"TABLE 10. PROPOSED NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2019"				
MS?DRG	Number of Cases	Threshold		
1	2079	"$580,961"		
2	285	"$368,704"		
3	15639	"$380,326"		
4	16205	"$236,212"		
5	1185	"$250,942"		
6	433	"$142,233"		
7	626	"$275,320"		
8	416	"$155,642"		
10	50	"$134,914"		
11	1740	"$121,026"		
12	1825	"$98,518"		
13	694	"$71,413"		
14	844	"$255,529"		
16	4	"$15,752"		
17	2	"$15,752"		
20	1471	"$256,683"		
21	357	"$191,800"		
22	103	"$148,987"		
23	7552	"$141,065"		
24	2596	"$107,786"		
25	19536	"$111,897"		
26	8896	"$85,222"		
27	10653	"$72,879"		
28	1684	"$133,061"		
29	3240	"$86,247"		
30	1910	"$65,012"		
31	976	"$97,908"		
32	1885	"$65,101"		
33	2789	"$57,871"		
34	578	"$109,110"		
35	1621	"$70,008"		
36	2690	"$59,754"		
37	4150	"$89,694"		
38	12047	"$57,113"		
39	27252	"$47,319"		
40	3219	"$93,194"		
41	4731	"$71,271"		
42	2048	"$63,107"		
52	868	"$49,686"		
53	245	"$39,096"		
54	12965	"$44,984"		
55	5657	"$39,672"		
56	11473	"$48,832"		
57	30028	"$37,940"		
58	936	"$50,033"		
59	3231	"$39,702"		
60	2987	"$34,205"		
61	4921	"$90,684"		
62	9407	"$73,761"		
63	2096	"$67,506"		
64	77931	"$53,671"		
65	112902	"$42,702"		
66	41682	"$34,456"		
67	845	"$49,459"		
68	3969	"$40,331"		
69	52489	"$35,284"		
70	15825	"$49,118"		
71	16924	"$38,406"		
72	4736	"$33,180"		
73	6923	"$44,823"		
74	18239	"$37,896"		
75	713	"$53,264"		
76	266	"$39,931"		
77	2230	"$51,053"		
78	2886	"$41,488"		
79	1291	"$35,071"		
80	506	"$48,648"		
81	669	"$30,932"		
82	4290	"$58,973"		
83	4470	"$45,311"		
84	3235	"$38,213"		
85	10524	"$56,985"		
86	16752	"$43,015"		
87	11639	"$34,782"		
88	677	"$48,785"		
89	1736	"$42,028"		
90	936	"$36,211"		
91	13408	"$47,402"		
92	20616	"$36,992"		
93	8607	"$31,764"		
94	1343	"$83,680"		
95	1212	"$67,141"		
96	497	"$67,101"		
97	2118	"$85,406"		
98	1417	"$56,622"		
99	594	"$45,006"		
100	24779	"$49,520"		
101	43297	"$34,481"		
102	1569	"$40,640"		
103	10806	"$33,040"		
113	488	"$64,316"		
114	167	"$48,261"		
115	688	"$51,301"		
116	351	"$51,358"		
117	180	"$41,453"		
121	610	"$35,253"		
122	242	"$26,425"		
123	2639	"$35,329"		
124	960	"$42,546"		
125	3432	"$31,372"		
129	1823	"$69,911"		
130	1002	"$54,932"		
131	1268	"$76,425"		
132	552	"$55,654"		
133	1988	"$58,829"		
134	1174	"$45,456"		
135	247	"$67,640"		
136	113	"$51,357"		
137	629	"$45,937"		
138	384	"$35,652"		
139	360	"$44,522"		
146	889	"$52,322"		
147	962	"$40,893"		
148	256	"$33,940"		
149	16736	"$31,424"		
150	1163	"$40,717"		
151	3416	"$26,179"		
152	3135	"$38,092"		
153	8863	"$28,170"		
154	2047	"$46,515"		
155	4359	"$35,516"		
156	1882	"$27,757"		
157	1809	"$47,110"		
158	3583	"$34,683"		
159	1170	"$27,719"		
163	10399	"$127,345"		
164	15416	"$78,895"		
165	8432	"$62,948"		
166	15310	"$89,252"		
167	9598	"$59,168"		
168	3184	"$49,266"		
175	26342	"$51,107"		
176	35663	"$38,302"		
177	73402	"$53,494"		
178	37110	"$43,223"		
179	7998	"$34,547"		
180	18442	"$53,090"		
181	12694	"$42,459"		
182	957	"$36,806"		
183	4801	"$48,501"		
184	9572	"$40,454"		
185	2845	"$31,790"		
186	11258	"$48,446"		
187	7903	"$40,129"		
188	1836	"$33,560"		
189	146009	"$42,685"		
190	134767	"$41,419"		
191	94863	"$35,004"		
192	44969	"$28,378"		
193	140794	"$45,652"		
194	126048	"$35,810"		
195	41005	"$28,105"		
196	7728	"$48,254"		
197	3538	"$39,190"		
198	1062	"$32,184"		
199	5186	"$53,496"		
200	8551	"$39,741"		
201	2113	"$29,262"		
202	36054	"$35,315"		
203	12894	"$27,443"		
204	10399	"$32,302"		
205	7643	"$45,840"		
206	10737	"$34,451"		
207	22139	"$141,165"		
208	60533	"$69,919"		
215	285	"$246,407"		
216	9666	"$248,316"		
217	3711	"$176,015"		
218	528	"$163,056"		
219	16843	"$196,794"		
220	19386	"$146,624"		
221	3709	"$130,838"		
222	1522	"$226,162"		
223	956	"$174,875"		
224	2130	"$198,715"		
225	1910	"$161,189"		
226	4377	"$174,863"		
227	6718	"$142,706"		
228	3292	"$177,916"		
229	4500	"$134,886"		
231	1122	"$242,622"		
232	819	"$185,865"		
233	12666	"$202,293"		
234	16954	"$155,270"		
235	10107	"$158,539"		
236	19972	"$120,442"		
239	9052	"$98,980"		
240	7753	"$68,028"		
241	955	"$47,407"		
242	17938	"$99,321"		
243	26166	"$78,942"		
244	18178	"$69,168"		
245	2533	"$139,453"		
246	38893	"$106,860"		
247	88744	"$83,183"		
248	7033	"$102,324"		
249	11330	"$79,127"		
250	3872	"$87,081"		
251	6341	"$69,325"		
252	32685	"$86,114"		
253	26325	"$78,169"		
254	13003	"$61,890"		
255	2136	"$65,786"		
256	2616	"$52,824"		
257	169	"$40,065"		
258	803	"$87,247"		
259	1961	"$65,552"		
260	2245	"$93,748"		
261	3465	"$62,938"		
262	1622	"$57,239"		
263	481	"$66,261"		
264	9303	"$76,668"		
265	901	"$85,530"		
266	11219	"$190,593"		
267	15010	"$155,534"		
268	3996	"$166,365"		
269	17973	"$110,671"		
270	17982	"$128,821"		
271	15110	"$97,188"		
272	5803	"$75,176"		
273	6922	"$109,057"		
274	15340	"$93,382"		
280	72696	"$51,216"		
281	47434	"$40,508"		
282	24868	"$35,943"		
283	10041	"$51,363"		
284	1666	"$33,827"		
285	502	"$24,989"		
286	33615	"$69,799"		
287	74331	"$50,935"		
288	1424	"$67,654"		
289	718	"$50,608"		
290	147	"$40,046"		
291	235559	"$45,854"		
292	182975	"$34,679"		
293	52591	"$25,603"		
294	274	"$38,501"		
295	45	"$31,808"		
296	3473	"$49,100"		
297	542	"$29,337"		
298	263	"$20,649"		
299	20997	"$45,240"		
300	34437	"$37,253"		
301	12488	"$28,197"		
302	4815	"$38,679"		
303	16733	"$27,772"		
304	3085	"$39,626"		
305	20658	"$29,596"		
306	3791	"$42,011"		
307	3814	"$32,506"		
308	74268	"$41,676"		
309	91440	"$30,503"		
310	69795	"$23,148"		
311	6860	"$28,829"		
312	76176	"$33,638"		
313	57101	"$31,709"		
314	43045	"$52,797"		
315	20483	"$37,123"		
316	4418	"$30,967"		
326	17048	"$104,123"		
327	19316	"$62,227"		
328	10590	"$54,388"		
329	37038	"$119,401"		
330	57831	"$73,919"		
331	27065	"$58,617"		
332	232	"$89,800"		
333	889	"$61,295"		
334	1098	"$48,139"		
335	5811	"$105,976"		
336	10049	"$71,880"		
337	5538	"$56,964"		
338	1030	"$82,987"		
339	2934	"$61,261"		
340	2692	"$50,365"		
341	766	"$75,930"		
342	2075	"$56,609"		
343	2796	"$47,191"		
344	1872	"$73,870"		
345	3633	"$51,567"		
346	1646	"$43,533"		
347	900	"$70,464"		
348	2130	"$48,969"		
349	1271	"$40,703"		
350	1459	"$72,608"		
351	3429	"$54,070"		
352	3338	"$44,596"		
353	3346	"$83,115"		
354	8852	"$57,794"		
355	7657	"$49,477"		
356	5231	"$97,118"		
357	5278	"$65,706"		
358	1443	"$51,702"		
368	2909	"$55,168"		
369	4374	"$42,039"		
370	673	"$31,614"		
371	20345	"$49,262"		
372	31101	"$38,830"		
373	8635	"$29,630"		
374	10011	"$55,531"		
375	14284	"$43,180"		
376	1510	"$38,426"		
377	58236	"$51,830"		
378	129783	"$38,155"		
379	22390	"$27,057"		
380	4217	"$55,678"		
381	7012	"$42,279"		
382	1789	"$34,491"		
383	1361	"$48,280"		
384	5434	"$38,262"		
385	2595	"$49,705"		
386	9562	"$38,222"		
387	3095	"$30,476"		
388	18285	"$47,382"		
389	51186	"$33,725"		
390	33928	"$25,147"		
391	42169	"$42,917"		
392	170229	"$32,345"		
393	23390	"$49,011"		
394	42436	"$37,565"		
395	13659	"$28,708"		
405	4020	"$128,386"		
406	4760	"$83,925"		
407	1719	"$67,190"		
408	1048	"$100,079"		
409	852	"$72,650"		
410	314	"$59,753"		
411	339	"$99,153"		
412	399	"$79,449"		
413	241	"$62,520"		
414	2472	"$95,403"		
415	3289	"$67,291"		
416	1936	"$51,945"		
417	15400	"$76,987"		
418	22707	"$62,218"		
419	17628	"$53,464"		
420	631	"$97,557"		
421	790	"$60,967"		
422	223	"$55,125"		
423	818	"$92,942"		
424	408	"$67,270"		
425	100	"$57,307"		
432	13887	"$52,631"		
433	11146	"$39,224"		
434	857	"$26,212"		
435	13681	"$52,697"		
436	8689	"$42,138"		
437	970	"$38,406"		
438	14771	"$50,076"		
439	27867	"$36,138"		
440	16265	"$28,286"		
441	18069	"$50,357"		
442	18696	"$36,234"		
443	3367	"$28,273"		
444	12713	"$51,275"		
445	18779	"$42,162"		
446	8139	"$35,530"		
453	2941	"$221,013"		
454	11733	"$151,577"		
455	11894	"$125,178"		
456	1410	"$214,404"		
457	3689	"$162,990"		
458	1455	"$126,166"		
459	5660	"$139,966"		
460	65732	"$103,226"		
461	403	"$123,021"		
462	8801	"$91,401"		
463	5590	"$104,694"		
464	10125	"$74,344"		
465	3762	"$58,141"		
466	4105	"$119,382"		
467	20338	"$91,347"		
468	17559	"$77,294"		
469	29421	"$86,988"		
470	484360	"$64,644"		
471	3822	"$125,020"		
472	16975	"$81,678"		
473	26469	"$70,132"		
474	3601	"$87,833"		
475	4175	"$60,869"		
476	986	"$43,673"		
477	3383	"$85,046"		
478	7032	"$69,303"		
479	2140	"$60,130"		
480	28634	"$84,423"		
481	79725	"$65,902"		
482	24302	"$57,268"		
483	54540	"$72,984"		
485	919	"$91,117"		
486	2026	"$68,806"		
487	727	"$56,806"		
488	2942	"$59,627"		
489	2673	"$47,765"		
492	6251	"$89,638"		
493	19053	"$68,469"		
494	14059	"$58,555"		
495	479	"$80,839"		
496	1808	"$61,266"		
497	1397	"$48,870"		
498	1136	"$68,312"		
499	329	"$45,725"		
500	2489	"$76,775"		
501	5304	"$54,567"		
502	3593	"$46,883"		
503	1868	"$68,979"		
504	4419	"$55,032"		
505	1798	"$50,499"		
506	546	"$49,109"		
507	484	"$60,741"		
508	244	"$52,774"		
509	74	"$54,682"		
510	1184	"$75,195"		
511	3555	"$61,463"		
512	2706	"$53,819"		
513	1632	"$53,028"		
514	601	"$41,729"		
515	5072	"$79,098"		
516	13755	"$61,856"		
517	14099	"$51,024"		
518	4060	"$79,114"		
519	8324	"$59,970"		
520	10437	"$49,032"		
533	891	"$42,790"		
534	2603	"$27,055"		
535	7901	"$41,355"		
536	25588	"$27,656"		
537	822	"$35,859"		
538	368	"$25,775"		
539	4135	"$50,480"		
540	5095	"$41,814"		
541	1125	"$34,590"		
542	6931	"$50,745"		
543	14432	"$39,689"		
544	4407	"$29,373"		
545	3303	"$57,404"		
546	4343	"$39,425"		
547	1533	"$31,258"		
548	672	"$55,810"		
549	1262	"$41,983"		
550	488	"$34,477"		
551	12727	"$48,569"		
552	53154	"$35,672"		
553	2620	"$40,556"		
554	13430	"$27,564"		
555	2660	"$42,460"		
556	11280	"$30,729"		
557	3865	"$46,277"		
558	12074	"$32,792"		
559	3171	"$46,579"		
560	6350	"$36,307"		
561	3579	"$26,484"		
562	6351	"$44,183"		
563	25058	"$30,781"		
564	3763	"$46,697"		
565	6410	"$36,220"		
566	1928	"$30,976"		
570	4345	"$62,525"		
571	4953	"$49,831"		
572	1647	"$42,550"		
573	1311	"$81,737"		
574	924	"$72,813"		
575	301	"$51,436"		
576	473	"$103,316"		
577	1555	"$69,208"		
578	1236	"$51,386"		
579	4643	"$69,059"		
580	7883	"$53,388"		
581	4605	"$47,996"		
582	895	"$51,650"		
583	1104	"$48,413"		
584	665	"$58,843"		
585	865	"$55,618"		
592	5494	"$41,662"		
593	4361	"$35,007"		
594	635	"$25,927"		
595	995	"$51,023"		
596	2992	"$33,465"		
597	1299	"$53,558"		
598	1628	"$40,533"		
599	97	"$33,695"		
600	1067	"$35,071"		
601	531	"$23,616"		
602	29095	"$43,957"		
603	121059	"$29,870"		
604	3481	"$46,277"		
605	15133	"$34,890"		
606	1736	"$41,325"		
607	6190	"$28,511"		
614	1927	"$73,354"		
615	1203	"$56,779"		
616	1889	"$96,037"		
617	9174	"$61,205"		
618	168	"$42,490"		
619	987	"$82,652"		
620	3452	"$62,856"		
621	13490	"$57,073"		
622	1043	"$77,111"		
623	3507	"$53,589"		
624	222	"$41,604"		
625	1032	"$77,021"		
626	1358	"$56,191"		
627	1964	"$45,665"		
628	2800	"$86,650"		
629	4030	"$65,570"		
630	273	"$52,929"		
637	28440	"$43,480"		
638	50797	"$31,833"		
639	12471	"$24,746"		
640	69013	"$39,653"		
641	94323	"$28,616"		
642	1983	"$40,334"		
643	9227	"$47,949"		
644	12211	"$37,275"		
645	4655	"$28,467"		
652	10720	"$104,247"		
653	1724	"$138,265"		
654	3867	"$87,875"		
655	1482	"$70,705"		
656	3036	"$93,004"		
657	7145	"$67,789"		
658	6503	"$58,319"		
659	3010	"$84,417"		
660	6371	"$59,926"		
661	3117	"$54,983"		
662	436	"$78,325"		
663	813	"$56,583"		
664	479	"$46,128"		
665	649	"$84,776"		
666	1723	"$56,316"		
667	719	"$39,390"		
668	3916	"$73,733"		
669	13243	"$51,030"		
670	3051	"$40,921"		
671	480	"$51,622"		
672	279	"$41,785"		
673	7221	"$87,470"		
674	4796	"$68,791"		
675	557	"$56,209"		
682	127179	"$45,214"		
683	145891	"$34,723"		
684	22703	"$25,179"		
685	116	"$36,825"		
686	1635	"$51,729"		
687	2952	"$40,403"		
688	377	"$35,473"		
689	81929	"$39,061"		
690	147276	"$30,558"		
691	484	"$55,750"		
692	67	"$45,125"		
693	2607	"$48,742"		
694	16626	"$36,150"		
695	1540	"$40,571"		
696	7761	"$26,860"		
697	572	"$38,686"		
698	48696	"$46,331"		
699	33209	"$37,117"		
700	3261	"$30,317"		
707	4827	"$63,907"		
708	14233	"$56,423"		
709	455	"$62,413"		
710	284	"$49,754"		
711	433	"$61,937"		
712	146	"$39,737"		
713	5474	"$48,694"		
714	2422	"$36,259"		
715	384	"$63,079"		
716	214	"$55,825"		
717	870	"$60,084"		
718	304	"$47,693"		
722	850	"$49,539"		
723	1657	"$39,933"		
724	120	"$31,610"		
725	692	"$42,544"		
726	2728	"$28,790"		
727	1721	"$45,690"		
728	5035	"$30,907"		
729	753	"$38,149"		
730	155	"$26,495"		
734	1279	"$69,738"		
735	886	"$53,886"		
736	651	"$108,726"		
737	2569	"$65,821"		
738	580	"$54,245"		
739	592	"$94,828"		
740	2571	"$61,142"		
741	2201	"$51,198"		
742	5368	"$56,366"		
743	8335	"$44,748"		
744	1425	"$55,019"		
745	310	"$42,227"		
746	1486	"$52,202"		
747	1724	"$38,459"		
748	1795	"$49,282"		
749	737	"$71,964"		
750	174	"$49,214"		
754	1689	"$51,176"		
755	2969	"$39,984"		
756	185	"$27,291"		
757	971	"$46,566"		
758	1498	"$37,729"		
759	596	"$27,227"		
760	1696	"$33,801"		
761	648	"$28,125"		
765	3943	"$36,251"		
766	2227	"$27,264"		
767	315	"$29,732"		
768	21	"$34,917"		
769	97	"$48,109"		
770	103	"$30,705"		
774	2178	"$22,660"		
775	5229	"$17,113"		
776	459	"$29,615"		
777	90	"$37,751"		
778	238	"$16,132"		
779	70	"$24,150"		
780	65	"$12,429"		
781	2482	"$26,781"		
782	99	"$19,266"		
794	1	"$6,019"		
799	500	"$122,461"		
800	394	"$80,127"		
801	201	"$59,987"		
802	542	"$81,036"		
803	803	"$59,700"		
804	463	"$48,367"		
808	7370	"$56,621"		
809	14562	"$41,054"		
810	1989	"$35,824"		
811	26943	"$43,728"		
812	63800	"$33,307"		
813	8976	"$47,312"		
814	1550	"$50,758"		
815	2675	"$38,773"		
816	841	"$30,574"		
820	928	"$133,631"		
821	1153	"$70,048"		
822	1012	"$49,494"		
823	2173	"$107,768"		
824	2489	"$67,900"		
825	820	"$50,203"		
826	744	"$130,058"		
827	1305	"$73,509"		
828	740	"$57,945"		
829	1536	"$80,290"		
830	426	"$49,421"		
834	4000	"$101,403"		
835	2291	"$51,710"		
836	600	"$40,042"		
837	1813	"$111,746"		
838	1133	"$56,539"		
839	1023	"$42,336"		
840	9818	"$79,056"		
841	7981	"$50,671"		
842	2032	"$43,143"		
843	2060	"$52,620"		
844	2165	"$42,416"		
845	423	"$37,014"		
846	3296	"$61,897"		
847	13551	"$43,737"		
848	446	"$34,909"		
849	521	"$54,450"		
853	69263	"$121,027"		
854	15961	"$71,543"		
855	251	"$51,687"		
856	6677	"$97,947"		
857	8106	"$58,082"		
858	1173	"$46,714"		
862	11097	"$51,515"		
863	13035	"$36,881"		
864	11306	"$34,557"		
865	3738	"$44,973"		
866	6580	"$31,379"		
867	3142	"$54,706"		
868	2475	"$38,158"		
869	626	"$30,703"		
870	34216	"$154,871"		
871	555045	"$53,695"		
872	156669	"$39,759"		
876	575	"$74,521"		
880	6758	"$31,404"		
881	5623	"$20,639"		
882	2216	"$24,201"		
883	1177	"$28,590"		
884	19929	"$37,546"		
885	77686	"$29,077"		
886	391	"$27,874"		
887	459	"$36,390"		
894	4405	"$17,737"		
895	4050	"$31,838"		
896	8709	"$46,106"		
897	32491	"$25,797"		
901	964	"$91,337"		
902	1819	"$57,733"		
903	612	"$44,063"		
904	953	"$77,748"		
905	310	"$49,670"		
906	529	"$54,579"		
907	8193	"$97,175"		
908	9009	"$60,387"		
909	3674	"$48,741"		
913	893	"$45,977"		
914	2955	"$34,930"		
915	2335	"$48,902"		
916	4280	"$22,552"		
917	34311	"$44,882"		
918	25446	"$28,460"		
919	13038	"$50,192"		
920	13739	"$37,622"		
921	3960	"$28,691"		
922	1486	"$47,367"		
923	1964	"$30,787"		
927	172	"$360,188"		
928	1044	"$115,928"		
929	326	"$67,846"		
933	124	"$63,592"		
934	513	"$43,397"		
935	1785	"$41,240"		
939	1178	"$84,587"		
940	2458	"$65,475"		
941	1396	"$55,880"		
945	736	"$28,802"		
946	168	"$25,839"		
947	11438	"$40,157"		
948	38159	"$30,850"		
949	2576	"$36,853"		
950	640	"$25,963"		
951	739	"$29,390"		
955	392	"$157,844"		
956	5425	"$92,415"		
957	1909	"$179,558"		
958	1539	"$116,761"		
959	164	"$83,505"		
963	2650	"$73,236"		
964	4017	"$49,334"		
965	820	"$39,373"		
969	536	"$125,691"		
970	48	"$71,002"		
974	4928	"$68,657"		
975	2749	"$44,165"		
976	603	"$37,250"		
977	1831	"$42,087"		
981	31927	"$101,803"		
982	16275	"$70,674"		
983	3754	"$53,957"		
987	8115	"$85,158"		
988	8216	"$56,822"		
989	2194	"$44,468"		
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.				
