"TABLE 10. FINAL NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2019"				
MS?DRG	Number of Cases	Threshold		
001	2151	"$586,281"		
002	290	"$368,372"		
003	16591	"$378,692"		
004	15584	"$233,931"		
005	1220	"$251,193"		
006	447	"$142,665"		
007	637	"$275,581"		
008	427	"$154,637"		
010	50	"$134,353"		
011	1749	"$121,220"		
012	1833	"$98,631"		
013	695	"$71,303"		
014	903	"$257,217"		
016	1980	"$161,062"		
017	157	"$119,393"		
020	1483	"$256,611"		
021	362	"$192,335"		
022	101	"$148,534"		
023	7694	"$141,249"		
024	2671	"$107,806"		
025	19657	"$112,027"		
026	8957	"$85,221"		
027	10730	"$72,820"		
028	1695	"$133,153"		
029	3250	"$86,113"		
030	1934	"$64,967"		
031	978	"$97,627"		
032	1892	"$65,036"		
033	2796	"$57,872"		
034	608	"$109,054"		
035	1680	"$69,855"		
036	2797	"$59,872"		
037	4163	"$89,727"		
038	12084	"$57,085"		
039	27337	"$47,270"		
040	4462	"$95,799"		
041	5309	"$70,666"		
042	2178	"$61,600"		
052	853	"$49,316"		
053	243	"$38,857"		
054	12919	"$44,754"		
055	5652	"$39,598"		
056	11473	"$48,720"		
057	30092	"$37,915"		
058	932	"$49,612"		
059	3241	"$39,637"		
060	3011	"$34,221"		
061	4908	"$90,416"		
062	9423	"$73,791"		
063	2099	"$67,414"		
064	77607	"$53,401"		
065	113049	"$42,626"		
066	41824	"$34,458"		
067	845	"$49,250"		
068	3975	"$40,277"		
069	52592	"$35,260"		
070	15859	"$49,034"		
071	16960	"$38,412"		
072	4749	"$33,219"		
073	6969	"$44,685"		
074	18293	"$37,839"		
075	716	"$53,086"		
076	269	"$39,880"		
077	2236	"$51,080"		
078	2891	"$41,487"		
079	1292	"$35,117"		
080	507	"$48,596"		
081	671	"$31,141"		
082	4243	"$58,412"		
083	4441	"$45,190"		
084	3244	"$38,209"		
085	10372	"$56,547"		
086	16656	"$42,849"		
087	11604	"$34,797"		
088	678	"$48,548"		
089	1732	"$41,931"		
090	944	"$36,400"		
091	13422	"$47,304"		
092	20611	"$36,962"		
093	8612	"$31,804"		
094	1345	"$83,337"		
095	1213	"$67,172"		
096	501	"$67,050"		
097	2114	"$85,267"		
098	1418	"$56,544"		
099	597	"$44,976"		
100	24821	"$49,423"		
101	43447	"$34,495"		
102	1579	"$40,564"		
103	10862	"$33,058"		
113	492	"$64,080"		
114	169	"$48,160"		
115	690	"$51,218"		
116	355	"$51,274"		
117	181	"$41,601"		
121	612	"$35,157"		
122	242	"$26,428"		
123	2648	"$35,374"		
124	956	"$42,256"		
125	3431	"$31,299"		
129	1833	"$69,864"		
130	1004	"$54,903"		
131	1280	"$76,910"		
132	556	"$55,933"		
133	1997	"$58,802"		
134	1187	"$45,454"		
135	249	"$67,590"		
136	112	"$51,006"		
137	668	"$46,165"		
138	395	"$36,108"		
139	357	"$44,330"		
146	896	"$52,215"		
147	968	"$40,954"		
148	255	"$34,183"		
149	16758	"$31,451"		
150	1156	"$40,434"		
151	3414	"$26,051"		
152	3141	"$38,050"		
153	8892	"$28,196"		
154	2041	"$46,366"		
155	4357	"$35,410"		
156	1883	"$27,760"		
157	1795	"$46,893"		
158	3568	"$34,671"		
159	1167	"$27,736"		
163	12175	"$123,139"		
164	16031	"$78,021"		
165	8525	"$62,796"		
166	19229	"$90,108"		
167	11696	"$60,153"		
168	3340	"$49,500"		
175	23877	"$48,835"		
176	33736	"$36,102"		
177	73371	"$53,347"		
178	37156	"$43,140"		
179	8017	"$34,545"		
180	18274	"$52,755"		
181	12640	"$42,355"		
182	958	"$36,792"		
183	4827	"$48,454"		
184	9744	"$40,469"		
185	2893	"$31,797"		
186	11267	"$48,332"		
187	7937	"$40,072"		
188	1846	"$33,491"		
189	146154	"$42,587"		
190	134915	"$41,332"		
191	94991	"$34,956"		
192	45065	"$28,382"		
193	140848	"$45,563"		
194	126253	"$35,768"		
195	41104	"$28,113"		
196	7748	"$48,189"		
197	3542	"$39,135"		
198	1072	"$32,098"		
199	5195	"$53,388"		
200	8612	"$39,705"		
201	2123	"$29,229"		
202	36093	"$35,224"		
203	12916	"$27,450"		
204	10400	"$32,163"		
205	7574	"$45,580"		
206	10743	"$34,444"		
207	21783	"$140,324"		
208	60134	"$69,533"		
215	304	"$245,193"		
216	9725	"$248,177"		
217	3738	"$175,626"		
218	528	"$163,290"		
219	16933	"$196,613"		
220	19483	"$146,523"		
221	3726	"$131,073"		
222	1534	"$226,142"		
223	959	"$174,894"		
224	2144	"$199,260"		
225	1926	"$161,005"		
226	4416	"$174,425"		
227	6752	"$142,504"		
228	3770	"$168,705"		
229	4945	"$129,388"		
231	1126	"$242,663"		
232	823	"$185,646"		
233	12724	"$202,266"		
234	17069	"$155,114"		
235	10155	"$158,484"		
236	20051	"$120,431"		
239	9096	"$98,921"		
240	7797	"$67,911"		
241	959	"$47,308"		
242	17889	"$99,174"		
243	26178	"$78,921"		
244	18174	"$69,094"		
245	2552	"$139,227"		
246	39004	"$106,776"		
247	89074	"$83,100"		
248	7039	"$102,299"		
249	11351	"$79,097"		
250	3880	"$86,957"		
251	6353	"$69,306"		
252	35664	"$85,164"		
253	28903	"$75,939"		
254	13746	"$60,778"		
255	2140	"$65,817"		
256	2626	"$52,722"		
257	172	"$39,958"		
258	805	"$86,594"		
259	1967	"$65,436"		
260	2240	"$93,236"		
261	3455	"$62,619"		
262	1627	"$57,245"		
263	476	"$65,682"		
264	9237	"$76,367"		
265	899	"$85,333"		
266	11330	"$190,714"		
267	15152	"$155,554"		
268	4001	"$166,332"		
269	18034	"$110,576"		
270	18056	"$128,774"		
271	15153	"$97,155"		
272	5830	"$75,154"		
273	6947	"$109,205"		
274	15495	"$93,446"		
280	72804	"$51,122"		
281	47516	"$40,440"		
282	24945	"$35,938"		
283	10058	"$51,249"		
284	1669	"$33,735"		
285	501	"$24,936"		
286	33651	"$69,697"		
287	74511	"$50,886"		
288	1423	"$67,493"		
289	723	"$50,569"		
290	147	"$40,002"		
291	236047	"$45,790"		
292	183399	"$34,659"		
293	52688	"$25,615"		
294	253	"$36,910"		
295	43	"$30,845"		
296	3479	"$49,056"		
297	541	"$29,401"		
298	264	"$20,690"		
299	19153	"$43,725"		
300	32468	"$36,300"		
301	11860	"$27,173"		
302	4826	"$38,588"		
303	16783	"$27,767"		
304	3088	"$39,579"		
305	20708	"$29,594"		
306	3793	"$41,932"		
307	3818	"$32,488"		
308	74255	"$41,576"		
309	91564	"$30,452"		
310	69921	"$23,140"		
311	6858	"$28,762"		
312	76255	"$33,611"		
313	57228	"$31,717"		
314	43109	"$52,651"		
315	20475	"$37,048"		
316	4436	"$30,991"		
326	17099	"$104,154"		
327	19396	"$62,182"		
328	10626	"$54,318"		
329	37244	"$119,336"		
330	58128	"$73,846"		
331	27205	"$58,571"		
332	231	"$90,045"		
333	887	"$61,418"		
334	1086	"$48,051"		
335	5840	"$105,960"		
336	10084	"$71,805"		
337	5560	"$56,939"		
338	1033	"$83,066"		
339	2944	"$61,229"		
340	2705	"$50,320"		
341	772	"$75,736"		
342	2083	"$56,542"		
343	2812	"$47,334"		
344	1882	"$73,854"		
345	3648	"$51,567"		
346	1659	"$43,493"		
347	901	"$70,378"		
348	2131	"$48,863"		
349	1268	"$40,729"		
350	1462	"$72,577"		
351	3435	"$54,069"		
352	3344	"$44,551"		
353	3360	"$83,091"		
354	8876	"$57,755"		
355	7690	"$49,455"		
356	6876	"$95,140"		
357	6510	"$64,905"		
358	1486	"$51,597"		
368	2894	"$54,958"		
369	4379	"$41,965"		
370	675	"$31,542"		
371	20376	"$49,126"		
372	31177	"$38,789"		
373	8658	"$29,618"		
374	9874	"$55,004"		
375	14253	"$43,054"		
376	1517	"$38,392"		
377	57541	"$51,468"		
378	129357	"$37,958"		
379	22415	"$27,032"		
380	4182	"$55,380"		
381	7016	"$42,153"		
382	1795	"$34,451"		
383	1351	"$47,924"		
384	5438	"$38,217"		
385	2581	"$49,496"		
386	9639	"$38,013"		
387	3052	"$30,371"		
388	18301	"$47,251"		
389	51310	"$33,717"		
390	34020	"$25,140"		
391	42181	"$42,804"		
392	170663	"$32,341"		
393	23250	"$48,707"		
394	42408	"$37,425"		
395	13650	"$28,696"		
405	4060	"$128,445"		
406	4796	"$83,818"		
407	1725	"$67,157"		
408	1049	"$99,935"		
409	852	"$72,614"		
410	314	"$59,739"		
411	341	"$99,027"		
412	403	"$79,166"		
413	243	"$62,551"		
414	2476	"$95,493"		
415	3305	"$67,300"		
416	1940	"$51,866"		
417	15449	"$76,976"		
418	22781	"$62,173"		
419	17699	"$53,437"		
420	638	"$97,046"		
421	798	"$60,972"		
422	225	"$55,093"		
423	1090	"$96,873"		
424	485	"$67,832"		
425	102	"$56,793"		
432	13917	"$52,480"		
433	11176	"$39,138"		
434	861	"$26,292"		
435	13656	"$52,465"		
436	8710	"$42,083"		
437	972	"$38,317"		
438	14795	"$49,939"		
439	27962	"$36,120"		
440	16316	"$28,280"		
441	18106	"$50,245"		
442	18786	"$36,203"		
443	3390	"$28,242"		
444	12720	"$51,142"		
445	18823	"$42,126"		
446	8170	"$35,541"		
453	2958	"$221,423"		
454	11782	"$151,465"		
455	11955	"$125,213"		
456	1418	"$215,246"		
457	3708	"$162,845"		
458	1460	"$126,185"		
459	5691	"$139,973"		
460	66046	"$103,248"		
461	402	"$122,585"		
462	8824	"$91,235"		
463	5627	"$104,860"		
464	10191	"$74,421"		
465	3786	"$58,123"		
466	4118	"$119,285"		
467	20401	"$91,289"		
468	17632	"$77,223"		
469	29535	"$86,956"		
470	485985	"$64,603"		
471	3850	"$125,099"		
472	17081	"$81,640"		
473	26625	"$70,102"		
474	3622	"$87,849"		
475	4195	"$60,808"		
476	989	"$43,602"		
477	3395	"$85,069"		
478	7087	"$69,260"		
479	2145	"$60,097"		
480	28766	"$84,416"		
481	80008	"$65,864"		
482	24364	"$57,233"		
483	54669	"$72,918"		
485	925	"$90,945"		
486	2036	"$68,842"		
487	729	"$56,790"		
488	2966	"$59,580"		
489	2688	"$47,772"		
492	6307	"$89,771"		
493	19222	"$68,536"		
494	14166	"$58,569"		
495	481	"$80,915"		
496	1814	"$61,214"		
497	1403	"$48,754"		
498	1138	"$68,158"		
499	329	"$45,486"		
500	2774	"$76,125"		
501	5924	"$54,150"		
502	3745	"$46,652"		
503	1849	"$68,656"		
504	4355	"$54,957"		
505	1795	"$50,516"		
506	540	"$48,965"		
507	480	"$60,072"		
508	245	"$52,652"		
509	75	"$54,623"		
510	1180	"$75,220"		
511	3567	"$61,609"		
512	2720	"$53,882"		
513	1703	"$52,433"		
514	624	"$41,397"		
515	5392	"$79,679"		
516	14067	"$61,746"		
517	14167	"$51,017"		
518	4078	"$79,228"		
519	8378	"$59,954"		
520	10474	"$48,986"		
533	890	"$42,676"		
534	2603	"$26,909"		
535	7895	"$41,175"		
536	25647	"$27,644"		
537	823	"$35,729"		
538	369	"$25,927"		
539	4130	"$50,362"		
540	5070	"$41,627"		
541	1133	"$34,550"		
542	6938	"$50,638"		
543	14459	"$39,663"		
544	4408	"$29,370"		
545	3289	"$56,801"		
546	4353	"$39,314"		
547	1548	"$31,368"		
548	670	"$55,810"		
549	1243	"$41,639"		
550	480	"$34,530"		
551	12762	"$48,407"		
552	53349	"$35,650"		
553	2618	"$40,398"		
554	13427	"$27,556"		
555	2572	"$41,692"		
556	11157	"$30,346"		
557	3852	"$46,095"		
558	12008	"$32,686"		
559	3137	"$46,302"		
560	6285	"$36,037"		
561	3566	"$26,316"		
562	6353	"$44,083"		
563	25108	"$30,775"		
564	3711	"$46,501"		
565	6344	"$36,080"		
566	1914	"$30,929"		
570	4374	"$62,515"		
571	4995	"$49,776"		
572	1653	"$42,588"		
573	1316	"$81,564"		
574	935	"$73,042"		
575	302	"$51,381"		
576	476	"$103,162"		
577	1561	"$69,300"		
578	1240	"$51,491"		
579	5513	"$66,739"		
580	10679	"$50,641"		
581	5953	"$45,170"		
582	894	"$51,771"		
583	1105	"$48,430"		
584	665	"$58,956"		
585	871	"$55,592"		
592	5499	"$41,595"		
593	4353	"$34,909"		
594	636	"$25,927"		
595	996	"$50,968"		
596	3002	"$33,459"		
597	1302	"$53,317"		
598	1639	"$40,411"		
599	98	"$33,449"		
600	1060	"$35,050"		
601	527	"$23,716"		
602	28588	"$43,733"		
603	118343	"$29,522"		
604	3282	"$45,644"		
605	14512	"$34,442"		
606	1734	"$41,384"		
607	6170	"$28,414"		
614	1933	"$73,250"		
615	1208	"$56,699"		
616	1901	"$96,169"		
617	9230	"$61,193"		
618	171	"$42,651"		
619	1000	"$82,613"		
620	3511	"$62,752"		
621	13695	"$57,071"		
622	1048	"$77,183"		
623	3547	"$53,588"		
624	224	"$41,907"		
625	1034	"$77,165"		
626	1371	"$56,227"		
627	1970	"$45,631"		
628	2961	"$87,654"		
629	4128	"$65,517"		
630	281	"$52,619"		
637	28522	"$43,372"		
638	50910	"$31,767"		
639	12516	"$24,783"		
640	69178	"$39,581"		
641	94602	"$28,607"		
642	1991	"$40,270"		
643	9259	"$47,862"		
644	12250	"$37,244"		
645	4669	"$28,447"		
652	10907	"$104,022"		
653	1879	"$131,959"		
654	4297	"$83,575"		
655	1571	"$68,404"		
656	3046	"$92,929"		
657	7158	"$67,711"		
658	6531	"$58,307"		
659	3083	"$84,293"		
660	6559	"$59,614"		
661	3162	"$54,882"		
662	440	"$78,487"		
663	810	"$56,356"		
664	501	"$45,999"		
665	641	"$84,806"		
666	1699	"$56,269"		
667	725	"$39,596"		
668	3856	"$73,851"		
669	13061	"$50,922"		
670	3032	"$40,879"		
671	475	"$51,409"		
672	274	"$41,734"		
673	8381	"$86,929"		
674	5427	"$68,257"		
675	579	"$55,341"		
682	127384	"$45,107"		
683	146273	"$34,685"		
684	22800	"$25,183"		
685	116	"$36,801"		
686	1614	"$51,246"		
687	2928	"$40,195"		
688	382	"$35,224"		
689	82014	"$38,993"		
690	147531	"$30,526"		
691	482	"$55,428"		
692	66	"$45,548"		
693	2576	"$48,306"		
694	16483	"$35,937"		
695	1499	"$39,971"		
696	7698	"$26,517"		
697	565	"$38,567"		
698	48693	"$46,166"		
699	31556	"$37,311"		
700	4971	"$29,311"		
707	4866	"$63,745"		
708	14365	"$56,309"		
709	460	"$62,803"		
710	285	"$49,819"		
711	438	"$61,662"		
712	146	"$39,755"		
713	5498	"$48,636"		
714	2433	"$36,277"		
715	398	"$63,462"		
716	219	"$56,007"		
717	896	"$59,880"		
718	306	"$47,552"		
722	844	"$49,138"		
723	1655	"$39,836"		
724	121	"$31,721"		
725	693	"$42,532"		
726	2724	"$28,673"		
727	1712	"$45,512"		
728	5030	"$30,849"		
729	751	"$38,092"		
730	155	"$26,579"		
734	1282	"$69,657"		
735	884	"$53,967"		
736	652	"$108,706"		
737	2577	"$65,796"		
738	583	"$54,340"		
739	591	"$94,837"		
740	2584	"$61,138"		
741	2208	"$51,157"		
742	5397	"$56,305"		
743	8369	"$44,703"		
744	1430	"$54,974"		
745	313	"$42,130"		
746	1485	"$52,214"		
747	1726	"$38,543"		
748	2139	"$46,766"		
749	839	"$71,740"		
750	170	"$49,930"		
754	1668	"$50,892"		
755	2960	"$39,766"		
756	189	"$27,152"		
757	972	"$46,433"		
758	1488	"$37,540"		
759	594	"$27,205"		
760	1643	"$33,207"		
761	440	"$28,088"		
765	3981	"$36,255"		
766	2260	"$27,239"		
767	322	"$29,143"		
768	23	"$36,400"		
769	105	"$47,569"		
770	103	"$30,787"		
774	2197	"$22,614"		
775	5294	"$17,119"		
776	455	"$29,373"		
777	91	"$37,804"		
778	239	"$16,267"		
779	73	"$23,808"		
780	65	"$12,477"		
781	2490	"$26,802"		
782	98	"$19,503"		
790	1	"$869,151"		
791	1	"$154,393"		
794	1	"$6,026"		
799	506	"$123,903"		
800	397	"$80,240"		
801	202	"$59,911"		
802	874	"$81,868"		
803	1063	"$59,837"		
804	479	"$48,280"		
808	7359	"$56,403"		
809	14614	"$40,988"		
810	2001	"$35,846"		
811	26801	"$43,500"		
812	63817	"$33,210"		
813	8938	"$47,105"		
814	1544	"$50,436"		
815	2686	"$38,776"		
816	846	"$30,716"		
820	924	"$133,591"		
821	1157	"$69,872"		
822	1019	"$49,491"		
823	2246	"$107,313"		
824	2521	"$68,000"		
825	826	"$50,299"		
826	745	"$129,643"		
827	1313	"$73,417"		
828	742	"$57,861"		
829	1611	"$80,767"		
830	428	"$49,301"		
834	4005	"$100,919"		
835	2303	"$51,677"		
836	604	"$39,844"		
837	1825	"$111,230"		
838	1143	"$56,472"		
839	1027	"$42,319"		
840	8353	"$70,694"		
841	7745	"$48,935"		
842	1892	"$40,104"		
843	2047	"$52,262"		
844	2162	"$42,326"		
845	425	"$36,932"		
846	3200	"$59,573"		
847	13568	"$43,535"		
848	449	"$35,010"		
849	521	"$54,351"		
853	73191	"$120,822"		
854	16956	"$70,444"		
855	261	"$51,243"		
856	7115	"$96,161"		
857	8988	"$57,008"		
858	1296	"$46,518"		
862	10778	"$50,920"		
863	12165	"$35,908"		
864	11333	"$34,477"		
865	3746	"$44,897"		
866	6605	"$31,393"		
867	3134	"$54,074"		
868	2466	"$37,996"		
869	622	"$30,734"		
870	33679	"$154,160"		
871	554290	"$53,499"		
872	156372	"$39,661"		
876	639	"$72,795"		
880	6800	"$31,368"		
881	5652	"$20,635"		
882	2230	"$24,184"		
883	1189	"$28,437"		
884	19948	"$37,516"		
885	78016	"$29,068"		
886	394	"$27,784"		
887	462	"$36,306"		
894	4431	"$17,740"		
895	4076	"$31,785"		
896	8745	"$45,995"		
897	32653	"$25,787"		
901	969	"$91,329"		
902	1833	"$57,585"		
903	620	"$44,016"		
904	963	"$78,000"		
905	312	"$49,724"		
906	555	"$54,761"		
907	8668	"$96,300"		
908	9721	"$59,377"		
909	3973	"$48,088"		
913	900	"$45,637"		
914	3034	"$34,999"		
915	2340	"$48,867"		
916	4295	"$22,545"		
917	34425	"$44,776"		
918	25544	"$28,413"		
919	12858	"$49,796"		
920	13254	"$37,251"		
921	3735	"$27,895"		
922	1483	"$47,166"		
923	1956	"$30,645"		
927	176	"$361,160"		
928	1048	"$116,212"		
929	327	"$67,921"		
933	124	"$63,615"		
934	518	"$43,636"		
935	1787	"$41,286"		
939	1231	"$84,404"		
940	2578	"$65,387"		
941	1424	"$55,711"		
945	745	"$29,024"		
946	168	"$25,861"		
947	11493	"$40,081"		
948	38342	"$30,818"		
949	2544	"$36,526"		
950	642	"$25,715"		
951	745	"$29,591"		
955	398	"$157,616"		
956	5503	"$93,062"		
957	2079	"$178,552"		
958	1660	"$115,616"		
959	174	"$80,592"		
963	2631	"$72,072"		
964	4040	"$49,296"		
965	825	"$39,380"		
969	565	"$126,588"		
970	48	"$70,962"		
974	4935	"$68,327"		
975	2755	"$44,142"		
976	606	"$37,237"		
977	1841	"$42,017"		
981	31100	"$101,571"		
982	15914	"$70,213"		
983	3695	"$53,999"		
987	8471	"$82,950"		
988	8846	"$55,690"		
989	2341	"$43,991"		
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 2016 MedPAR file; MS-DRGs are from GROUPER Version35.0.				
