	"$65,593"								
040	"$130,860"								
041	"$99,633"								
042	"$85,074"								
052	"$71,161"								
053	"$50,177"								
054	"$62,775"								
055	"$55,152"								
056	"$72,527"								
057	"$53,853"								
058	"$67,556"								
059	"$56,130"								
060	"$49,950"								
061	"$118,721"								
062	"$95,632"								
063	"$83,869"								
064	"$77,058"								
065	"$57,662"								
066	"$47,515"								
067	"$68,462"								
068	"$55,715"								
069	"$54,446"								
070	"$66,331"								
071	"$53,359"								
072	"$47,308"								
073	"$62,404"								
074	"$53,392"								
075	"$73,949"								
076	"$50,369"								
077	"$69,761"								
078	"$57,944"								
079	"$47,118"								
080	"$71,401"								
081	"$50,003"								
082	"$83,530"								
083	"$63,667"								
084	"$51,799"								
085	"$81,941"								
086	"$62,521"								
087	"$51,403"								
088	"$68,392"								
089	"$60,082"								
090	"$52,927"								
091	"$67,847"								
092	"$53,159"								
093	"$48,270"								
094	"$116,837"								
095	"$93,007"								
096	"$93,007"								
097	"$117,053"								
098	"$84,647"								
099	"$66,095"								
100	"$72,879"								
101	"$50,333"								
102	"$60,138"								
103	"$51,903"								
113	"$91,311"								
114	"$62,021"								
115	"$71,369"								
116	"$73,326"								
117	"$55,654"								
121	"$49,785"								
122	"$31,651"								
123	"$52,806"								
124	"$59,778"								
125	"$48,482"								
135	"$93,130"								
136	"$60,645"								
137	"$59,869"								
138	"$48,109"								
139	"$64,686"								
140	"$146,270"								
141	"$96,027"								
142	"$79,750"								
143	"$113,928"								
144	"$77,753"								
145	"$64,194"								
146	"$76,816"								
147	"$55,192"								
148	"$44,692"								
149	"$48,527"								
150	"$55,919"								
151	"$38,168"								
152	"$53,049"								
153	"$39,032"								
154	"$64,296"								
155	"$49,607"								
156	"$38,676"								
157	"$64,269"								
158	"$49,410"								
159	"$38,503"								
163	"$158,405"								
164	"$106,219"								
165	"$88,615"								
166	"$122,474"								
167	"$80,800"								
168	"$70,117"								
173	"$128,930"								
175	"$62,034"								
176	"$46,081"								
177	"$64,644"								
178	"$48,856"								
179	"$39,696"								
180	"$71,371"								
181	"$55,747"								
182	"$49,360"								
183	"$67,610"								
184	"$55,625"								
185	"$45,254"								
186	"$65,384"								
187	"$52,492"								
188	"$42,933"								
189	"$56,264"								
190	"$52,746"								
191	"$44,401"								
192	"$34,782"								
193	"$58,661"								
194	"$43,744"								
195	"$34,658"								
196	"$68,166"								
197	"$50,714"								
198	"$39,721"								
199	"$69,338"								
200	"$54,117"								
201	"$36,516"								
202	"$49,368"								
203	"$36,855"								
204	"$47,799"								
205	"$68,164"								
206	"$48,843"								
207	"$202,050"								
208	"$99,659"								
212	"$396,309"								
215	"$355,625"								
216	"$350,215"								
217	"$255,358"								
218	"$245,518"								
219	"$279,295"								
220	"$212,475"								
221	"$178,517"								
228	"$185,025"								
229	"$132,195"								
231	"$350,334"								
232	"$261,110"								
233	"$292,008"								
234	"$221,608"								
235	"$222,159"								
236	"$174,137"								
239	"$144,066"								
240	"$98,497"								
241	"$66,948"								
242	"$132,189"								
243	"$102,101"								
244	"$89,038"								
245	"$185,336"								
250	"$110,991"								
251	"$91,361"								
252	"$121,811"								
253	"$107,195"								
254	"$82,845"								
255	"$91,102"								
256	"$70,897"								
257	"$42,281"								
258	"$111,641"								
259	"$84,749"								
260	"$122,557"								
261	"$86,424"								
262	"$76,708"								
263	"$101,171"								
264	"$105,213"								
265	"$126,884"								
266	"$217,616"								
267	"$181,285"								
268	"$234,439"								
269	"$156,513"								
270	"$177,503"								
271	"$134,916"								
272	"$103,871"								
273	"$158,047"								
274	"$131,659"								
275	"$274,644"								
276	"$229,780"								
277	"$191,230"								
278	"$176,920"								
279	"$131,588"								
280	"$66,901"								
281	"$53,683"								
282	"$49,097"								
283	"$73,063"								
284	"$44,639"								
285	"$33,639"								
286	"$91,162"								
287	"$66,213"								
288	"$90,417"								
289	"$66,225"								
290	"$51,884"								
291	"$55,314"								
292	"$42,434"								
293	"$29,948"								
294	"$55,060"								
295	"$37,457"								
296	"$68,180"								
297	"$44,045"								
298	"$28,571"								
299	"$62,434"								
300	"$50,240"								
301	"$39,163"								
302	"$52,679"								
303	"$39,282"								
304	"$55,095"								
305	"$44,867"								
306	"$59,142"								
307	"$47,730"								
308	"$55,580"								
309	"$40,354"								
310	"$31,875"								
311	"$41,926"								
312	"$49,770"								
313	"$43,982"								
314	"$73,485"								
315	"$49,594"								
316	"$40,193"								
317	"$231,504"								
319	"$157,271"								
320	"$104,004"								
321	"$137,384"								
322	"$106,197"								
323	"$185,381"								
324	"$153,632"								
325	"$132,938"								
326	"$158,351"								
327	"$100,952"								
328	"$79,025"								
329	"$152,548"								
330	"$100,267"								
331	"$80,385"								
332	"$126,590"								
333	"$92,923"								
334	"$79,368"								
335	"$127,283"								
336	"$92,643"								
337	"$75,724"								
344	"$94,786"								
345	"$70,065"								
346	"$65,019"								
347	"$91,016"								
348	"$63,168"								
349	"$52,491"								
350	"$100,455"								
351	"$76,555"								
352	"$64,129"								
353	"$112,014"								
354	"$80,629"								
355	"$69,575"								
356	"$144,266"								
357	"$96,082"								
358	"$70,543"								
368	"$70,235"								
369	"$54,979"								
370	"$42,492"								
371	"$67,095"								
372	"$51,679"								
373	"$39,205"								
374	"$75,395"								
375	"$58,231"								
376	"$50,806"								
377	"$72,398"								
378	"$53,128"								
379	"$37,866"								
380	"$76,036"								
381	"$57,044"								
382	"$43,991"								
383	"$63,794"								
384	"$53,101"								
385	"$66,431"								
386	"$51,985"								
387	"$38,298"								
388	"$60,532"								
389	"$43,933"								
390	"$31,873"								
391	"$58,110"								
392	"$45,304"								
393	"$65,144"								
394	"$50,183"								
395	"$37,633"								
397	"$102,939"								
398	"$77,902"								
399	"$65,443"								
402	"$150,361"								
405	"$179,623"								
406	"$117,224"								
407	"$97,707"								
408	"$125,109"								
409	"$95,078"								
410	"$78,013"								
411	"$111,661"								
412	"$101,033"								
413	"$87,819"								
414	"$127,897"								
415	"$89,658"								
416	"$70,424"								
417	"$104,636"								
418	"$85,970"								
419	"$74,470"								
420	"$117,182"								
421	"$79,997"								
422	"$74,451"								
423	"$141,502"								
424	"$99,982"								
425	"$77,039"								
426	"$330,534"								
427	"$239,799"								
428	"$197,828"								
429	"$297,460"								
430	"$200,745"								
432	"$74,709"								
433	"$54,519"								
434	"$40,346"								
435	"$74,884"								
436	"$57,357"								
437	"$48,204"								
438	"$67,695"								
439	"$49,181"								
440	"$37,707"								
441	"$69,347"								
442	"$50,118"								
443	"$40,730"								
444	"$71,820"								
445	"$57,792"								
446	"$50,028"								
447	"$225,576"								
448	"$151,243"								
450	"$187,040"								
451	"$123,756"								
456	"$284,500"								
457	"$203,877"								
458	"$155,688"								
461	"$194,207"								
462	"$117,024"								
463	"$148,912"								
464	"$102,511"								
465	"$77,037"								
466	"$167,962"								
467	"$127,057"								
468	"$105,835"								
469	"$119,716"								
470	"$85,087"								
471	"$176,489"								
472	"$119,275"								
473	"$103,233"								
474	"$132,528"								
475	"$83,563"								
476	"$59,860"								
477	"$121,094"								
478	"$96,366"								
479	"$82,343"								
480	"$113,316"								
481	"$92,077"								
482	"$76,725"								
483	"$106,349"								
485	"$122,628"								
486	"$91,532"								
487	"$75,285"								
488	"$80,498"								
489	"$65,222"								
492	"$129,400"								
493	"$100,742"								
494	"$85,812"								
495	"$119,245"								
496	"$84,071"								
497	"$68,061"								
498	"$96,260"								
499	"$57,900"								
500	"$107,656"								
501	"$76,767"								
502	"$67,535"								
503	"$98,620"								
504	"$75,113"								
505	"$75,113"								
506	"$69,763"								
507	"$83,728"								
508	"$63,694"								
509	"$67,744"								
510	"$113,077"								
511	"$91,190"								
512	"$80,002"								
513	"$68,415"								
514	"$57,590"								
515	"$116,122"								
516	"$88,795"								
517	"$74,287"								
518	"$131,903"								
519	"$87,939"								
520	"$72,696"								
521	"$116,256"								
522	"$95,826"								
533	"$57,255"								
534	"$39,912"								
535	"$56,462"								
536	"$41,455"								
537	"$47,643"								
538	"$35,729"								
539	"$68,921"								
540	"$54,350"								
541	"$42,758"								
542	"$68,225"								
543	"$52,131"								
544	"$40,361"								
545	"$77,143"								
546	"$53,347"								
547	"$42,107"								
548	"$75,483"								
549	"$55,259"								
550	"$45,578"								
551	"$67,985"								
552	"$51,708"								
553	"$55,603"								
554	"$40,813"								
555	"$57,475"								
556	"$44,105"								
557	"$62,217"								
558	"$45,430"								
559	"$64,675"								
560	"$49,980"								
561	"$37,732"								
562	"$60,771"								
563	"$46,242"								
564	"$65,044"								
565	"$51,567"								
566	"$41,650"								
570	"$91,381"								
571	"$67,388"								
572	"$56,282"								
573	"$159,976"								
574	"$106,885"								
575	"$77,493"								
576	"$162,271"								
577	"$101,627"								
578	"$77,076"								
579	"$101,781"								
580	"$73,278"								
581	"$69,086"								
582	"$80,090"								
583	"$74,142"								
584	"$87,110"								
585	"$89,586"								
592	"$62,840"								
593	"$49,463"								
594	"$35,818"								
595	"$68,014"								
596	"$47,184"								
597	"$67,337"								
598	"$53,227"								
599	"$48,730"								
600	"$46,655"								
601	"$29,311"								
602	"$58,524"								
603	"$41,179"								
604	"$64,425"								
605	"$49,921"								
606	"$58,562"								
607	"$41,896"								
614	"$98,863"								
615	"$77,320"								
616	"$121,298"								
617	"$77,727"								
618	"$61,481"								
619	"$104,304"								
620	"$77,876"								
621	"$73,541"								
622	"$107,233"								
623	"$71,833"								
624	"$52,569"								
625	"$107,800"								
626	"$79,556"								
627	"$69,964"								
628	"$122,344"								
629	"$86,252"								
630	"$74,254"								
637	"$60,442"								
638	"$45,764"								
639	"$33,701"								
640	"$55,428"								
641	"$40,979"								
642	"$53,249"								
643	"$65,194"								
644	"$50,656"								
645	"$40,888"								
650	"$179,903"								
651	"$152,376"								
652	"$142,333"								
653	"$176,951"								
654	"$121,615"								
655	"$98,184"								
656	"$124,162"								
657	"$89,403"								
658	"$79,871"								
659	"$94,239"								
660	"$67,171"								
661	"$59,959"								
662	"$106,361"								
663	"$70,396"								
664	"$60,053"								
665	"$116,755"								
666	"$75,851"								
667	"$57,979"								
668	"$106,001"								
669	"$72,190"								
670	"$55,908"								
671	"$75,657"								
672	"$59,444"								
673	"$132,636"								
674	"$87,737"								
675	"$70,750"								
682	"$60,838"								
683	"$45,931"								
684	"$33,398"								
686	"$71,318"								
687	"$51,556"								
688	"$44,740"								
689	"$53,208"								
690	"$41,815"								
693	"$62,451"								
694	"$45,993"								
695	"$52,021"								
696	"$35,907"								
697	"$50,225"								
698	"$63,781"								
699	"$49,269"								
700	"$36,916"								
707	"$93,500"								
708	"$81,939"								
709	"$86,485"								
710	"$69,435"								
711	"$79,222"								
712	"$53,331"								
713	"$67,628"								
714	"$54,206"								
715	"$91,217"								
716	"$74,700"								
717	"$78,728"								
718	"$66,406"								
722	"$67,052"								
723	"$53,398"								
724	"$34,433"								
725	"$55,669"								
726	"$39,553"								
727	"$61,288"								
728	"$42,419"								
729	"$50,220"								
730	"$34,460"								
734	"$95,670"								
735	"$70,726"								
736	"$146,925"								
737	"$94,966"								
738	"$80,894"								
739	"$143,445"								
740	"$89,793"								
741	"$74,720"								
742	"$82,702"								
743	"$65,887"								
744	"$77,495"								
745	"$57,571"								
746	"$71,211"								
747	"$56,800"								
748	"$68,752"								
749	"$101,543"								
750	"$68,163"								
754	"$69,729"								
755	"$53,419"								
756	"$50,171"								
757	"$61,493"								
758	"$50,339"								
759	"$34,512"								
760	"$49,178"								
761	"$39,816"								
768	"$39,774"								
769	"$55,579"								
770	"$53,045"								
776	"$32,865"								
779	"$45,969"								
783	"$67,709"								
784	"$48,403"								
785	"$43,552"								
786	"$58,669"								
787	"$47,665"								
788	"$40,945"								
793	"$52,165"								
796	"$48,780"								
797	"$42,014"								
798	"$42,014"								
799	"$166,837"								
800	"$114,644"								
801	"$83,211"								
802	"$117,124"								
803	"$82,385"								
804	"$65,216"								
805	"$36,832"								
806	"$26,590"								
807	"$23,140"								
808	"$78,911"								
809	"$56,321"								
810	"$49,207"								
811	"$61,703"								
812	"$48,152"								
813	"$62,242"								
814	"$72,722"								
815	"$51,932"								
816	"$41,156"								
817	"$79,755"								
818	"$54,589"								
819	"$38,086"								
820	"$190,669"								
821	"$94,256"								
822	"$66,797"								
823	"$152,841"								
824	"$94,384"								
825	"$66,445"								
826	"$164,060"								
827	"$102,224"								
828	"$80,680"								
829	"$108,975"								
830	"$75,545"								
831	"$47,522"								
832	"$31,499"								
833	"$21,538"								
834	"$139,373"								
835	"$73,643"								
836	"$51,708"								
837	"$125,066"								
838	"$69,676"								
839	"$55,383"								
840	"$96,856"								
841	"$65,148"								
842	"$52,423"								
843	"$73,381"								
844	"$56,624"								
845	"$49,102"								
846	"$81,063"								
847	"$55,206"								
848	"$40,234"								
849	"$92,416"								
850	"$236,443"								
853	"$154,365"								
854	"$85,029"								
855	"$72,130"								
856	"$134,085"								
857	"$82,739"								
858	"$62,694"								
862	"$68,578"								
863	"$48,507"								
864	"$49,753"								
865	"$58,509"								
866	"$45,927"								
867	"$73,160"								
868	"$49,605"								
869	"$38,728"								
870	"$220,168"								
871	"$74,444"								
872	"$52,902"								
876	"$104,498"								
880	"$47,899"								
881	"$32,946"								
882	"$40,047"								
883	"$43,968"								
884	"$55,135"								
885	"$43,235"								
886	"$48,485"								
887	"$51,732"								
894	"$29,721"								
895	"$44,407"								
896	"$65,103"								
897	"$40,823"								
901	"$124,179"								
902	"$75,844"								
903	"$58,023"								
904	"$121,760"								
905	"$71,452"								
906	"$77,840"								
907	"$127,812"								
908	"$82,325"								
909	"$63,968"								
913	"$66,700"								
914	"$50,827"								
915	"$66,884"								
916	"$33,812"								
917	"$63,027"								
918	"$43,814"								
919	"$68,295"								
920	"$50,065"								
921	"$37,645"								
922	"$66,288"								
923	"$47,459"								
927	"$545,333"								
928	"$175,495"								
929	"$100,763"								
933	"$85,814"								
934	"$61,479"								
935	"$60,906"								
939	"$109,658"								
940	"$87,797"								
941	"$84,455"								
945	"$67,332"								
946	"$60,863"								
947	"$53,769"								
948	"$41,729"								
949	"$44,941"								
950	"$25,927"								
951	"$27,523"								
955	"$237,448"								
956	"$129,429"								
957	"$251,148"								
958	"$154,567"								
959	"$107,942"								
963	"$96,645"								
964	"$67,052"								
965	"$51,548"								
969	"$197,383"								
970	"$96,668"								
974	"$93,434"								
975	"$59,730"								
976	"$47,637"								
977	"$57,448"								
981	"$146,285"								
982	"$96,151"								
983	"$77,236"								
987	"$114,445"								
988	"$74,480"								
989	"$60,418"								
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)									
