PROPOSED NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1 FOR APPLICATIONS FOR FY 2025									
MS?DRG	Threshold								
001	"$841,245"								
002	"$419,359"								
003	"$582,310"								
004	"$390,903"								
005	"$331,935"								
006	"$198,938"								
007	"$442,341"								
008	"$214,941"								
010	"$178,312"								
011	"$168,405"								
012	"$150,381"								
013	"$101,369"								
014	"$317,608"								
016	"$182,800"								
017	"$182,800"								
018	"$1,398,277"								
019	"$290,931"								
020	"$263,840"								
021	"$190,152"								
022	"$125,780"								
023	"$188,083"								
024	"$140,663"								
025	"$151,532"								
026	"$113,660"								
027	"$100,528"								
028	"$191,115"								
029	"$123,145"								
030	"$93,246"								
031	"$131,859"								
032	"$88,322"								
033	"$76,972"								
034	"$140,918"								
035	"$95,463"								
036	"$81,173"								
037	"$124,492"								
038	"$77,129"								
039	"$64,366"								
040	"$128,751"								
041	"$96,406"								
042	"$82,585"								
052	"$73,392"								
053	"$51,904"								
054	"$61,139"								
055	"$53,685"								
056	"$71,151"								
057	"$53,160"								
058	"$64,702"								
059	"$55,610"								
060	"$48,913"								
061	"$120,563"								
062	"$96,840"								
063	"$84,628"								
064	"$75,316"								
065	"$56,607"								
066	"$45,618"								
067	"$67,127"								
068	"$54,525"								
069	"$53,112"								
070	"$65,570"								
071	"$52,509"								
072	"$46,329"								
073	"$60,179"								
074	"$51,835"								
075	"$76,055"								
076	"$50,506"								
077	"$68,452"								
078	"$57,122"								
079	"$47,464"								
080	"$73,239"								
081	"$49,011"								
082	"$81,072"								
083	"$61,830"								
084	"$50,822"								
085	"$79,376"								
086	"$61,135"								
087	"$50,256"								
088	"$69,771"								
089	"$60,503"								
090	"$54,460"								
091	"$65,824"								
092	"$51,913"								
093	"$46,138"								
094	"$116,474"								
095	"$90,956"								
096	"$91,132"								
097	"$117,185"								
098	"$82,549"								
099	"$64,941"								
100	"$71,364"								
101	"$49,409"								
102	"$58,683"								
103	"$50,807"								
113	"$93,362"								
114	"$62,224"								
115	"$68,945"								
116	"$70,582"								
117	"$60,434"								
121	"$50,540"								
122	"$33,745"								
123	"$52,160"								
124	"$57,610"								
125	"$45,555"								
135	"$99,342"								
136	"$56,472"								
137	"$61,785"								
138	"$50,514"								
139	"$61,412"								
140	"$139,068"								
141	"$92,262"								
142	"$75,237"								
143	"$112,881"								
144	"$75,493"								
145	"$63,167"								
146	"$70,808"								
147	"$56,431"								
148	"$47,340"								
149	"$46,250"								
150	"$54,289"								
151	"$37,753"								
152	"$52,440"								
153	"$38,874"								
154	"$62,674"								
155	"$49,442"								
156	"$35,793"								
157	"$64,753"								
158	"$48,573"								
159	"$37,855"								
163	"$155,925"								
164	"$103,696"								
165	"$85,838"								
166	"$122,433"								
167	"$78,114"								
168	"$67,809"								
173	"$124,712"								
175	"$61,055"								
176	"$44,570"								
177	"$64,407"								
178	"$47,243"								
179	"$38,092"								
180	"$69,945"								
181	"$54,572"								
182	"$46,605"								
183	"$66,035"								
184	"$54,288"								
185	"$42,298"								
186	"$63,568"								
187	"$51,932"								
188	"$41,288"								
189	"$55,411"								
190	"$51,807"								
191	"$42,733"								
192	"$33,305"								
193	"$58,297"								
194	"$42,891"								
195	"$33,918"								
196	"$66,875"								
197	"$50,327"								
198	"$42,700"								
199	"$68,142"								
200	"$52,499"								
201	"$35,845"								
202	"$47,719"								
203	"$35,728"								
204	"$46,681"								
205	"$65,405"								
206	"$48,198"								
207	"$218,893"								
208	"$97,860"								
212	"$376,685"								
215	"$337,893"								
216	"$341,111"								
217	"$242,472"								
218	"$222,942"								
219	"$269,072"								
220	"$202,988"								
221	"$175,698"								
228	"$179,237"								
229	"$130,404"								
231	"$321,125"								
232	"$250,367"								
233	"$282,989"								
234	"$211,028"								
235	"$214,525"								
236	"$166,533"								
239	"$137,214"								
240	"$93,230"								
241	"$60,950"								
242	"$129,820"								
243	"$99,487"								
244	"$87,048"								
245	"$168,659"								
250	"$110,887"								
251	"$89,304"								
252	"$116,849"								
253	"$104,371"								
254	"$80,466"								
255	"$89,993"								
256	"$68,398"								
257	"$49,389"								
258	"$107,966"								
259	"$85,184"								
260	"$116,347"								
261	"$83,927"								
262	"$78,129"								
263	"$99,884"								
264	"$99,167"								
265	"$126,164"								
266	"$216,373"								
267	"$176,833"								
268	"$230,722"								
269	"$150,314"								
270	"$171,302"								
271	"$130,816"								
272	"$100,129"								
273	"$154,987"								
274	"$129,635"								
275	"$263,370"								
276	"$221,005"								
277	"$186,513"								
278	"$163,223"								
279	"$128,168"								
280	"$64,712"								
281	"$52,332"								
282	"$47,828"								
283	"$71,021"								
284	"$43,440"								
285	"$30,523"								
286	"$88,550"								
287	"$64,805"								
288	"$87,275"								
289	"$62,384"								
290	"$50,556"								
291	"$54,167"								
292	"$41,421"								
293	"$29,870"								
294	"$52,309"								
295	"$36,282"								
296	"$67,604"								
297	"$43,435"								
298	"$27,405"								
299	"$60,078"								
300	"$49,631"								
301	"$37,861"								
302	"$51,129"								
303	"$37,685"								
304	"$53,275"								
305	"$43,825"								
306	"$57,584"								
307	"$47,232"								
308	"$54,377"								
309	"$39,535"								
310	"$30,819"								
311	"$40,112"								
312	"$48,362"								
313	"$43,217"								
314	"$71,805"								
315	"$48,983"								
316	"$40,189"								
319	"$154,883"								
320	"$96,266"								
321	"$134,549"								
322	"$103,663"								
323	"$171,463"								
324	"$139,460"								
325	"$120,110"								
326	"$156,066"								
327	"$99,782"								
328	"$76,406"								
329	"$147,669"								
330	"$97,508"								
331	"$78,808"								
332	"$128,866"								
333	"$88,604"								
334	"$75,303"								
335	"$125,016"								
336	"$89,534"								
337	"$73,547"								
344	"$94,357"								
345	"$69,930"								
346	"$64,391"								
347	"$89,382"								
348	"$63,554"								
349	"$55,697"								
350	"$96,492"								
351	"$73,334"								
352	"$62,501"								
353	"$109,478"								
354	"$79,326"								
355	"$68,520"								
356	"$140,102"								
357	"$92,248"								
358	"$66,728"								
368	"$69,400"								
369	"$53,430"								
370	"$44,558"								
371	"$65,542"								
372	"$50,951"								
373	"$37,811"								
374	"$74,294"								
375	"$56,465"								
376	"$49,063"								
377	"$70,084"								
378	"$52,220"								
379	"$36,675"								
380	"$75,272"								
381	"$55,791"								
382	"$44,814"								
383	"$63,241"								
384	"$52,672"								
385	"$63,681"								
386	"$50,711"								
387	"$37,937"								
388	"$59,315"								
389	"$42,214"								
390	"$31,281"								
391	"$57,083"								
392	"$44,011"								
393	"$63,663"								
394	"$49,254"								
395	"$36,691"								
397	"$94,702"								
398	"$76,147"								
399	"$64,011"								
405	"$176,392"								
406	"$115,961"								
407	"$95,093"								
408	"$129,863"								
409	"$88,135"								
410	"$75,588"								
411	"$119,367"								
412	"$95,144"								
413	"$79,560"								
414	"$124,174"								
415	"$87,515"								
416	"$67,944"								
417	"$100,748"								
418	"$82,801"								
419	"$72,369"								
420	"$114,597"								
421	"$80,559"								
422	"$70,663"								
423	"$135,622"								
424	"$90,206"								
425	"$73,808"								
432	"$73,188"								
433	"$52,786"								
434	"$37,348"								
435	"$72,591"								
436	"$55,809"								
437	"$50,029"								
438	"$65,677"								
439	"$47,433"								
440	"$36,718"								
441	"$67,574"								
442	"$49,107"								
443	"$39,484"								
444	"$69,012"								
445	"$56,659"								
446	"$49,420"								
453	"$280,621"								
454	"$200,393"								
455	"$161,740"								
456	"$277,468"								
457	"$205,595"								
458	"$160,724"								
459	"$208,088"								
460	"$132,387"								
461	"$196,987"								
462	"$112,204"								
463	"$148,456"								
464	"$101,011"								
465	"$77,491"								
466	"$165,561"								
467	"$124,288"								
468	"$102,957"								
469	"$116,974"								
470	"$82,384"								
471	"$171,214"								
472	"$117,582"								
473	"$102,159"								
474	"$125,470"								
475	"$81,355"								
476	"$59,162"								
477	"$116,135"								
478	"$94,573"								
479	"$81,330"								
480	"$110,442"								
481	"$89,071"								
482	"$74,391"								
483	"$100,083"								
485	"$122,301"								
486	"$86,605"								
487	"$73,512"								
488	"$82,062"								
489	"$63,344"								
492	"$123,612"								
493	"$97,305"								
494	"$82,284"								
495	"$121,623"								
496	"$83,113"								
497	"$68,675"								
498	"$95,759"								
499	"$58,331"								
500	"$105,153"								
501	"$74,354"								
502	"$64,751"								
503	"$96,179"								
504	"$73,322"								
505	"$73,267"								
506	"$65,647"								
507	"$85,062"								
508	"$66,487"								
509	"$63,157"								
510	"$106,412"								
511	"$88,597"								
512	"$77,761"								
513	"$70,633"								
514	"$56,790"								
515	"$113,548"								
516	"$87,196"								
517	"$72,194"								
518	"$129,549"								
519	"$86,050"								
520	"$70,961"								
521	"$114,145"								
522	"$92,515"								
533	"$58,636"								
534	"$37,926"								
535	"$54,810"								
536	"$38,988"								
537	"$47,935"								
538	"$36,833"								
539	"$66,698"								
540	"$53,912"								
541	"$42,880"								
542	"$66,442"								
543	"$52,175"								
544	"$40,003"								
545	"$75,338"								
546	"$53,548"								
547	"$42,851"								
548	"$72,581"								
549	"$55,212"								
550	"$47,415"								
551	"$66,352"								
552	"$50,917"								
553	"$54,624"								
554	"$38,924"								
555	"$57,753"								
556	"$42,837"								
557	"$61,086"								
558	"$43,830"								
559	"$63,236"								
560	"$48,940"								
561	"$35,475"								
562	"$60,227"								
563	"$44,951"								
564	"$64,107"								
565	"$50,921"								
566	"$41,043"								
570	"$88,497"								
571	"$66,479"								
572	"$55,496"								
573	"$150,956"								
574	"$103,538"								
575	"$76,189"								
576	"$153,986"								
577	"$99,053"								
578	"$73,167"								
579	"$101,679"								
580	"$71,613"								
581	"$64,823"								
582	"$76,748"								
583	"$70,667"								
584	"$80,092"								
585	"$78,351"								
592	"$61,955"								
593	"$48,605"								
594	"$34,429"								
595	"$67,943"								
596	"$45,733"								
597	"$65,431"								
598	"$53,524"								
599	"$34,362"								
600	"$47,867"								
601	"$30,162"								
602	"$57,371"								
603	"$40,070"								
604	"$63,605"								
605	"$49,026"								
606	"$58,831"								
607	"$41,495"								
614	"$97,331"								
615	"$77,221"								
616	"$119,368"								
617	"$77,357"								
618	"$59,184"								
619	"$99,410"								
620	"$76,231"								
621	"$72,592"								
622	"$106,241"								
623	"$68,854"								
624	"$50,742"								
625	"$108,346"								
626	"$76,586"								
627	"$68,372"								
628	"$120,119"								
629	"$84,615"								
630	"$69,629"								
637	"$59,158"								
638	"$43,727"								
639	"$32,318"								
640	"$54,262"								
641	"$39,524"								
642	"$54,061"								
643	"$63,712"								
644	"$50,161"								
645	"$38,603"								
650	"$171,531"								
651	"$145,276"								
652	"$135,464"								
653	"$170,327"								
654	"$114,777"								
655	"$96,318"								
656	"$118,557"								
657	"$87,454"								
658	"$77,078"								
659	"$92,615"								
660	"$66,105"								
661	"$59,213"								
662	"$99,981"								
663	"$67,305"								
664	"$57,355"								
665	"$111,502"								
666	"$74,000"								
667	"$57,101"								
668	"$102,584"								
669	"$71,094"								
670	"$53,909"								
671	"$73,873"								
672	"$55,733"								
673	"$114,841"								
674	"$89,436"								
675	"$72,201"								
682	"$59,516"								
683	"$44,814"								
684	"$32,416"								
686	"$68,508"								
687	"$50,617"								
688	"$43,358"								
689	"$52,428"								
690	"$40,565"								
693	"$59,331"								
694	"$44,899"								
695	"$52,019"								
696	"$34,709"								
697	"$52,267"								
698	"$61,984"								
699	"$48,452"								
700	"$35,918"								
707	"$90,931"								
708	"$79,195"								
709	"$83,870"								
710	"$62,639"								
711	"$84,952"								
712	"$56,630"								
713	"$66,402"								
714	"$54,303"								
715	"$89,508"								
716	"$73,518"								
717	"$74,993"								
718	"$63,828"								
722	"$68,876"								
723	"$52,994"								
724	"$38,677"								
725	"$53,844"								
726	"$37,663"								
727	"$61,167"								
728	"$40,344"								
729	"$48,670"								
730	"$33,511"								
734	"$93,418"								
735	"$70,135"								
736	"$140,392"								
737	"$90,220"								
738	"$73,613"								
739	"$131,566"								
740	"$85,754"								
741	"$70,981"								
742	"$80,242"								
743	"$63,226"								
744	"$77,441"								
745	"$56,565"								
746	"$68,948"								
747	"$52,997"								
748	"$69,140"								
749	"$97,144"								
750	"$67,389"								
754	"$66,942"								
755	"$52,149"								
756	"$48,923"								
757	"$62,393"								
758	"$49,405"								
759	"$35,292"								
760	"$49,801"								
761	"$36,028"								
768	"$48,176"								
769	"$60,243"								
770	"$45,983"								
776	"$31,884"								
779	"$44,167"								
783	"$60,898"								
784	"$46,888"								
785	"$38,889"								
786	"$58,343"								
787	"$45,123"								
788	"$37,469"								
793	"$36,285"								
794	"$15,503"								
796	"$50,918"								
797	"$41,796"								
798	"$35,289"								
799	"$172,600"								
800	"$106,982"								
801	"$87,383"								
802	"$113,995"								
803	"$80,610"								
804	"$65,964"								
805	"$35,234"								
806	"$25,365"								
807	"$22,242"								
808	"$76,064"								
809	"$54,451"								
810	"$49,172"								
811	"$60,355"								
812	"$45,929"								
813	"$61,590"								
814	"$71,554"								
815	"$51,321"								
816	"$40,261"								
817	"$79,875"								
818	"$55,289"								
819	"$48,427"								
820	"$191,567"								
821	"$91,810"								
822	"$68,045"								
823	"$149,586"								
824	"$93,380"								
825	"$68,270"								
826	"$153,628"								
827	"$98,860"								
828	"$79,943"								
829	"$105,182"								
830	"$74,223"								
831	"$44,084"								
832	"$28,624"								
833	"$21,990"								
834	"$139,203"								
835	"$73,086"								
836	"$51,693"								
837	"$119,661"								
838	"$65,159"								
839	"$54,083"								
840	"$92,747"								
841	"$64,632"								
842	"$52,478"								
843	"$71,119"								
844	"$55,223"								
845	"$45,908"								
846	"$74,739"								
847	"$52,815"								
848	"$36,195"								
849	"$88,273"								
853	"$151,075"								
854	"$84,110"								
855	"$73,725"								
856	"$129,194"								
857	"$79,820"								
858	"$61,222"								
862	"$66,758"								
863	"$47,522"								
864	"$47,020"								
865	"$60,436"								
866	"$45,369"								
867	"$70,442"								
868	"$50,283"								
869	"$38,399"								
870	"$220,362"								
871	"$73,620"								
872	"$51,895"								
876	"$98,691"								
880	"$46,932"								
881	"$31,412"								
882	"$36,725"								
883	"$43,003"								
884	"$54,650"								
885	"$42,155"								
886	"$46,770"								
887	"$50,951"								
894	"$27,439"								
895	"$45,635"								
896	"$63,133"								
897	"$38,204"								
901	"$118,318"								
902	"$73,690"								
903	"$58,709"								
904	"$106,689"								
905	"$69,294"								
906	"$73,168"								
907	"$121,109"								
908	"$80,433"								
909	"$63,901"								
913	"$63,011"								
914	"$49,479"								
915	"$66,129"								
916	"$32,814"								
917	"$61,411"								
918	"$41,771"								
919	"$66,617"								
920	"$49,798"								
921	"$36,671"								
922	"$64,610"								
923	"$47,128"								
927	"$640,443"								
928	"$173,171"								
929	"$101,258"								
933	"$76,834"								
934	"$62,204"								
935	"$58,801"								
939	"$107,933"								
940	"$84,900"								
941	"$76,282"								
945	"$66,173"								
946	"$57,672"								
947	"$52,167"								
948	"$40,530"								
949	"$41,594"								
950	"$27,006"								
951	"$27,497"								
955	"$217,191"								
956	"$125,015"								
957	"$237,652"								
958	"$148,797"								
959	"$105,393"								
963	"$94,292"								
964	"$65,282"								
965	"$51,038"								
969	"$190,451"								
970	"$83,725"								
974	"$91,351"								
975	"$56,001"								
976	"$47,063"								
977	"$56,137"								
981	"$144,368"								
982	"$94,176"								
983	"$73,395"								
987	"$109,981"								
988	"$72,230"								
989	"$57,630"								
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)									
