"PROPOSED NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2020"				
MS?DRG	Number of Cases	Threshold		
001	2290	"$622,572"		
002	199	"$347,728"		
003	15714	"$398,760"		
004	14460	"$248,267"		
005	1329	"$256,153"		
006	528	"$157,013"		
007	615	"$306,726"		
008	434	"$166,721"		
010	58	"$137,525"		
011	1832	"$128,113"		
012	1801	"$109,308"		
013	604	"$72,291"		
014	935	"$272,489"		
016	2058	"$166,714"		
017	134	"$119,253"		
020	1486	"$274,494"		
021	360	"$198,542"		
022	92	"$141,860"		
023	9435	"$143,437"		
024	3396	"$112,577"		
025	21621	"$115,232"		
026	9073	"$87,238"		
027	10775	"$75,905"		
028	2059	"$134,061"		
029	3660	"$87,864"		
030	1676	"$68,351"		
031	1075	"$99,865"		
032	2034	"$68,675"		
033	2763	"$59,463"		
034	748	"$103,197"		
035	2202	"$71,617"		
036	3149	"$60,894"		
037	4202	"$92,139"		
038	12455	"$60,461"		
039	26308	"$49,430"		
040	4701	"$99,105"		
041	5999	"$74,300"		
042	2301	"$63,988"		
052	873	"$52,729"		
053	247	"$39,909"		
054	12777	"$45,639"		
055	4502	"$40,381"		
056	12262	"$50,879"		
057	29661	"$39,840"		
058	976	"$50,645"		
059	3054	"$41,498"		
060	2678	"$35,666"		
061	5454	"$93,594"		
062	10241	"$76,692"		
063	2100	"$69,967"		
064	80600	"$55,279"		
065	112184	"$43,628"		
066	36616	"$35,322"		
067	903	"$51,417"		
068	3906	"$41,185"		
069	47538	"$37,683"		
070	16377	"$50,171"		
071	16432	"$39,588"		
072	4182	"$33,584"		
073	7362	"$45,602"		
074	17810	"$39,453"		
075	720	"$52,936"		
076	237	"$35,509"		
077	1956	"$52,074"		
078	2776	"$42,351"		
079	763	"$36,522"		
080	597	"$50,465"		
081	644	"$34,267"		
082	4951	"$60,578"		
083	5548	"$46,607"		
084	3571	"$39,937"		
085	10428	"$59,113"		
086	16675	"$44,842"		
087	10701	"$36,736"		
088	788	"$50,625"		
089	1903	"$44,757"		
090	922	"$38,203"		
091	14315	"$49,271"		
092	21369	"$38,186"		
093	8215	"$33,315"		
094	1472	"$87,490"		
095	1247	"$69,952"		
096	487	"$68,482"		
097	2203	"$83,851"		
098	1461	"$58,569"		
099	554	"$47,088"		
100	26118	"$52,057"		
101	42158	"$36,072"		
102	1575	"$41,913"		
103	10419	"$35,480"		
113	462	"$69,634"		
114	158	"$46,649"		
115	653	"$50,810"		
116	348	"$53,630"		
117	160	"$42,540"		
121	540	"$37,728"		
122	185	"$24,700"		
123	2688	"$37,217"		
124	895	"$43,515"		
125	3236	"$33,656"		
129	1980	"$74,143"		
130	1078	"$58,085"		
131	1280	"$80,267"		
132	555	"$57,000"		
133	1925	"$63,001"		
134	1107	"$47,741"		
135	297	"$71,655"		
136	100	"$49,735"		
137	848	"$48,170"		
138	406	"$36,933"		
139	356	"$45,458"		
146	1024	"$54,774"		
147	930	"$42,693"		
148	250	"$31,750"		
149	16123	"$33,238"		
150	1030	"$41,329"		
151	2452	"$25,458"		
152	3921	"$38,958"		
153	10490	"$28,612"		
154	2073	"$47,094"		
155	4322	"$35,599"		
156	1770	"$27,850"		
157	1713	"$49,029"		
158	3412	"$35,863"		
159	1058	"$28,199"		
163	11779	"$125,897"		
164	15557	"$80,255"		
165	8230	"$65,371"		
166	19286	"$91,411"		
167	10495	"$62,592"		
168	3184	"$52,236"		
175	24309	"$49,837"		
176	34508	"$37,495"		
177	67459	"$53,552"		
178	30949	"$43,410"		
179	6810	"$35,162"		
180	18353	"$54,145"		
181	11255	"$43,109"		
182	756	"$37,263"		
183	4978	"$49,762"		
184	9030	"$41,421"		
185	2597	"$31,107"		
186	10570	"$50,034"		
187	7158	"$41,278"		
188	1535	"$33,047"		
189	168102	"$44,282"		
190	216797	"$43,422"		
191	90076	"$36,027"		
192	39633	"$29,171"		
193	108573	"$44,842"		
194	103180	"$35,011"		
195	35468	"$27,768"		
196	8029	"$50,084"		
197	3255	"$39,762"		
198	946	"$31,997"		
199	5819	"$54,926"		
200	9022	"$41,111"		
201	1953	"$27,593"		
202	35514	"$36,993"		
203	11999	"$27,844"		
204	9078	"$33,559"		
205	8253	"$47,315"		
206	10409	"$35,633"		
207	21139	"$144,277"		
208	59383	"$72,637"		
215	3643	"$251,284"		
216	7505	"$262,718"		
217	2918	"$184,201"		
218	365	"$171,241"		
219	16535	"$205,273"		
220	17476	"$152,546"		
221	3108	"$134,455"		
222	1639	"$227,734"		
223	617	"$182,135"		
224	2088	"$209,554"		
225	1763	"$169,994"		
226	4835	"$182,627"		
227	5638	"$148,365"		
228	4812	"$178,638"		
229	5721	"$136,217"		
231	1115	"$256,599"		
232	731	"$200,031"		
233	12801	"$215,249"		
234	15815	"$161,892"		
235	10828	"$164,103"		
236	19660	"$125,303"		
239	9344	"$102,540"		
240	7630	"$71,208"		
241	1313	"$51,901"		
242	19326	"$103,495"		
243	26053	"$81,043"		
244	16944	"$71,522"		
245	2500	"$137,365"		
246	46311	"$111,997"		
247	87665	"$85,535"		
248	5379	"$109,184"		
249	7567	"$82,778"		
250	4034	"$91,194"		
251	6004	"$72,223"		
252	35557	"$89,113"		
253	26952	"$80,049"		
254	13340	"$63,261"		
255	2258	"$68,859"		
256	2172	"$54,382"		
257	336	"$42,689"		
258	726	"$87,680"		
259	1392	"$68,755"		
260	2526	"$96,712"		
261	3389	"$65,334"		
262	1472	"$59,294"		
263	319	"$67,167"		
264	10893	"$77,417"		
265	738	"$86,040"		
266	14597	"$187,474"		
267	19593	"$156,540"		
268	4043	"$174,711"		
269	17884	"$114,611"		
270	18661	"$135,032"		
271	14583	"$102,465"		
272	5868	"$80,290"		
273	7400	"$113,154"		
274	18051	"$100,483"		
280	82016	"$52,267"		
281	46984	"$41,747"		
282	23250	"$37,136"		
283	10528	"$53,222"		
284	1462	"$34,178"		
285	450	"$26,100"		
286	41343	"$70,875"		
287	64073	"$52,123"		
288	1419	"$69,053"		
289	711	"$51,573"		
290	111	"$40,023"		
291	369572	"$44,401"		
292	102395	"$34,363"		
293	36022	"$26,255"		
294	320	"$38,970"		
295	31	"$22,600"		
296	3864	"$51,282"		
297	499	"$29,746"		
298	246	"$21,880"		
299	18960	"$45,339"		
300	30861	"$37,841"		
301	10336	"$28,404"		
302	4481	"$40,491"		
303	15389	"$29,073"		
304	15090	"$40,902"		
305	29458	"$31,455"		
306	3638	"$43,650"		
307	3509	"$33,965"		
308	72616	"$43,014"		
309	90858	"$30,975"		
310	64334	"$24,034"		
311	6287	"$30,620"		
312	72845	"$34,971"		
313	49266	"$32,844"		
314	44185	"$55,078"		
315	20481	"$37,862"		
316	4238	"$32,413"		
326	11413	"$124,843"		
327	11583	"$74,258"		
328	10090	"$57,247"		
329	35357	"$124,590"		
330	52686	"$77,989"		
331	29668	"$61,149"		
332	198	"$89,886"		
333	702	"$63,516"		
334	814	"$50,523"		
335	5793	"$107,437"		
336	9987	"$73,402"		
337	5164	"$58,750"		
338	953	"$87,733"		
339	2950	"$64,029"		
340	2734	"$51,717"		
341	682	"$75,390"		
342	1988	"$57,044"		
343	2531	"$49,568"		
344	1285	"$82,231"		
345	2474	"$57,915"		
346	1271	"$50,144"		
347	820	"$69,589"		
348	1938	"$50,238"		
349	1040	"$40,439"		
350	1463	"$74,615"		
351	3334	"$56,499"		
352	2936	"$46,375"		
353	3157	"$84,896"		
354	8297	"$60,348"		
355	7122	"$51,974"		
356	7248	"$101,313"		
357	6391	"$68,464"		
358	1451	"$52,024"		
368	3195	"$58,532"		
369	4198	"$43,764"		
370	622	"$32,292"		
371	19124	"$50,699"		
372	29535	"$39,197"		
373	7735	"$30,630"		
374	10289	"$56,956"		
375	13414	"$43,870"		
376	1170	"$39,542"		
377	64034	"$54,504"		
378	134355	"$40,009"		
379	19558	"$28,301"		
380	5154	"$58,565"		
381	7461	"$43,635"		
382	1611	"$34,396"		
383	1312	"$49,922"		
384	5087	"$39,502"		
385	2504	"$50,811"		
386	8089	"$39,898"		
387	4066	"$30,165"		
388	18811	"$48,221"		
389	50071	"$34,302"		
390	32108	"$25,890"		
391	42287	"$44,150"		
392	158401	"$33,251"		
393	24625	"$50,088"		
394	42007	"$38,630"		
395	12008	"$29,781"		
405	4109	"$131,474"		
406	4997	"$86,980"		
407	1784	"$68,649"		
408	899	"$104,249"		
409	711	"$73,605"		
410	288	"$61,079"		
411	261	"$106,439"		
412	280	"$81,343"		
413	186	"$64,162"		
414	2350	"$98,734"		
415	3019	"$68,388"		
416	1730	"$53,751"		
417	14762	"$79,795"		
418	22469	"$64,355"		
419	16443	"$55,545"		
420	747	"$93,132"		
421	798	"$62,063"		
422	232	"$56,279"		
423	1065	"$97,987"		
424	457	"$68,243"		
425	83	"$57,132"		
432	14382	"$55,070"		
433	11705	"$40,659"		
434	854	"$28,225"		
435	13357	"$54,639"		
436	7902	"$43,243"		
437	885	"$38,478"		
438	14819	"$50,908"		
439	27238	"$36,958"		
440	15239	"$28,722"		
441	18906	"$52,685"		
442	18362	"$37,325"		
443	2951	"$29,801"		
444	13119	"$52,899"		
445	17954	"$43,523"		
446	8487	"$37,166"		
453	3080	"$228,231"		
454	13110	"$154,415"		
455	13591	"$129,234"		
456	1514	"$224,448"		
457	3869	"$162,555"		
458	1465	"$128,458"		
459	5115	"$151,617"		
460	63043	"$108,022"		
461	366	"$121,472"		
462	8114	"$93,945"		
463	5813	"$109,411"		
464	10404	"$78,978"		
465	3949	"$59,493"		
466	4131	"$123,476"		
467	21311	"$94,967"		
468	18244	"$80,223"		
469	29738	"$90,005"		
470	494675	"$65,906"		
471	3741	"$131,636"		
472	16331	"$87,079"		
473	19050	"$74,910"		
474	3311	"$90,867"		
475	3635	"$62,803"		
476	844	"$45,143"		
477	3434	"$87,244"		
478	6934	"$72,584"		
479	1978	"$62,670"		
480	29356	"$86,282"		
481	79778	"$68,460"		
482	23378	"$59,275"		
483	58196	"$75,234"		
485	971	"$94,484"		
486	2097	"$71,581"		
487	703	"$58,746"		
488	2898	"$63,613"		
489	2584	"$49,883"		
492	6313	"$93,646"		
493	19326	"$71,766"		
494	13250	"$60,585"		
495	480	"$89,024"		
496	1818	"$62,652"		
497	1290	"$51,645"		
498	1061	"$67,066"		
499	306	"$44,802"		
500	2726	"$79,358"		
501	5741	"$56,304"		
502	3396	"$48,652"		
503	1165	"$72,141"		
504	2992	"$57,050"		
505	1369	"$53,800"		
506	496	"$51,406"		
507	467	"$61,964"		
508	194	"$53,839"		
509	60	"$57,590"		
510	1158	"$80,130"		
511	3423	"$65,078"		
512	2536	"$57,410"		
513	1663	"$53,882"		
514	594	"$42,086"		
515	5091	"$85,541"		
516	13726	"$64,002"		
517	12889	"$53,067"		
518	3144	"$86,420"		
519	8333	"$63,274"		
520	8594	"$51,728"		
533	897	"$44,835"		
534	2652	"$27,982"		
535	8071	"$42,217"		
536	24897	"$28,314"		
537	830	"$35,674"		
538	372	"$28,486"		
539	3194	"$52,763"		
540	3444	"$42,646"		
541	831	"$33,320"		
542	7325	"$51,261"		
543	14539	"$40,555"		
544	4436	"$31,215"		
545	3770	"$58,697"		
546	4247	"$41,361"		
547	1435	"$33,301"		
548	612	"$59,031"		
549	1234	"$43,379"		
550	448	"$36,271"		
551	13134	"$50,275"		
552	52817	"$37,190"		
553	2469	"$41,855"		
554	12870	"$28,464"		
555	2516	"$42,436"		
556	10180	"$31,087"		
557	3834	"$46,619"		
558	10791	"$33,675"		
559	3116	"$48,957"		
560	5566	"$35,102"		
561	3200	"$27,197"		
562	6659	"$45,815"		
563	24795	"$32,325"		
564	4743	"$49,204"		
565	8172	"$39,077"		
566	2175	"$31,924"		
570	3033	"$69,985"		
571	6519	"$52,210"		
572	1778	"$44,300"		
573	619	"$104,652"		
574	1392	"$74,444"		
575	310	"$55,082"		
576	492	"$107,807"		
577	1476	"$71,906"		
578	1029	"$54,002"		
579	4367	"$70,332"		
580	11418	"$52,343"		
581	5257	"$46,740"		
582	765	"$54,071"		
583	805	"$52,157"		
584	743	"$60,169"		
585	829	"$56,025"		
592	2639	"$46,597"		
593	5363	"$37,436"		
594	743	"$28,249"		
595	1058	"$50,383"		
596	2879	"$35,451"		
597	1323	"$52,325"		
598	1595	"$41,752"		
599	100	"$28,362"		
600	874	"$35,980"		
601	382	"$23,151"		
602	27298	"$44,925"		
603	110915	"$30,233"		
604	3371	"$47,445"		
605	13624	"$35,817"		
606	1842	"$42,777"		
607	6012	"$29,157"		
614	2062	"$76,293"		
615	1204	"$58,918"		
616	2601	"$98,486"		
617	13494	"$62,254"		
618	142	"$43,522"		
619	942	"$80,939"		
620	3662	"$63,141"		
621	13473	"$58,116"		
622	1546	"$81,566"		
623	4973	"$55,837"		
624	246	"$45,118"		
625	934	"$81,797"		
626	1259	"$59,635"		
627	1492	"$48,255"		
628	3268	"$91,995"		
629	5542	"$67,437"		
630	291	"$53,494"		
637	32633	"$45,222"		
638	56449	"$33,178"		
639	11621	"$25,630"		
640	72852	"$40,908"		
641	88632	"$29,343"		
642	1902	"$41,223"		
643	9825	"$49,809"		
644	12044	"$38,313"		
645	4538	"$29,629"		
652	10969	"$108,157"		
653	1838	"$133,853"		
654	4142	"$89,280"		
655	1584	"$71,128"		
656	3187	"$95,368"		
657	7836	"$68,921"		
658	6548	"$60,371"		
659	8030	"$74,794"		
660	18385	"$53,105"		
661	13414	"$46,758"		
662	634	"$80,895"		
663	1338	"$55,633"		
664	626	"$45,563"		
665	636	"$86,433"		
666	1550	"$58,338"		
667	627	"$44,550"		
668	2243	"$78,629"		
669	5697	"$55,695"		
670	2077	"$41,576"		
671	382	"$56,188"		
672	200	"$45,332"		
673	7845	"$89,692"		
674	5148	"$69,827"		
675	504	"$55,766"		
682	111223	"$46,683"		
683	135342	"$34,962"		
684	18803	"$25,890"		
686	1604	"$52,307"		
687	2496	"$39,924"		
688	297	"$35,963"		
689	84277	"$40,163"		
690	136425	"$31,142"		
691	168	"$55,843"		
692	114	"$44,872"		
693	1366	"$45,267"		
694	7661	"$31,596"		
695	1398	"$40,319"		
696	6771	"$27,156"		
697	447	"$37,603"		
698	56904	"$47,960"		
699	33927	"$38,019"		
700	4431	"$30,295"		
707	5409	"$66,199"		
708	15339	"$59,023"		
709	449	"$60,400"		
710	239	"$55,866"		
711	497	"$65,151"		
712	105	"$46,070"		
713	5364	"$50,553"		
714	2070	"$38,668"		
715	403	"$70,065"		
716	190	"$57,895"		
717	1295	"$60,481"		
718	402	"$49,050"		
722	868	"$50,547"		
723	1498	"$40,154"		
724	102	"$31,335"		
725	731	"$42,754"		
726	2743	"$30,050"		
727	1482	"$47,165"		
728	4634	"$30,982"		
729	689	"$38,658"		
730	135	"$24,714"		
734	1186	"$74,983"		
735	706	"$57,046"		
736	657	"$110,200"		
737	2554	"$69,434"		
738	566	"$56,155"		
739	575	"$100,278"		
740	2563	"$63,877"		
741	2018	"$54,919"		
742	4803	"$59,668"		
743	7239	"$47,265"		
744	1402	"$55,656"		
745	309	"$43,343"		
746	1468	"$53,672"		
747	1540	"$42,088"		
748	1816	"$49,711"		
749	838	"$74,263"		
750	175	"$50,331"		
754	1624	"$53,352"		
755	2678	"$40,044"		
756	219	"$33,877"		
757	934	"$46,332"		
758	1431	"$38,829"		
759	478	"$28,244"		
760	1699	"$34,989"		
761	355	"$25,174"		
768	173	"$30,562"		
769	131	"$43,905"		
770	101	"$38,805"		
776	562	"$25,397"		
779	57	"$26,865"		
783	191	"$50,642"		
784	546	"$37,195"		
785	501	"$30,571"		
786	739	"$45,567"		
787	2030	"$35,197"		
788	1852	"$30,609"		
793	1	"$20,535"		
794	1	"$81,381"		
796	49	"$44,153"		
797	121	"$28,573"		
798	162	"$28,573"		
799	486	"$124,749"		
800	372	"$81,214"		
801	184	"$58,272"		
802	864	"$86,874"		
803	993	"$59,567"		
804	499	"$51,264"		
805	506	"$29,662"		
806	2125	"$19,699"		
807	3807	"$17,107"		
808	7571	"$58,293"		
809	14372	"$42,008"		
810	1974	"$36,650"		
811	26187	"$45,088"		
812	58858	"$34,480"		
813	15723	"$47,258"		
814	1626	"$50,351"		
815	2575	"$39,657"		
816	830	"$32,934"		
817	76	"$64,101"		
818	85	"$45,338"		
819	49	"$37,419"		
820	1147	"$138,369"		
821	1163	"$73,210"		
822	960	"$50,895"		
823	2485	"$114,428"		
824	2620	"$70,381"		
825	786	"$53,297"		
826	730	"$128,857"		
827	1331	"$72,866"		
828	782	"$61,087"		
829	1677	"$81,702"		
830	392	"$54,023"		
831	857	"$34,084"		
832	1240	"$22,609"		
833	658	"$15,865"		
834	3331	"$104,794"		
835	1701	"$53,889"		
836	416	"$39,839"		
837	1731	"$107,400"		
838	1027	"$58,367"		
839	816	"$42,197"		
840	9238	"$73,850"		
841	7843	"$50,049"		
842	1727	"$41,273"		
843	2173	"$54,470"		
844	2066	"$43,141"		
845	389	"$36,949"		
846	3472	"$66,686"		
847	13650	"$45,989"		
848	308	"$34,682"		
849	464	"$56,145"		
853	82762	"$120,763"		
854	22699	"$67,838"		
855	312	"$54,830"		
856	8100	"$99,237"		
857	9573	"$60,027"		
858	1260	"$48,746"		
862	11209	"$52,469"		
863	11177	"$36,386"		
864	12144	"$35,759"		
865	3213	"$44,105"		
866	6905	"$32,578"		
867	2846	"$55,007"		
868	2248	"$38,257"		
869	518	"$30,008"		
870	34325	"$161,505"		
871	592056	"$55,265"		
872	154438	"$40,681"		
876	645	"$72,158"		
880	7303	"$33,638"		
881	4691	"$21,933"		
882	2177	"$25,507"		
883	1219	"$30,823"		
884	19521	"$39,530"		
885	73791	"$30,319"		
886	339	"$28,474"		
887	397	"$37,591"		
894	4337	"$18,314"		
895	3871	"$33,160"		
896	9230	"$48,766"		
897	32089	"$27,468"		
901	1028	"$96,628"		
902	1909	"$58,180"		
903	634	"$44,020"		
904	964	"$81,514"		
905	283	"$53,476"		
906	490	"$55,944"		
907	8006	"$99,759"		
908	9314	"$61,234"		
909	3445	"$48,705"		
913	762	"$47,870"		
914	2600	"$36,085"		
915	2396	"$50,503"		
916	4140	"$24,408"		
917	33646	"$46,891"		
918	21101	"$30,077"		
919	13300	"$52,026"		
920	13658	"$38,512"		
921	3236	"$29,237"		
922	1447	"$48,009"		
923	1887	"$32,506"		
927	170	"$364,818"		
928	1080	"$118,907"		
929	311	"$73,344"		
933	131	"$60,155"		
934	529	"$44,499"		
935	1825	"$43,117"		
939	882	"$83,865"		
940	1814	"$64,075"		
941	927	"$58,377"		
945	943	"$32,583"		
946	209	"$24,904"		
947	10606	"$41,462"		
948	34758	"$31,822"		
949	1540	"$36,257"		
950	378	"$23,793"		
951	630	"$31,253"		
955	474	"$161,717"		
956	5767	"$95,121"		
957	2179	"$189,390"		
958	1692	"$116,713"		
959	178	"$77,776"		
963	2759	"$75,451"		
964	4305	"$50,486"		
965	813	"$40,790"		
969	483	"$137,693"		
970	90	"$80,564"		
974	4675	"$69,644"		
975	2556	"$45,163"		
976	546	"$38,561"		
977	1636	"$41,683"		
981	30292	"$106,518"		
982	17119	"$70,555"		
983	3582	"$54,180"		
987	9858	"$86,757"		
988	9751	"$56,590"		
989	2070	"$43,964"		
				
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 2017 MedPAR file; MS-DRGs are from GROUPER Version36.0.				
