"NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2022 FINAL RULE"											
MS?DRG	Number of Cases	Threshold									
001	2213	"$751,817"									
002	145	"$437,800"									
003	14532	"$452,139"									
004	12702	"$280,009"									
005	1236	"$288,862"									
006	507	"$171,436"									
007	595	"$361,233"									
008	347	"$185,637"									
010	29	"$127,976"									
011	1885	"$141,031"									
012	1863	"$123,665"									
013	545	"$88,050"									
014	1101	"$314,148"									
016	2127	"$180,928"									
017	114	"$131,564"									
018	145	"$1,251,126"									
019	86	"$217,441"									
020	1732	"$288,301"									
021	444	"$207,811"									
022	144	"$138,493"									
023	12867	"$163,617"									
024	4624	"$124,692"									
025	21980	"$133,757"									
026	9547	"$99,226"									
027	10495	"$86,937"									
028	2247	"$157,195"									
029	3863	"$101,611"									
030	1432	"$80,748"									
031	976	"$115,883"									
032	2235	"$77,286"									
033	2794	"$67,856"									
034	1372	"$120,869"									
035	3671	"$83,514"									
036	5157	"$70,690"									
037	3530	"$105,086"									
038	11624	"$68,287"									
039	22008	"$55,687"									
040	3882	"$112,862"									
041	6422	"$84,970"									
042	2414	"$73,163"									
052	1042	"$60,538"									
053	229	"$46,678"									
054	12660	"$51,600"									
055	3931	"$46,022"									
056	11969	"$59,560"									
057	29969	"$45,390"									
058	814	"$58,716"									
059	2785	"$47,326"									
060	2316	"$42,724"									
061	5520	"$106,842"									
062	10537	"$87,712"									
063	2206	"$81,047"									
064	77911	"$63,898"									
065	107737	"$49,299"									
066	31642	"$39,257"									
067	992	"$58,794"									
068	4403	"$46,814"									
069	37294	"$43,681"									
070	18430	"$56,224"									
071	18407	"$44,596"									
072	3717	"$38,842"									
073	7403	"$51,679"									
074	16136	"$45,205"									
075	646	"$59,859"									
076	165	"$45,668"									
077	2111	"$58,993"									
078	2942	"$47,623"									
079	531	"$40,096"									
080	834	"$63,092"									
081	577	"$35,462"									
082	6980	"$70,408"									
083	10061	"$52,856"									
084	4885	"$43,344"									
085	8178	"$68,918"									
086	16035	"$51,794"									
087	8140	"$41,893"									
088	623	"$58,725"									
089	1936	"$49,529"									
090	625	"$45,060"									
091	16177	"$56,021"									
092	22749	"$44,022"									
093	7401	"$38,953"									
094	1466	"$98,214"									
095	1361	"$77,930"									
096	436	"$78,909"									
097	2051	"$102,654"									
098	1573	"$68,841"									
099	495	"$56,843"									
100	25491	"$60,671"									
101	41079	"$41,967"									
102	1217	"$48,718"									
103	9530	"$41,340"									
113	475	"$76,713"									
114	132	"$59,893"									
115	713	"$59,065"									
116	384	"$64,448"									
117	162	"$49,683"									
121	578	"$42,887"									
122	173	"$24,534"									
123	3100	"$41,728"									
124	1009	"$50,449"									
125	3349	"$38,798"									
135	286	"$76,339"									
136	94	"$57,523"									
137	967	"$53,962"									
138	385	"$40,842"									
139	336	"$53,078"									
140	656	"$121,671"									
141	2499	"$81,683"									
142	1372	"$67,336"									
143	760	"$92,079"									
144	1599	"$65,664"									
145	1090	"$53,674"									
146	1094	"$60,351"									
147	922	"$47,120"									
148	228	"$37,586"									
149	15220	"$37,932"									
150	1070	"$47,343"									
151	2492	"$31,133"									
152	3060	"$44,621"									
153	7424	"$32,137"									
154	2029	"$54,023"									
155	3919	"$40,971"									
156	1467	"$31,194"									
157	1981	"$54,520"									
158	3402	"$39,590"									
159	850	"$30,926"									
163	10875	"$140,740"									
164	15818	"$91,709"									
165	8218	"$74,604"									
166	10127	"$105,132"									
167	6408	"$68,664"									
168	2346	"$59,148"									
175	31541	"$57,034"									
176	29119	"$41,247"									
177	77061	"$60,580"									
178	30448	"$47,811"									
179	5057	"$37,348"									
180	18953	"$61,503"									
181	9710	"$48,378"									
182	610	"$41,002"									
183	5039	"$56,472"									
184	10771	"$46,784"									
185	2908	"$36,416"									
186	10147	"$55,270"									
187	6466	"$45,688"									
188	1178	"$34,283"									
189	145606	"$49,064"									
190	129203	"$46,661"									
191	65317	"$38,434"									
192	23201	"$30,972"									
193	150028	"$50,951"									
194	102512	"$38,083"									
195	23599	"$29,976"									
196	9327	"$57,475"									
197	2950	"$44,519"									
198	725	"$34,855"									
199	6476	"$60,635"									
200	9961	"$45,941"									
201	1822	"$31,528"									
202	41224	"$42,355"									
203	8281	"$31,362"									
204	7662	"$38,537"									
205	9678	"$55,177"									
206	9443	"$40,358"									
207	18412	"$160,597"									
208	54946	"$83,264"									
215	7741	"$276,811"									
216	5603	"$310,475"									
217	1885	"$211,670"									
218	210	"$177,127"									
219	15597	"$237,679"									
220	15074	"$175,879"									
221	2417	"$146,585"									
222	1865	"$259,575"									
223	484	"$201,721"									
224	2334	"$231,834"									
225	1633	"$189,018"									
226	4869	"$200,364"									
227	4617	"$163,990"									
228	4436	"$187,542"									
229	5250	"$133,864"									
231	974	"$287,676"									
232	701	"$210,527"									
233	12150	"$245,702"									
234	13947	"$185,044"									
235	11497	"$188,377"									
236	19720	"$143,534"									
239	9925	"$116,267"									
240	7808	"$80,058"									
241	702	"$58,157"									
242	18955	"$116,484"									
243	25213	"$90,762"									
244	14488	"$79,311"									
245	1888	"$163,430"									
246	50992	"$122,615"									
247	86324	"$94,042"									
248	2416	"$122,624"									
249	3087	"$90,252"									
250	4434	"$100,117"									
251	5168	"$80,417"									
252	33326	"$100,347"									
253	23990	"$91,794"									
254	10540	"$70,946"									
255	2301	"$77,178"									
256	2112	"$59,274"									
257	140	"$47,045"									
258	547	"$102,924"									
259	902	"$77,279"									
260	2666	"$109,371"									
261	3652	"$74,543"									
262	1358	"$69,118"									
263	262	"$75,780"									
264	10418	"$86,944"									
265	580	"$98,779"									
266	20763	"$202,932"									
267	29772	"$165,178"									
268	3661	"$199,199"									
269	16291	"$129,870"									
270	18959	"$151,646"									
271	14540	"$115,465"									
272	5319	"$91,038"									
273	7557	"$134,785"									
274	26595	"$116,513"									
280	91211	"$57,486"									
281	48336	"$45,762"									
282	20556	"$40,456"									
283	10281	"$60,806"									
284	1086	"$37,461"									
285	273	"$26,018"									
286	44698	"$79,449"									
287	57246	"$58,548"									
288	1375	"$75,553"									
289	717	"$56,659"									
290	60	"$43,849"									
291	394415	"$49,333"									
292	84815	"$37,081"									
293	21884	"$28,639"									
294	285	"$47,743"									
295	27	"$36,927"									
296	3853	"$59,375"									
297	405	"$35,896"									
298	159	"$25,828"									
299	19592	"$52,147"									
300	28606	"$42,712"									
301	7624	"$32,422"									
302	3678	"$45,121"									
303	12095	"$32,471"									
304	16717	"$45,891"									
305	30522	"$36,011"									
306	4264	"$50,339"									
307	3301	"$39,160"									
308	69815	"$48,092"									
309	86566	"$34,089"									
310	55678	"$26,447"									
311	5291	"$33,760"									
312	68106	"$39,933"									
313	38352	"$36,660"									
314	43441	"$62,533"									
315	20108	"$42,802"									
316	3409	"$35,739"									
319	1615	"$136,294"									
320	591	"$86,240"									
326	10468	"$140,954"									
327	10366	"$87,499"									
328	7813	"$67,180"									
329	35642	"$134,364"									
330	50653	"$87,520"									
331	27638	"$68,635"									
332	180	"$114,447"									
333	647	"$77,674"									
334	677	"$64,575"									
335	5282	"$115,791"									
336	9354	"$81,214"									
337	4451	"$66,414"									
338	726	"$95,050"									
339	2368	"$70,134"									
340	1997	"$58,281"									
341	765	"$82,741"									
342	2323	"$64,125"									
343	2494	"$55,741"									
344	1068	"$84,814"									
345	2126	"$60,946"									
346	1068	"$55,204"									
347	869	"$76,491"									
348	2132	"$55,611"									
349	1115	"$46,355"									
350	1387	"$84,974"									
351	3468	"$63,468"									
352	2493	"$53,214"									
353	2743	"$95,124"									
354	7262	"$68,826"									
355	5308	"$58,567"									
356	6999	"$119,824"									
357	5646	"$80,179"									
358	1317	"$58,573"									
368	3063	"$64,920"									
369	3811	"$48,396"									
370	451	"$36,788"									
371	16733	"$56,194"									
372	25092	"$43,029"									
373	5674	"$33,270"									
374	11699	"$63,499"									
375	12795	"$49,319"									
376	1118	"$42,713"									
377	68798	"$61,267"									
378	127121	"$44,896"									
379	14801	"$30,807"									
380	5894	"$63,977"									
381	7629	"$48,493"									
382	1510	"$38,034"									
383	1065	"$54,330"									
384	3694	"$45,731"									
385	2907	"$56,547"									
386	7821	"$44,748"									
387	3436	"$33,788"									
388	18913	"$53,137"									
389	49330	"$37,191"									
390	29350	"$28,117"									
391	42106	"$49,612"									
392	136932	"$37,075"									
393	26139	"$55,901"									
394	38593	"$42,658"									
395	8877	"$32,023"									
405	3984	"$155,028"									
406	4994	"$98,818"									
407	1645	"$80,600"									
408	956	"$111,731"									
409	1011	"$79,022"									
410	319	"$66,628"									
411	159	"$117,935"									
412	231	"$86,167"									
413	148	"$71,822"									
414	1823	"$111,640"									
415	2642	"$76,926"									
416	1326	"$60,431"									
417	13113	"$89,388"									
418	22332	"$72,635"									
419	14230	"$62,046"									
420	725	"$102,940"									
421	790	"$72,106"									
422	178	"$60,333"									
423	1106	"$119,032"									
424	584	"$80,654"									
425	114	"$64,214"									
432	16711	"$62,165"									
433	11995	"$45,507"									
434	675	"$29,158"									
435	13803	"$61,991"									
436	7532	"$48,456"									
437	680	"$43,586"									
438	13934	"$56,568"									
439	24515	"$40,098"									
440	12269	"$31,003"									
441	20610	"$59,253"									
442	17960	"$41,041"									
443	2662	"$32,039"									
444	12849	"$60,150"									
445	18619	"$48,980"									
446	7202	"$42,317"									
453	3904	"$244,691"									
454	21434	"$166,354"									
455	21993	"$138,190"									
456	1397	"$239,054"									
457	3755	"$180,089"									
458	1251	"$137,821"									
459	3774	"$177,401"									
460	48813	"$116,797"									
461	264	"$163,856"									
462	6089	"$102,525"									
463	5234	"$122,317"									
464	8196	"$86,510"									
465	2564	"$66,079"									
466	5389	"$142,493"									
467	24331	"$107,409"									
468	18836	"$89,434"									
469	12309	"$97,499"									
470	359256	"$71,115"									
471	3534	"$148,802"									
472	16324	"$100,618"									
473	11837	"$87,571"									
474	3585	"$105,617"									
475	3644	"$70,929"									
476	712	"$51,194"									
477	3539	"$98,464"									
478	6813	"$82,158"									
479	1597	"$68,532"									
480	28795	"$97,001"									
481	79914	"$77,027"									
482	21361	"$65,309"									
483	68065	"$83,586"									
485	1526	"$106,224"									
486	3131	"$77,681"									
487	979	"$65,305"									
488	2641	"$68,217"									
489	2653	"$56,042"									
492	6314	"$106,531"									
493	19806	"$81,711"									
494	12201	"$70,085"									
495	501	"$106,129"									
496	1890	"$71,099"									
497	1225	"$58,343"									
498	1121	"$80,999"									
499	211	"$52,635"									
500	2848	"$90,013"									
501	6130	"$63,458"									
502	3048	"$54,934"									
503	1074	"$81,431"									
504	3026	"$63,826"									
505	1136	"$63,826"									
506	471	"$57,542"									
507	443	"$70,844"									
508	161	"$58,754"									
509	48	"$61,917"									
510	1076	"$90,679"									
511	3494	"$75,205"									
512	2145	"$64,756"									
513	1840	"$59,546"									
514	541	"$47,339"									
515	4831	"$97,613"									
516	14089	"$73,584"									
517	12675	"$59,696"									
518	2684	"$108,546"									
519	8454	"$72,891"									
520	6509	"$60,126"									
521	14987	"$100,483"									
522	50310	"$81,132"									
533	962	"$48,377"									
534	2733	"$31,342"									
535	7934	"$46,890"									
536	24006	"$32,361"									
537	905	"$39,678"									
538	329	"$30,883"									
539	3123	"$56,988"									
540	3338	"$46,921"									
541	570	"$34,008"									
542	7609	"$57,407"									
543	14615	"$44,389"									
544	3914	"$33,531"									
545	3740	"$66,193"									
546	4136	"$46,624"									
547	1277	"$36,615"									
548	648	"$62,487"									
549	1303	"$47,738"									
550	368	"$37,243"									
551	13411	"$56,700"									
552	53403	"$42,949"									
553	2441	"$46,875"									
554	11984	"$32,570"									
555	2299	"$50,325"									
556	9113	"$36,261"									
557	3567	"$52,347"									
558	10237	"$36,782"									
559	3049	"$55,713"									
560	5556	"$40,255"									
561	2624	"$31,270"									
562	6823	"$51,288"									
563	25615	"$37,067"									
564	5069	"$54,982"									
565	8538	"$43,934"									
566	2079	"$34,498"									
570	3103	"$75,696"									
571	6326	"$56,835"									
572	1393	"$47,763"									
573	788	"$119,706"									
574	1434	"$84,829"									
575	222	"$59,607"									
576	452	"$129,418"									
577	1612	"$83,201"									
578	882	"$63,315"									
579	4952	"$80,517"									
580	11253	"$58,260"									
581	4174	"$52,283"									
582	683	"$64,797"									
583	656	"$59,785"									
584	708	"$67,387"									
585	740	"$66,277"									
592	3048	"$51,036"									
593	4591	"$41,194"									
594	551	"$30,355"									
595	1039	"$57,180"									
596	2679	"$39,068"									
597	1489	"$56,356"									
598	1472	"$46,790"									
599	59	"$28,566"									
600	811	"$39,851"									
601	328	"$27,503"									
602	25738	"$49,739"									
603	96293	"$33,066"									
604	3379	"$54,494"									
605	13605	"$41,423"									
606	1862	"$48,696"									
607	5809	"$33,385"									
614	2161	"$85,582"									
615	1172	"$68,891"									
616	3054	"$107,289"									
617	15120	"$68,189"									
618	104	"$52,655"									
619	956	"$91,286"									
620	3732	"$68,837"									
621	11815	"$64,094"									
622	2063	"$88,743"									
623	6040	"$61,524"									
624	229	"$46,002"									
625	837	"$93,722"									
626	1195	"$69,459"									
627	1333	"$57,097"									
628	3404	"$103,448"									
629	5529	"$74,533"									
630	228	"$58,523"									
637	33859	"$50,610"									
638	53822	"$36,913"									
639	8786	"$27,660"									
640	76387	"$46,247"									
641	85545	"$32,984"									
642	1983	"$45,984"									
643	11224	"$56,384"									
644	13350	"$43,196"									
645	4343	"$33,876"									
650	2555	"$146,542"									
651	1155	"$130,378"									
652	9191	"$118,429"									
653	1668	"$148,501"									
654	4079	"$101,821"									
655	1537	"$80,142"									
656	3013	"$105,332"									
657	7456	"$76,142"									
658	5840	"$67,945"									
659	9343	"$81,846"									
660	19445	"$59,011"									
661	12927	"$51,808"									
662	695	"$85,852"									
663	1522	"$60,426"									
664	571	"$50,963"									
665	659	"$94,493"									
666	1528	"$64,718"									
667	488	"$46,544"									
668	2203	"$87,431"									
669	5563	"$61,051"									
670	1692	"$47,201"									
671	387	"$63,817"									
672	202	"$51,765"									
673	15760	"$95,640"									
674	7325	"$78,107"									
675	474	"$65,992"									
682	103511	"$51,592"									
683	126937	"$37,820"									
684	14530	"$28,251"									
686	1677	"$58,898"									
687	2515	"$44,851"									
688	287	"$36,126"									
689	79854	"$45,243"									
690	128530	"$34,542"									
693	1285	"$49,887"									
694	6462	"$35,778"									
695	1283	"$44,685"									
696	5927	"$30,107"									
697	448	"$44,007"									
698	68198	"$53,728"									
699	36755	"$41,976"									
700	3409	"$32,685"									
707	3415	"$76,333"									
708	6088	"$67,630"									
709	469	"$72,467"									
710	216	"$61,359"									
711	443	"$74,634"									
712	107	"$49,230"									
713	4769	"$57,704"									
714	1535	"$43,837"									
715	418	"$76,076"									
716	88	"$59,313"									
717	1691	"$65,378"									
718	492	"$54,870"									
722	811	"$56,665"									
723	1452	"$45,579"									
724	78	"$30,382"									
725	758	"$47,701"									
726	2919	"$32,778"									
727	1416	"$51,706"									
728	3873	"$34,613"									
729	618	"$42,181"									
730	97	"$25,178"									
734	804	"$82,300"									
735	470	"$64,107"									
736	606	"$129,624"									
737	2547	"$79,456"									
738	561	"$65,428"									
739	569	"$116,492"									
740	2283	"$73,454"									
741	1645	"$60,844"									
742	4104	"$67,468"									
743	5424	"$53,349"									
744	1423	"$64,561"									
745	205	"$50,642"									
746	1410	"$58,781"									
747	1371	"$46,305"									
748	1331	"$56,791"									
749	783	"$85,313"									
750	108	"$60,532"									
754	1796	"$58,833"									
755	2491	"$45,685"									
756	205	"$38,673"									
757	841	"$53,539"									
758	1312	"$41,674"									
759	378	"$31,688"									
760	1564	"$40,363"									
761	275	"$29,181"									
768	174	"$38,901"									
769	114	"$50,996"									
770	59	"$41,109"									
776	509	"$31,971"									
779	52	"$41,283"									
783	197	"$56,398"									
784	536	"$41,125"									
785	412	"$35,364"									
786	669	"$52,173"									
787	1652	"$38,989"									
788	1680	"$33,569"									
789	2	"$51,036"									
793	1	"$23,494"									
794	1	"$56,106"									
796	31	"$40,346"									
797	81	"$33,387"									
798	115	"$30,864"									
799	455	"$147,037"									
800	300	"$96,193"									
801	131	"$67,880"									
802	563	"$97,715"									
803	822	"$70,263"									
804	457	"$59,558"									
805	508	"$32,948"									
806	1928	"$22,924"									
807	3369	"$19,711"									
808	8264	"$65,191"									
809	13849	"$47,209"									
810	1632	"$41,314"									
811	29162	"$51,480"									
812	52621	"$38,190"									
813	17852	"$51,991"									
814	1547	"$59,305"									
815	2381	"$44,390"									
816	596	"$33,665"									
817	65	"$72,031"									
818	74	"$51,857"									
819	38	"$47,552"									
820	1102	"$158,516"									
821	1111	"$78,864"									
822	915	"$58,746"									
823	2357	"$128,694"									
824	2308	"$82,880"									
825	657	"$60,441"									
826	744	"$140,819"									
827	1372	"$88,315"									
828	769	"$69,720"									
829	1766	"$92,965"									
830	333	"$62,885"									
831	748	"$40,081"									
832	1138	"$26,206"									
833	508	"$18,926"									
834	4533	"$124,924"									
835	2223	"$59,908"									
836	446	"$43,255"									
837	1899	"$116,200"									
838	1275	"$62,724"									
839	866	"$50,450"									
840	8693	"$80,994"									
841	6960	"$56,011"									
842	1350	"$45,192"									
843	2214	"$61,801"									
844	1920	"$48,256"									
845	276	"$41,666"									
846	3176	"$70,840"									
847	12012	"$49,973"									
848	228	"$41,100"									
849	345	"$67,945"									
853	85196	"$131,705"									
854	25555	"$73,864"									
855	233	"$59,101"									
856	9258	"$111,387"									
857	9904	"$67,198"									
858	1139	"$53,273"									
862	12351	"$58,822"									
863	10549	"$39,672"									
864	9418	"$40,024"									
865	3090	"$50,342"									
866	6369	"$36,526"									
867	2608	"$63,407"									
868	1926	"$42,912"									
869	379	"$32,752"									
870	32497	"$181,072"									
871	609320	"$62,180"									
872	154981	"$44,790"									
876	673	"$81,904"									
880	7350	"$39,496"									
881	4001	"$25,008"									
882	1957	"$28,739"									
883	1206	"$37,067"									
884	20227	"$44,903"									
885	68596	"$34,044"									
886	297	"$36,278"									
887	387	"$42,048"									
894	4278	"$21,511"									
895	3514	"$39,263"									
896	9565	"$55,881"									
897	30261	"$31,367"									
901	1187	"$106,513"									
902	2056	"$64,942"									
903	572	"$48,737"									
904	1036	"$98,128"									
905	255	"$59,392"									
906	577	"$61,945"									
907	10342	"$107,147"									
908	9129	"$69,718"									
909	2992	"$55,848"									
913	764	"$56,795"									
914	2453	"$41,770"									
915	2487	"$57,610"									
916	3929	"$28,459"									
917	28772	"$52,590"									
918	15928	"$33,930"									
919	14891	"$58,009"									
920	13640	"$43,274"									
921	2729	"$31,231"									
922	1697	"$54,335"									
923	1964	"$37,806"									
927	161	"$483,059"									
928	1093	"$142,947"									
929	261	"$86,808"									
933	119	"$63,406"									
934	496	"$50,308"									
935	1751	"$49,627"									
939	645	"$94,946"									
940	1418	"$73,705"									
941	738	"$66,593"									
945	2162	"$55,606"									
946	679	"$54,388"									
947	8832	"$45,339"									
948	28283	"$34,733"									
949	1184	"$39,706"									
950	237	"$26,550"									
951	3040	"$21,931"									
955	473	"$185,321"									
956	6229	"$107,581"									
957	2325	"$212,482"									
958	1845	"$131,751"									
959	130	"$92,290"									
963	3070	"$83,786"									
964	4627	"$56,997"									
965	746	"$43,735"									
969	409	"$153,815"									
970	91	"$87,376"									
974	4294	"$75,849"									
975	2062	"$50,269"									
976	354	"$41,552"									
977	1194	"$48,278"									
981	26451	"$122,741"									
982	13852	"$81,909"									
983	2652	"$63,590"									
987	8949	"$94,964"									
988	8173	"$62,966"									
989	1228	"$51,102"									
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 2019 MedPAR file; MS-DRGs are from GROUPER Version38.0.											
