"NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2021"				
MS?DRG	Number of Cases	Threshold		
001	2408	"$663,186"		
002	194	"$374,702"		
003	15314	"$423,706"		
004	13820	"$258,420"		
005	1248	"$268,392"		
006	513	"$164,300"		
007	560	"$322,960"		
008	468	"$175,045"		
010	41	"$129,099"		
011	1902	"$134,968"		
012	2002	"$114,504"		
013	572	"$78,907"		
014	982	"$295,900"		
016	2360	"$170,583"		
017	110	"$130,438"		
020	1534	"$291,178"		
021	477	"$215,981"		
022	117	"$132,761"		
023	11195	"$151,203"		
024	4250	"$119,814"		
025	21567	"$122,582"		
026	9694	"$93,270"		
027	10878	"$78,602"		
028	2100	"$141,903"		
029	3946	"$93,542"		
030	1586	"$73,403"		
031	907	"$109,474"		
032	2176	"$71,635"		
033	2661	"$62,624"		
034	1132	"$111,970"		
035	3052	"$77,261"		
036	4313	"$64,265"		
037	3663	"$97,065"		
038	12098	"$63,829"		
039	23342	"$51,929"		
040	4620	"$106,043"		
041	6641	"$79,245"		
042	2382	"$67,715"		
052	838	"$54,070"		
053	224	"$40,582"		
054	12580	"$48,060"		
055	4372	"$42,120"		
056	10696	"$55,863"		
057	30714	"$42,188"		
058	802	"$56,736"		
059	2912	"$44,014"		
060	2415	"$38,595"		
061	5395	"$97,308"		
062	10771	"$82,049"		
063	2189	"$74,670"		
064	73623	"$58,823"		
065	115671	"$46,284"		
066	33181	"$36,714"		
067	845	"$54,141"		
068	4015	"$43,913"		
069	41183	"$40,164"		
070	17029	"$52,933"		
071	16733	"$41,154"		
072	4017	"$35,093"		
073	7123	"$48,340"		
074	17084	"$41,860"		
075	683	"$56,687"		
076	217	"$40,339"		
077	2068	"$54,745"		
078	2956	"$44,335"		
079	654	"$37,161"		
080	674	"$55,552"		
081	728	"$36,488"		
082	6571	"$65,063"		
083	9502	"$48,842"		
084	4682	"$40,489"		
085	7856	"$63,986"		
086	16157	"$47,723"		
087	8647	"$37,799"		
088	606	"$53,757"		
089	1914	"$45,537"		
090	726	"$41,716"		
091	14424	"$51,313"		
092	22205	"$40,597"		
093	7524	"$35,354"		
094	1398	"$93,380"		
095	1323	"$72,540"		
096	487	"$76,751"		
097	1838	"$92,916"		
098	1815	"$62,225"		
099	513	"$50,433"		
100	23613	"$56,335"		
101	44589	"$38,996"		
102	1229	"$46,791"		
103	9402	"$37,624"		
113	474	"$69,147"		
114	139	"$48,517"		
115	713	"$55,809"		
116	396	"$59,669"		
117	163	"$47,470"		
121	620	"$41,174"		
122	150	"$28,070"		
123	2658	"$39,333"		
124	850	"$46,736"		
125	3271	"$34,260"		
129	2112	"$77,032"		
130	1065	"$59,374"		
131	1279	"$83,958"		
132	459	"$62,163"		
133	1812	"$65,048"		
134	948	"$49,457"		
135	297	"$73,915"		
136	87	"$51,474"		
137	944	"$48,828"		
138	399	"$39,086"		
139	321	"$50,299"		
146	1032	"$57,626"		
147	860	"$44,373"		
148	244	"$35,962"		
149	15700	"$35,201"		
150	885	"$43,759"		
151	2295	"$26,484"		
152	3999	"$40,919"		
153	10643	"$29,491"		
154	2019	"$48,893"		
155	4246	"$38,187"		
156	1553	"$29,094"		
157	1826	"$50,912"		
158	3354	"$36,202"		
159	889	"$29,793"		
163	11579	"$129,729"		
164	15979	"$83,084"		
165	8295	"$68,164"		
166	12764	"$99,202"		
167	7616	"$65,781"		
168	2422	"$54,430"		
175	27833	"$51,826"		
176	30099	"$37,175"		
177	77778	"$57,570"		
178	34481	"$45,470"		
179	5767	"$34,871"		
180	19195	"$57,459"		
181	10898	"$45,948"		
182	604	"$39,701"		
183	4988	"$52,647"		
184	9772	"$43,629"		
185	2659	"$32,595"		
186	9962	"$52,015"		
187	6831	"$42,848"		
188	1233	"$32,203"		
189	151669	"$45,771"		
190	144912	"$44,200"		
191	75643	"$36,535"		
192	29455	"$29,532"		
193	164222	"$48,066"		
194	133734	"$36,373"		
195	32331	"$28,416"		
196	8580	"$53,111"		
197	3198	"$41,939"		
198	795	"$33,168"		
199	6302	"$57,098"		
200	9751	"$43,268"		
201	1825	"$29,488"		
202	40835	"$38,832"		
203	10033	"$28,865"		
204	8490	"$36,882"		
205	9205	"$51,312"		
206	10214	"$37,593"		
207	20257	"$152,093"		
208	57795	"$77,006"		
215	6844	"$250,209"		
216	6175	"$278,977"		
217	2245	"$199,495"		
218	265	"$169,350"		
219	15944	"$217,072"		
220	16946	"$161,372"		
221	2676	"$140,299"		
222	1836	"$237,483"		
223	531	"$180,691"		
224	2212	"$216,309"		
225	1650	"$176,460"		
226	5054	"$188,243"		
227	5188	"$152,717"		
228	4152	"$178,027"		
229	4907	"$129,372"		
231	975	"$264,692"		
232	695	"$199,440"		
233	12541	"$226,795"		
234	14845	"$170,202"		
235	10975	"$172,533"		
236	19625	"$132,893"		
239	9739	"$107,727"		
240	8276	"$74,973"		
241	830	"$51,423"		
242	19032	"$108,343"		
243	26084	"$84,619"		
244	15076	"$74,083"		
245	2115	"$148,011"		
246	48553	"$115,071"		
247	86819	"$88,422"		
248	3436	"$111,972"		
249	4564	"$84,935"		
250	4177	"$93,755"		
251	5636	"$75,395"		
252	35174	"$92,985"		
253	26080	"$84,045"		
254	11894	"$66,384"		
255	2275	"$72,876"		
256	2208	"$56,203"		
257	196	"$42,850"		
258	664	"$91,717"		
259	1029	"$71,857"		
260	2627	"$101,557"		
261	3593	"$68,931"		
262	1485	"$63,013"		
263	333	"$67,941"		
264	10828	"$81,873"		
265	657	"$89,201"		
266	18383	"$191,786"		
267	24999	"$158,183"		
268	3696	"$183,321"		
269	16981	"$120,966"		
270	18557	"$141,140"		
271	14842	"$107,276"		
272	5524	"$83,937"		
273	6886	"$122,902"		
274	21790	"$108,167"		
280	87704	"$54,099"		
281	48934	"$43,598"		
282	21719	"$38,112"		
283	10583	"$55,958"		
284	1285	"$34,343"		
285	320	"$25,103"		
286	43132	"$74,292"		
287	60351	"$54,941"		
288	1359	"$71,598"		
289	774	"$54,472"		
290	89	"$42,980"		
291	392389	"$46,518"		
292	94490	"$35,162"		
293	24889	"$26,889"		
294	257	"$43,986"		
295	22	"$23,935"		
296	4078	"$54,448"		
297	449	"$35,176"		
298	194	"$24,603"		
299	17954	"$47,319"		
300	29146	"$39,488"		
301	8487	"$29,718"		
302	3976	"$42,187"		
303	13767	"$30,405"		
304	15488	"$42,881"		
305	30014	"$33,167"		
306	3370	"$45,626"		
307	3338	"$37,122"		
308	70807	"$44,937"		
309	89020	"$32,129"		
310	59390	"$24,717"		
311	5735	"$31,398"		
312	70919	"$36,767"		
313	44045	"$34,172"		
314	45324	"$57,773"		
315	20573	"$39,855"		
316	3736	"$33,209"		
319	1700	"$120,960"		
320	624	"$79,463"		
326	10725	"$130,128"		
327	10715	"$79,943"		
328	8397	"$60,709"		
329	35080	"$127,294"		
330	53808	"$81,600"		
331	28826	"$63,548"		
332	162	"$94,938"		
333	612	"$73,801"		
334	591	"$58,420"		
335	5247	"$111,749"		
336	9699	"$75,624"		
337	4602	"$62,191"		
338	9	"$84,628"		
339	66	"$64,319"		
340	13	"$51,308"		
341	1364	"$84,442"		
342	5018	"$63,598"		
343	4916	"$53,137"		
344	1051	"$81,990"		
345	2090	"$58,520"		
346	1058	"$51,897"		
347	920	"$73,918"		
348	2217	"$53,236"		
349	1156	"$43,433"		
350	1401	"$79,351"		
351	3465	"$58,439"		
352	2593	"$49,574"		
353	2820	"$87,854"		
354	8010	"$63,302"		
355	5870	"$54,742"		
356	7699	"$109,060"		
357	6200	"$74,307"		
358	1272	"$55,926"		
368	2993	"$59,964"		
369	4050	"$44,950"		
370	525	"$34,912"		
371	17954	"$52,831"		
372	28194	"$40,188"		
373	6614	"$30,922"		
374	11065	"$58,417"		
375	13483	"$46,066"		
376	1332	"$43,200"		
377	65601	"$56,840"		
378	134006	"$41,846"		
379	16537	"$29,316"		
380	5565	"$60,001"		
381	7805	"$45,373"		
382	1539	"$36,541"		
383	1218	"$51,536"		
384	4447	"$41,569"		
385	2718	"$52,777"		
386	7923	"$41,646"		
387	3699	"$31,116"		
388	18702	"$50,411"		
389	50545	"$35,720"		
390	30372	"$26,192"		
391	41031	"$46,525"		
392	146322	"$34,695"		
393	24693	"$52,314"		
394	40206	"$40,226"		
395	9554	"$30,052"		
405	3965	"$140,057"		
406	4906	"$90,264"		
407	1700	"$74,284"		
408	860	"$101,746"		
409	741	"$79,797"		
410	267	"$63,047"		
411	224	"$115,180"		
412	246	"$83,407"		
413	127	"$65,296"		
414	2073	"$99,121"		
415	2752	"$73,116"		
416	1426	"$55,545"		
417	13472	"$82,845"		
418	22354	"$67,495"		
419	15019	"$58,369"		
420	696	"$96,349"		
421	760	"$65,857"		
422	180	"$58,153"		
423	889	"$109,760"		
424	399	"$71,320"		
425	72	"$59,590"		
432	15611	"$58,027"		
433	12247	"$42,942"		
434	683	"$28,206"		
435	13316	"$57,287"		
436	7867	"$45,447"		
437	758	"$40,057"		
438	14390	"$53,496"		
439	26117	"$37,842"		
440	13166	"$29,418"		
441	19002	"$55,280"		
442	18119	"$38,643"		
443	2872	"$30,433"		
444	12793	"$55,937"		
445	18535	"$45,816"		
446	7669	"$39,148"		
453	3344	"$235,500"		
454	17734	"$157,061"		
455	18129	"$130,748"		
456	1401	"$232,544"		
457	3843	"$170,199"		
458	1302	"$124,204"		
459	4155	"$167,715"		
460	56008	"$110,697"		
461	289	"$140,345"		
462	7282	"$96,311"		
463	5855	"$116,148"		
464	10605	"$82,226"		
465	3540	"$64,133"		
466	4390	"$129,301"		
467	22595	"$99,473"		
468	18228	"$84,371"		
469	27866	"$93,465"		
470	451087	"$68,492"		
471	3556	"$138,515"		
472	15530	"$93,365"		
473	13638	"$81,319"		
474	3444	"$95,941"		
475	3730	"$64,959"		
476	749	"$48,038"		
477	3436	"$91,609"		
478	6977	"$76,659"		
479	1715	"$65,160"		
480	28452	"$90,544"		
481	80944	"$72,087"		
482	21765	"$61,370"		
483	63305	"$78,533"		
485	1256	"$96,932"		
486	2830	"$72,975"		
487	838	"$60,033"		
488	2564	"$64,353"		
489	2362	"$51,636"		
492	6323	"$98,527"		
493	20003	"$76,376"		
494	12635	"$64,778"		
495	508	"$94,076"		
496	1875	"$67,074"		
497	1125	"$54,628"		
498	1124	"$75,224"		
499	281	"$49,036"		
500	2663	"$82,627"		
501	6293	"$58,475"		
502	3313	"$51,459"		
503	1046	"$77,642"		
504	3171	"$59,615"		
505	1226	"$57,154"		
506	474	"$51,940"		
507	478	"$67,882"		
508	183	"$56,972"		
509	60	"$51,615"		
510	1089	"$86,610"		
511	3441	"$68,596"		
512	2286	"$59,623"		
513	1778	"$55,728"		
514	593	"$46,882"		
515	4703	"$91,275"		
516	13984	"$67,999"		
517	12285	"$56,283"		
518	2651	"$99,325"		
519	8669	"$67,227"		
520	7726	"$54,441"		
533	934	"$46,908"		
534	2760	"$29,407"		
535	7526	"$43,966"		
536	24922	"$29,745"		
537	854	"$36,408"		
538	367	"$29,316"		
539	3054	"$52,659"		
540	3349	"$44,372"		
541	688	"$35,215"		
542	7167	"$54,327"		
543	14578	"$41,638"		
544	3846	"$30,579"		
545	3619	"$62,342"		
546	4041	"$43,439"		
547	1348	"$33,556"		
548	637	"$58,929"		
549	1267	"$44,417"		
550	408	"$36,090"		
551	12961	"$52,651"		
552	52627	"$39,034"		
553	2488	"$44,054"		
554	12245	"$30,435"		
555	2354	"$45,351"		
556	9813	"$33,091"		
557	3632	"$49,618"		
558	11097	"$34,896"		
559	3015	"$50,981"		
560	5597	"$36,945"		
561	2806	"$27,617"		
562	6415	"$47,345"		
563	25263	"$34,118"		
564	4718	"$50,821"		
565	8865	"$41,043"		
566	2144	"$32,534"		
570	3113	"$71,670"		
571	6589	"$54,250"		
572	1653	"$45,383"		
573	704	"$106,367"		
574	1560	"$79,277"		
575	270	"$56,813"		
576	499	"$117,463"		
577	1630	"$75,991"		
578	923	"$58,486"		
579	4771	"$76,449"		
580	11351	"$54,859"		
581	4608	"$49,277"		
582	650	"$58,441"		
583	688	"$54,861"		
584	730	"$62,083"		
585	774	"$60,880"		
592	2859	"$48,802"		
593	5405	"$39,457"		
594	577	"$29,234"		
595	992	"$54,005"		
596	2756	"$35,902"		
597	1483	"$55,052"		
598	1459	"$43,250"		
599	105	"$30,694"		
600	876	"$36,493"		
601	366	"$23,663"		
602	25057	"$46,582"		
603	103946	"$31,065"		
604	3232	"$50,976"		
605	13107	"$38,118"		
606	1772	"$46,351"		
607	5848	"$31,045"		
614	2112	"$80,084"		
615	1232	"$60,847"		
616	2944	"$98,924"		
617	15011	"$64,674"		
618	98	"$49,238"		
619	955	"$87,012"		
620	3900	"$66,130"		
621	12884	"$60,231"		
622	1929	"$85,132"		
623	6179	"$59,147"		
624	258	"$43,050"		
625	862	"$89,472"		
626	1326	"$65,556"		
627	1292	"$52,456"		
628	3202	"$96,690"		
629	5508	"$70,180"		
630	251	"$55,512"		
637	31399	"$47,797"		
638	56558	"$34,990"		
639	9869	"$25,860"		
640	72025	"$43,337"		
641	89299	"$30,989"		
642	1921	"$42,495"		
643	9729	"$52,308"		
644	13470	"$40,839"		
645	4211	"$31,582"		
652	11473	"$113,418"		
653	1532	"$141,513"		
654	4149	"$92,659"		
655	1513	"$73,948"		
656	3115	"$97,526"		
657	7740	"$71,688"		
658	6157	"$63,032"		
659	8262	"$77,774"		
660	19093	"$55,184"		
661	12934	"$49,316"		
662	644	"$86,053"		
663	1438	"$55,772"		
664	563	"$46,179"		
665	623	"$87,661"		
666	1669	"$61,559"		
667	483	"$41,877"		
668	2198	"$82,224"		
669	5631	"$57,606"		
670	1752	"$44,237"		
671	387	"$60,991"		
672	200	"$46,485"		
673	11425	"$93,627"		
674	6709	"$74,730"		
675	468	"$57,480"		
682	103295	"$48,674"		
683	140975	"$35,985"		
684	17008	"$26,598"		
686	1674	"$54,591"		
687	2545	"$42,426"		
688	284	"$36,921"		
689	72065	"$42,645"		
690	139902	"$32,253"		
693	1416	"$48,085"		
694	7944	"$33,610"		
695	1139	"$42,621"		
696	6284	"$27,876"		
697	483	"$40,410"		
698	60731	"$50,469"		
699	36260	"$39,628"		
700	3678	"$30,191"		
707	4362	"$70,299"		
708	9595	"$62,436"		
709	454	"$69,664"		
710	219	"$55,773"		
711	456	"$66,723"		
712	132	"$45,037"		
713	5200	"$53,136"		
714	1676	"$40,642"		
715	391	"$68,125"		
716	119	"$59,450"		
717	1551	"$60,469"		
718	421	"$49,897"		
722	863	"$55,459"		
723	1558	"$43,082"		
724	100	"$29,264"		
725	715	"$46,056"		
726	2564	"$30,890"		
727	1331	"$48,358"		
728	4562	"$32,484"		
729	688	"$40,737"		
730	91	"$28,217"		
734	894	"$75,498"		
735	542	"$59,176"		
736	654	"$119,557"		
737	2563	"$72,906"		
738	538	"$58,768"		
739	520	"$108,255"		
740	2362	"$67,159"		
741	1721	"$57,648"		
742	4532	"$62,163"		
743	6065	"$50,531"		
744	1351	"$57,990"		
745	226	"$47,746"		
746	1451	"$55,375"		
747	1411	"$42,398"		
748	1519	"$52,992"		
749	797	"$78,127"		
750	151	"$55,515"		
754	1729	"$54,261"		
755	2492	"$41,674"		
756	208	"$35,649"		
757	868	"$48,088"		
758	1409	"$39,217"		
759	436	"$27,399"		
760	1540	"$36,683"		
761	312	"$26,384"		
768	188	"$32,763"		
769	87	"$47,858"		
770	68	"$33,753"		
776	533	"$27,529"		
779	63	"$35,563"		
783	233	"$53,953"		
784	594	"$37,675"		
785	437	"$31,589"		
786	722	"$50,233"		
787	1926	"$35,987"		
788	1608	"$32,175"		
793	1	"$16,262"		
794	4	"$18,181"		
796	28	"$48,100"		
797	109	"$30,608"		
798	113	"$30,608"		
799	462	"$135,742"		
800	330	"$85,748"		
801	173	"$67,599"		
802	856	"$88,307"		
803	945	"$64,229"		
804	415	"$57,271"		
805	465	"$31,285"		
806	2220	"$20,428"		
807	3525	"$18,003"		
808	7875	"$60,357"		
809	14015	"$44,229"		
810	1761	"$38,441"		
811	26231	"$46,879"		
812	56269	"$35,385"		
813	17387	"$49,335"		
814	1634	"$55,529"		
815	2834	"$41,664"		
816	722	"$33,767"		
817	70	"$68,139"		
818	94	"$46,348"		
819	30	"$38,261"		
820	1136	"$146,635"		
821	1121	"$74,038"		
822	939	"$54,473"		
823	2204	"$117,273"		
824	2264	"$77,862"		
825	661	"$56,438"		
826	785	"$136,549"		
827	1319	"$78,144"		
828	817	"$64,379"		
829	1783	"$85,211"		
830	333	"$56,250"		
831	819	"$36,477"		
832	1277	"$23,674"		
833	599	"$18,220"		
834	4245	"$115,020"		
835	2240	"$55,818"		
836	449	"$42,553"		
837	2011	"$116,839"		
838	1191	"$56,278"		
839	910	"$43,117"		
840	8639	"$76,050"		
841	7529	"$52,886"		
842	1485	"$43,908"		
843	2067	"$58,472"		
844	1987	"$45,520"		
845	331	"$39,638"		
846	3165	"$67,061"		
847	12429	"$47,286"		
848	279	"$37,159"		
849	400	"$58,974"		
853	84245	"$126,519"		
854	26085	"$70,776"		
855	259	"$57,972"		
856	8639	"$103,775"		
857	9444	"$62,315"		
858	1138	"$50,883"		
862	12470	"$55,253"		
863	11368	"$37,573"		
864	10029	"$36,332"		
865	3598	"$46,583"		
866	7654	"$33,744"		
867	2601	"$58,162"		
868	2079	"$41,241"		
869	374	"$30,722"		
870	34988	"$168,258"		
871	615493	"$58,297"		
872	166701	"$42,513"		
876	665	"$76,973"		
880	7427	"$36,658"		
881	4454	"$23,741"		
882	2051	"$27,068"		
883	1169	"$33,190"		
884	19314	"$42,140"		
885	72218	"$31,637"		
886	340	"$33,319"		
887	434	"$39,914"		
894	4063	"$20,979"		
895	3736	"$36,852"		
896	8917	"$52,133"		
897	31416	"$29,055"		
901	1080	"$96,846"		
902	2355	"$61,673"		
903	571	"$46,308"		
904	1057	"$87,564"		
905	242	"$57,333"		
906	542	"$58,837"		
907	10259	"$101,503"		
908	10071	"$65,365"		
909	3151	"$51,291"		
913	777	"$50,431"		
914	2700	"$38,614"		
915	2412	"$53,937"		
916	4030	"$25,458"		
917	29861	"$49,291"		
918	18802	"$31,630"		
919	13969	"$54,913"		
920	13407	"$40,488"		
921	2958	"$29,447"		
922	1576	"$50,554"		
923	2143	"$33,963"		
927	154	"$416,572"		
928	1218	"$130,472"		
929	314	"$75,365"		
933	144	"$63,696"		
934	515	"$44,419"		
935	1800	"$46,558"		
939	782	"$92,764"		
940	1695	"$69,584"		
941	802	"$62,593"		
945	1523	"$44,848"		
946	371	"$45,337"		
947	9194	"$43,032"		
948	30971	"$32,538"		
949	1480	"$37,578"		
950	293	"$23,410"		
951	1855	"$22,277"		
955	472	"$170,172"		
956	6224	"$101,960"		
957	2318	"$199,368"		
958	1788	"$121,238"		
959	142	"$93,651"		
963	2880	"$78,187"		
964	4726	"$53,672"		
965	817	"$39,894"		
969	442	"$147,713"		
970	119	"$88,988"		
974	4902	"$70,912"		
975	2440	"$47,322"		
976	466	"$37,392"		
977	1473	"$45,588"		
981	27697	"$113,274"		
982	16469	"$74,201"		
983	2986	"$58,188"		
987	8949	"$90,611"		
988	8890	"$59,964"		
989	1411	"$48,333"		
				
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 2018 MedPAR file; MS-DRGs are from GROUPER Version37.0.				
