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Data Files

FY 2015 IRF PPS Final Rule Data Files (79 FR 45871)

  • IRF Rate Setting Final Rule (79 FR 45871)
    This file contains data for each of the 1,142 inpatient rehabilitation facilities used to estimate the policy updates in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Values used in the final rule (79 FR 45871) and the standard deviations from the average lengths of stay.
  • IRF Wage Index Final Rule (79 FR 45871)
    These files contain the urban and rural Core-Based Statistical Area FY 2015 IRF wage index tables.
  • Tier Comorbidities – ICD-9-CM (79 FR 45871) (Unchanged from FY 2013)
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2014. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. Note that this list is unchanged from the list that was used for IRF discharges occurring on or after October 1, 2012.
  • Tier Comorbidities – ICD-10-CM (79 FR 45871)
    This file contains the list of diagnoses (ICD-10-CM codes) that are used to determine placement in tiers for IRF discharges, effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-10-CM codes are excluded from the tiers.
  • Codes That Meet Presumptive Compliance Criteria — ICD-9-CM (for compliance review periods beginning on or after October 1, 2015) (79 FR 45871)
    This file contains the list of diagnoses (ICD-9-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule. (Effective for compliance review periods beginning on or after October 1, 2015.) It contains the ICD-9-CM codes and the code labels.
  • Codes That Meet Presumptive Compliance Criteria — ICD-10-CM (79 FR 45871)
    This file contains the list of diagnoses (ICD-10-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule, effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes and the code labels.  Note that this list will only be used for compliance review periods beginning on or after October 1, 2015 if ICD-10-CM is the required medical data code set for use on Medicare claims and IRF-PAI submissions at that time.  Otherwise, please refer to the Draft Codes That Meet Presumptive Compliance Criteria – ICD-9-CM.
  • Impairment Group Codes That Meet Presumptive Compliance Criteria — ICD-9-CM (for compliance review periods beginning on or after October 1, 2015) (79 FR 45871)
    This file contains the list of impairment group codes that meet presumptive compliance criteria for the 60 percent rule. (Effective for compliance review periods beginning on or after October 1, 2015.) It contains the ICD-9-CM codes excluded from the impairment group codes and the code labels.
  • Impairment Group Codes That Meet Presumptive Compliance Criteria — ICD-10-CM (79 FR 45871)
    This file contains the list of impairment group codes that are used for determining presumptive compliance with the IRF 60 percent rule, effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes excluded from the impairment group codes and the code labels.  Note that this list will only be used for compliance review periods beginning on or after October 1, 2015 if ICD-10-CM is the required medical data code set for use on Medicare claims and IRF-PAI submissions at that time.  Otherwise, please refer to the Draft Impairment Group Codes That Meet Presumptive Compliance Criteria – ICD-9-CM.
  • ICD-9-CM to ICD-10-CM Code Translation and the Use of Combination Codes in the IRF PPS
    This file contains a document that outlines the use of combination diagnosis codes in the IRF PPS for the following ICD-10-CM code lists:  Tier Comorbidities, Codes That Meet Presumptive Compliance Criteria, and Impairment Group Codes That Meet Presumptive Compliance Criteria.

FY 2015 IRF PPS Proposed Rule Data Files (79 FR 26308)

  • IRF Rate Setting Proposed Rule (79 FR 26308)
    This file contains data for each of the 1,140 inpatient rehabilitation facilities used to estimate the proposed policy updates in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.
  • Case-Mix Groups, Proposed Relative Weights, and Proposed Average Length Of Stay Values used in the proposed rule (79 FR 26308) and the standard deviations from the average lengths of stay.
  • IRF Wage Index Proposed Rule (79 FR 26308)
    These files contain the urban and rural Core-Based Statistical Area proposed FY 2015 IRF wage index tables.
  • ICD-9-CM to ICD-10-CM Code Translation and the Use of Combination Codes in the IRF PPS
    This file contains a document that outlines the use of combination diagnosis codes in the IRF PPS for the following ICD-10-CM code lists:  Tier Comorbidities, Codes That Meet Presumptive Compliance Criteria, and Impairment Group Codes That Meet Presumptive Compliance Criteria
  • Draft Tier Comorbidities – ICD-10-CM (79 FR 26308) -
    This file contains the list of diagnoses (ICD-10-CM codes) that we propose to use to determine placement in tiers for IRF discharges, effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-10-CM codes are excluded from the tiers.
  • Draft Codes That Meet Presumptive Compliance Criteria — ICD-9-CM (for compliance review periods beginning on or after October 1, 2014) (79 FR 26308)
    This file contains the list of diagnoses (ICD-9-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule. (Effective for compliance review periods beginning on or after October 1, 2014.) It contains the ICD-9-CM codes and the code labels.
  • Draft Codes That Meet Presumptive Compliance Criteria — ICD-10-CM (79 FR 26308)
    This file contains the list of diagnoses (ICD-10-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule, effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes and the code labels.  Note that this list will only be used for compliance review periods beginning on or after October 1, 2014 if ICD-10-CM is the required medical data code set for use on Medicare claims and IRF-PAI submissions at that time.  Otherwise, please refer to the Draft Codes That Meet Presumptive Compliance Criteria – ICD-9-CM.
  • Draft Impairment Group Codes That Meet Presumptive Compliance Criteria — ICD-9-CM (for compliance review periods beginning on or after October 1, 2014) (79 FR 26308)
    This file contains the list of impairment group codes that meet presumptive compliance criteria for the 60 percent rule. (Effective for compliance review periods beginning on or after October 1, 2014.) It contains the ICD-9-CM codes excluded from the impairment group codes and the code labels.
  • Draft Impairment Group Codes That Meet Presumptive Compliance Criteria — ICD-10-CM (79 FR 26308)
    This file contains the list of impairment group codes that are used for determining presumptive compliance with the IRF 60 percent rule, effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes excluded from the impairment group codes and the code labels.  Note that this list will only be used for compliance review periods beginning on or after October 1, 2014 if ICD-10-CM is the required medical data code set for use on Medicare claims and IRF-PAI submissions at that time.  Otherwise, please refer to the Draft Impairment Group Codes That Meet Presumptive Compliance Criteria – ICD-9-CM.

FY 2014 IRF PPS Final Rule Data Files (78 FR 47860)

  • IRF Rate Setting Final Rule (78 FR 47860)
    This file contains data for each of the 1,134 inpatient rehabilitation facilities used to estimate the policy updates in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Values used in the final rule (78 FR 47860) and the standard deviations from the average lengths of stay.  8-13-13 – This file has been revised to reflect an average length of stay value of 21 for CMG 5104.
  • IRF Wage Index Final Rule (78 FR 47860)
    These files contain the urban and rural Core-Based Statistical Area FY 2014 IRF wage index tables.
  • ICD-9-CM Codes That Meet Presumptive Compliance Criteria
    This file contains the list of diagnoses (ICD-9-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule. (Effective for compliance review periods beginning on or after October 1, 2014.)  It contains the ICD-9-CM codes and the code labels.  8-30-13 – This file has been revised to reflect that ICD-9-CM code 806.9—Closed fracture of C5-C7 level with other specified spinal cord injury has been changed to 806.09—Closed fracture of C5-C7 level with other specified spinal cord injury.
  • List of Comorbidities (Unchanged from FY 2013)
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2013.  It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers.  Note that this list is unchanged from the list that was used for IRF discharges occurring on or after October 1, 2012.

FY 2014 IRF PPS Proposed Rule Data Files (78 FR 26880)

  • IRF Rate Setting Proposed Rule (78 FR 26880)
    This file contains data for each of the 1,132 inpatient rehabilitation facilities used to estimate the proposed policy updates in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.
  • Case-Mix Groups, Proposed Relative Weights, and Proposed Average Length Of Stay Values used in the proposed rule (78 FR 26880) and the standard deviations from the average lengths of stay.
  • IRF Wage Index Proposed Rule (78 FR 26880)
    These files contain the urban and rural Core-Based Statistical Area proposed FY 2014 IRF wage index tables.
  • Draft Appendix C—Presumptive Methodology Codes for FY 2014 (78 FR 26880) - Revised May 3, 2013
    This file contains the list of diagnoses (ICD-9-CM codes) that we propose to use for determining presumptive compliance with the IRF 60 percent rule for compliance review periods beginning on or after October 1, 2013. It contains the ICD-9-CM codes and the code labels.
  • Appendix C—List of Comorbidities (Unchanged from FY 2013)
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2013. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. Note that this list is unchanged from the list that was used for IRF discharges occurring on or after October 1, 2012.

FY 2013 IRF PPS Notice Data Files (77 FR 44618)

  • IRF Rate Setting Notice (77 FR 44618)
    This file contains data for each of the 1,139 inpatient rehabilitation facilities used to estimate the payment updates in the FY 2013 inpatient rehabilitation facility prospective payment system notice. The methodology used to update the payment data is described in detail in the notice.
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Values used in the notice (77 FR 44618) and the standard deviations from the average lengths of stay.
  • IRF Wage Index Notice (77 FR 44618)
    These files contain the urban and rural Core-Based Statistical Area final FY 2013 IRF wage index tables.  
  • Appendix C—List of Comorbidities
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2012. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2012 IRF PPS Correction Notice Data Files (78 FR 59256)

  • IRF Rate Setting Correction Notice (78 FR 59256)
    This file contains data for each of the 1,152 inpatient rehabilitation facilities used to estimate the policy updates in the inpatient rehabilitation prospective payment system correction notice. The methodology used to update the payment data is described in detail in the final rule (76 FR 47836).
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Values used in the correction notice (78 FR 59256) and the standard deviations from the average lengths of stay.

FY 2012 IRF PPS Final Rule Data Files (76 FR 47836)

  • IRF Rate Setting Final Rule (76 FR 47836)
    This file contains data for each of the 1,152 inpatient rehabilitation facilities used to estimate the policy updates in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.
  • IRF Wage Index Final Rule (76 FR 47836)
    These files contain the urban and rural Core-Based Statistical Area wage index tables.  
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Values used in the rule (76 FR 47836) and the standard deviations from the average lengths of stay.
  • Appendix C—List of Comorbidities
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2011. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2012 IRF PPS Proposed Rule Data Files (76 FR 24214)

  • IRF Rate Setting Proposed Rule (76 FR 24214)
    This file contains data for each of the 1,146 inpatient rehabilitation facilities used to estimate the proposed policy updates in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.
  • IRF Wage Index Proposed Rule (76 FR 24214)
    These files contain the urban and rural Core-Based Statistical Area proposed wage index tables.  
  • Case-Mix Groups, Proposed Relative Weights, and Proposed Average Length Of Stay Values used in the proposed rule (76 FR 24214) and the standard deviations from the average lengths of stay.

FY 2011 IRF PPS Notice Data Files (75 FR 42836)

  • IRF Rate Setting Notice (75 FR 42836)
    This file contains data for each of the 1,171 inpatient rehabilitation facilities used to estimate the payment updates in the FY 2011 inpatient rehabilitation prospective payment system notice. The methodology used to update the payment data is described in detail in the notice.
  • IRF Wage Index Notice (75 FR 42836)
    These files contain the urban and rural Core-Based Statistical Area final FY 2011 IRF wage index tables.
  • Case-Mix Groups, Relative Weights, and Average Length of Stay Values for the Notice (75 FR 42836)
  • Appendix C—List of Comorbidities
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2010. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.”

Legislative Changes to the IRF Prospective Payment Rates--Effective April 1, 2010

Section 3401(d)(2) of the Patient Protection and Affordable Care Act, as amended by section 10319(c) of such Act and further amended by Section 1105 of the Health Care and Education Reconciliation Act of 2010, amends Section 1886(b)(3)(B) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)) to apply a 0.25 percentage point reduction to the payment rates for inpatient rehabilitation facilities (IRFs) for part of fiscal year 2010. The new rates will become effective for discharges occurring on or after April 1, 2010, and will apply from April 1, 2010 through September 30, 2010. Payment rates for discharges occurring from October 1, 2009 through March 31, 2010 will continue to be based on the 2.5 percent market basket factor that was implemented in the FY 2010 IRF PPS final rule (74 FR 39762). See the related "Download" below for additional information.

FY 2010 IRF PPS Final Rule Data Files (74 FR 39762)

  • IRF Rate Setting Final Rule (74 FR 39762)
    This file contains data for each of the 1,181 inpatient rehabilitation facilities used to estimate the policy updates in the FY 2010 inpatient rehabilitation prospective payment system final rule. The methodology used to update the payment data is described in detail in the final rule.
  • IRF Wage Index Final Rule (74 FR 39762)
    These files contain the urban and rural Core-Based Statistical Area final FY 2010 IRF wage index tables.
  • Case-Mix Groups, Relative Weights, and Average Length of Stay Values for the Final Rule (74 FR 39762)
  • Appendix C—List of Comorbidities (Revised August 7, 2009)
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2009. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2010 IRF PPS Proposed Rule Data Files (74 FR 21052)

  • IRF Rate Setting Proposed Rule (74 FR 21052)
    This file contains data for each of the 1,205 inpatient rehabilitation facilities used to estimate the proposed policy updates in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.
  • IRF Wage Index Proposed Rule (74 FR 21052)
    These files contain the urban and rural Core-Based Statistical Area proposed wage index tables.  
  • Case-Mix Groups, Proposed Relative Weights, and Proposed Average Length Of Stay Values Used In The FY 2010 Proposed Rule (74 FR 21052).

FY 2009 IRF PPS Final Rule Data Files (73 FR 46370)

  • IRF Rate Setting Final Rule (73 FR 46370)—REVISED August 27, 2008
    This file contains data for each of the 1,205 inpatient rehabilitation facilities used to estimate the policy updates in the FY 2009 inpatient rehabilitation prospective payment system final rule. The methodology used to update the payment data is described in detail in the final rule. Note that this file is a revised version of the file that was posted on August 12, 2008. This revised file reflects the clarifications to the wage index methodology regarding treatment of New England deemed counties and multi-campus hospitals that were finalized in the FY 2009 IRF PPS final rule (73 FR 46370).
  • IRF Wage Index Final Rule (73 FR 46370)
    These files contain the urban and rural Core-Based Statistical Area final FY 2009 IRF wage index tables. 
  • Case-Mix Groups, Relative Weights, and Average Length of Stay Values for the Final Rule (73 FR 46370)
  • Appendix C—List of Comorbidities (Revised August 4, 2008)
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2008. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2009 IRF PPS Proposed Rule Data Files (73 FR 22674)

  • IRF Rate Setting Proposed Rule (73 FR 22674)
    This file contains data for each of the 1,231 inpatient rehabilitation facilities used to estimate the proposed policy updates in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.
  • IRF Wage Index Proposed Rule (73 FR 22674)
    These files contain the urban and rural Core-Based Statistical Area proposed wage index tables.  
  • Case-Mix Groups, Proposed Relative Weights, and Proposed Average Length Of Stay Values Used In The Proposed Rule (73 FR 22674)

Legislative Changes to the IRF Prospective Payment Rates--Effective April 1, 2008

Section 115 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 amended Section 1886(j)(3)(C) of the Social Security Act to apply a zero percent increase to payment rates for inpatient rehabilitation facilities (IRFs) for part of fiscal year (FY) 2008 and all of FY 2009. The new rates will become effective for discharges occurring on or after April 1, 2008, and will apply to the last two quarters of FY 2008 (from April 1, 2008 through September 30, 2008). Payment rates for the first two quarters of FY 2008 (from October 1, 2007 through March 31, 2008) will continue to be based on the 3.2 percent market basket increase that was implemented in the FY 2008 IRF PPS final rule (72 FR 44284).  See the related "Download" below for additional information.

FY 2008 IRF PPS Final Rule Data Files (72 FR 44284)

  • IRF Rate Setting Final Rule
    This file contains data for each of the 1,220 inpatient rehabilitation facilities used to estimate the final update to the outlier threshold amount and to simulate the distributional impacts shown in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.
  • IRF Wage Index Final Rule
    These files contain the urban and rural Core-Based Statistical Area final wage index tables.
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Used In The Final Rule
  • Appendix C—List of Comorbidities (Revised August 3, 2007)
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2007. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2008 IRF PPS Proposed Rule Data Files (72 FR 26230)

  • IRF Rate Setting Proposed Rule (72 FR 26230)
    This file contains data for each of the 1,234 inpatient rehabilitation facilities used to estimate the proposed update to the outlier threshold amount and to simulate the distributional impacts shown in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.
  • IRF Wage Index Proposed Rule (72 FR 26230)
    These files contain the urban and rural Core-Based Statistical Area proposed wage index tables.

FY 2007 IRF PPS Final Rule Data Files (71 FR 48354)

  • IRF Rate Setting Final Rule
    This file contains data for each of the 1,202 inpatient rehabilitation facilities used to estimate the final update to the outlier threshold amount and to simulate the distributional impacts shown in the final inpatient rehabilitation prospective payment system regulation. The methodology used to update the payment data is described in detail in the final rule.
  • IRF Wage Index Final Rule
    These files contain the urban and rural Core-Based Statistical Area final wage index tables.
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Used In The Final Rule
  • Appendix C—List of Comorbidities (Revised August 1, 2006)
    This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2006. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. It also notes the changes that were made from the previous version of the list.

FY 2007 IRF PPS Proposed Rule Data Files (71 FR 28106)

  • IRF Rate Setting Proposed Rule revised (71 FR 28106)
    This file contains data for each of the 1,202 inpatient rehabilitation facilities used to estimate the proposed update to the outlier threshold amount and to simulate the distributional impacts shown in the proposed inpatient rehabilitation prospective payment system regulation. The proposed methodology used to update the payment data is described in detail in the proposed rule.
  • IRF Wage Index Proposed Rule (71 FR 28106)
    These files contain the urban and rural Core-Based Statistical Area proposed wage index tables.
  • Hypothetical FY 2007 IRF MSA-based wage index: This wage index file is posted in response to a request from the industry. Since this file was not used to determine the wage index in the FY 2007 IRF PPS proposed rule, this is a hypothetical wage index file under the MSA-based area designation scenario. This file is for public informational purposes only and was not used to determine the proposed FY 2007 CBSA wage index for IRFs.
  • Case-Mix Groups, Relative Weights, and Average Length Of Stay Used In The Proposed Rule (71 FR 28106)