NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1 FOR APPLICATIONS FOR FY 2025									
MS?DRG	Threshold								
001	"$840,401"								
002	"$427,451"								
003	"$583,362"								
004	"$390,646"								
005	"$332,904"								
006	"$199,134"								
007	"$441,016"								
008	"$212,702"								
010	"$184,440"								
011	"$167,840"								
012	"$149,743"								
013	"$101,512"								
014	"$318,462"								
016	"$182,491"								
017	"$182,491"								
018	"$1,374,450"								
019	"$293,127"								
020	"$262,958"								
021	"$189,120"								
022	"$125,884"								
023	"$187,527"								
024	"$140,296"								
025	"$151,083"								
026	"$113,428"								
027	"$100,230"								
028	"$190,555"								
029	"$122,771"								
030	"$92,963"								
031	"$131,048"								
032	"$88,001"								
033	"$76,602"								
034	"$140,496"								
035	"$95,230"								
036	"$80,865"								
037	"$124,121"								
038	"$76,773"								
039	"$64,016"								
040	"$128,504"								
041	"$95,990"								
042	"$82,234"								
052	"$73,093"								
053	"$51,777"								
054	"$60,847"								
055	"$53,378"								
056	"$70,773"								
057	"$52,857"								
058	"$64,253"								
059	"$55,297"								
060	"$48,637"								
061	"$120,116"								
062	"$96,493"								
063	"$84,259"								
064	"$74,965"								
065	"$56,285"								
066	"$45,546"								
067	"$66,790"								
068	"$54,119"								
069	"$52,793"								
070	"$65,298"								
071	"$52,219"								
072	"$46,272"								
073	"$59,848"								
074	"$51,521"								
075	"$75,651"								
076	"$50,364"								
077	"$68,015"								
078	"$56,796"								
079	"$47,344"								
080	"$72,978"								
081	"$48,721"								
082	"$80,712"								
083	"$61,491"								
084	"$50,462"								
085	"$78,985"								
086	"$60,774"								
087	"$49,947"								
088	"$69,650"								
089	"$60,011"								
090	"$54,379"								
091	"$65,461"								
092	"$51,600"								
093	"$46,012"								
094	"$116,068"								
095	"$90,491"								
096	"$91,211"								
097	"$116,876"								
098	"$82,310"								
099	"$64,756"								
100	"$71,047"								
101	"$49,114"								
102	"$58,266"								
103	"$50,519"								
113	"$93,005"								
114	"$61,716"								
115	"$68,608"								
116	"$70,416"								
117	"$60,029"								
121	"$50,268"								
122	"$33,621"								
123	"$52,022"								
124	"$57,273"								
125	"$45,461"								
135	"$98,911"								
136	"$55,730"								
137	"$61,510"								
138	"$49,701"								
139	"$61,279"								
140	"$138,660"								
141	"$91,933"								
142	"$74,903"								
143	"$112,059"								
144	"$75,132"								
145	"$62,865"								
146	"$70,308"								
147	"$56,054"								
148	"$47,168"								
149	"$46,247"								
150	"$53,994"								
151	"$37,656"								
152	"$52,133"								
153	"$38,837"								
154	"$62,367"								
155	"$49,082"								
156	"$35,804"								
157	"$64,334"								
158	"$48,337"								
159	"$37,748"								
163	"$155,544"								
164	"$103,249"								
165	"$85,520"								
166	"$122,048"								
167	"$77,739"								
168	"$67,542"								
173	"$124,299"								
175	"$60,747"								
176	"$44,508"								
177	"$64,066"								
178	"$47,192"								
179	"$38,038"								
180	"$69,637"								
181	"$54,275"								
182	"$46,332"								
183	"$65,871"								
184	"$54,042"								
185	"$42,188"								
186	"$63,296"								
187	"$51,544"								
188	"$41,413"								
189	"$55,081"								
190	"$51,504"								
191	"$42,736"								
192	"$33,215"								
193	"$57,979"								
194	"$42,845"								
195	"$33,909"								
196	"$66,523"								
197	"$50,072"								
198	"$42,706"								
199	"$67,861"								
200	"$52,168"								
201	"$35,795"								
202	"$47,693"								
203	"$35,656"								
204	"$46,646"								
205	"$65,194"								
206	"$47,918"								
207	"$218,243"								
208	"$97,399"								
212	"$376,939"								
215	"$336,180"								
216	"$340,144"								
217	"$241,817"								
218	"$222,882"								
219	"$268,612"								
220	"$202,612"								
221	"$175,351"								
228	"$178,699"								
229	"$129,938"								
231	"$319,728"								
232	"$250,041"								
233	"$282,058"								
234	"$210,330"								
235	"$213,695"								
236	"$165,994"								
239	"$137,032"								
240	"$92,796"								
241	"$60,547"								
242	"$129,445"								
243	"$99,137"								
244	"$86,660"								
245	"$168,169"								
250	"$110,454"								
251	"$88,892"								
252	"$116,430"								
253	"$103,973"								
254	"$80,171"								
255	"$89,468"								
256	"$68,091"								
257	"$49,347"								
258	"$107,678"								
259	"$84,788"								
260	"$116,046"								
261	"$83,440"								
262	"$77,733"								
263	"$99,240"								
264	"$98,708"								
265	"$126,391"								
266	"$215,866"								
267	"$176,405"								
268	"$229,935"								
269	"$149,790"								
270	"$170,902"								
271	"$130,433"								
272	"$99,749"								
273	"$154,723"								
274	"$129,114"								
275	"$262,331"								
276	"$220,172"								
277	"$185,817"								
278	"$162,574"								
279	"$127,986"								
280	"$64,392"								
281	"$52,028"								
282	"$47,684"								
283	"$70,799"								
284	"$43,293"								
285	"$30,323"								
286	"$88,199"								
287	"$64,492"								
288	"$86,864"								
289	"$61,837"								
290	"$50,260"								
291	"$53,852"								
292	"$41,399"								
293	"$29,812"								
294	"$52,012"								
295	"$36,278"								
296	"$67,323"								
297	"$43,628"								
298	"$26,988"								
299	"$59,729"								
300	"$49,353"								
301	"$37,784"								
302	"$50,783"								
303	"$37,666"								
304	"$52,983"								
305	"$43,727"								
306	"$57,398"								
307	"$47,044"								
308	"$54,061"								
309	"$39,500"								
310	"$30,743"								
311	"$39,985"								
312	"$48,286"								
313	"$43,192"								
314	"$71,482"								
315	"$48,659"								
316	"$40,124"								
319	"$154,406"								
320	"$96,085"								
321	"$134,107"								
322	"$103,252"								
323	"$170,898"								
324	"$138,914"								
325	"$119,022"								
326	"$155,710"								
327	"$99,358"								
328	"$76,112"								
329	"$147,223"								
330	"$97,099"								
331	"$78,487"								
332	"$127,546"								
333	"$88,131"								
334	"$75,126"								
335	"$124,493"								
336	"$89,226"								
337	"$73,257"								
344	"$93,852"								
345	"$69,516"								
346	"$63,968"								
347	"$89,221"								
348	"$63,229"								
349	"$55,347"								
350	"$95,923"								
351	"$72,973"								
352	"$62,228"								
353	"$109,104"								
354	"$78,921"								
355	"$68,130"								
356	"$139,650"								
357	"$91,929"								
358	"$66,260"								
368	"$69,028"								
369	"$53,113"								
370	"$44,231"								
371	"$65,190"								
372	"$50,621"								
373	"$37,730"								
374	"$74,003"								
375	"$56,134"								
376	"$48,800"								
377	"$69,747"								
378	"$51,929"								
379	"$36,614"								
380	"$74,865"								
381	"$55,523"								
382	"$44,663"								
383	"$62,802"								
384	"$52,345"								
385	"$63,420"								
386	"$50,417"								
387	"$37,923"								
388	"$59,018"								
389	"$42,135"								
390	"$31,253"								
391	"$56,779"								
392	"$43,960"								
393	"$63,335"								
394	"$48,963"								
395	"$36,637"								
397	"$94,257"								
398	"$75,810"								
399	"$63,646"								
405	"$175,632"								
406	"$115,586"								
407	"$94,731"								
408	"$129,658"								
409	"$87,704"								
410	"$75,740"								
411	"$117,912"								
412	"$95,195"								
413	"$79,395"								
414	"$123,875"								
415	"$87,005"								
416	"$67,458"								
417	"$100,476"								
418	"$82,482"								
419	"$71,988"								
420	"$114,294"								
421	"$80,321"								
422	"$70,300"								
423	"$135,291"								
424	"$89,577"								
425	"$72,797"								
432	"$72,750"								
433	"$52,469"								
434	"$37,198"								
435	"$72,227"								
436	"$55,494"								
437	"$49,748"								
438	"$65,301"								
439	"$47,324"								
440	"$36,702"								
441	"$67,241"								
442	"$48,852"								
443	"$39,369"								
444	"$68,740"								
445	"$56,366"								
446	"$49,090"								
453	"$279,880"								
454	"$199,784"								
455	"$161,324"								
456	"$276,461"								
457	"$204,855"								
458	"$160,095"								
459	"$207,349"								
460	"$132,082"								
461	"$195,441"								
462	"$111,848"								
463	"$148,105"								
464	"$100,521"								
465	"$77,259"								
466	"$164,983"								
467	"$123,816"								
468	"$102,565"								
469	"$116,478"								
470	"$82,038"								
471	"$170,795"								
472	"$117,039"								
473	"$101,769"								
474	"$124,862"								
475	"$80,959"								
476	"$58,563"								
477	"$115,716"								
478	"$94,276"								
479	"$81,022"								
480	"$110,038"								
481	"$88,744"								
482	"$74,058"								
483	"$99,629"								
485	"$121,870"								
486	"$86,188"								
487	"$73,187"								
488	"$81,730"								
489	"$62,859"								
492	"$123,198"								
493	"$97,083"								
494	"$81,968"								
495	"$121,236"								
496	"$82,706"								
497	"$68,223"								
498	"$94,914"								
499	"$58,015"								
500	"$104,915"								
501	"$74,032"								
502	"$64,521"								
503	"$95,754"								
504	"$72,946"								
505	"$72,882"								
506	"$65,145"								
507	"$84,840"								
508	"$66,506"								
509	"$62,819"								
510	"$106,625"								
511	"$88,330"								
512	"$77,642"								
513	"$70,377"								
514	"$56,535"								
515	"$113,317"								
516	"$86,893"								
517	"$71,896"								
518	"$128,892"								
519	"$85,635"								
520	"$70,527"								
521	"$113,758"								
522	"$92,130"								
533	"$58,289"								
534	"$37,807"								
535	"$54,497"								
536	"$38,957"								
537	"$47,753"								
538	"$36,758"								
539	"$66,349"								
540	"$53,567"								
541	"$42,629"								
542	"$66,147"								
543	"$51,887"								
544	"$39,969"								
545	"$75,099"								
546	"$53,233"								
547	"$42,796"								
548	"$72,358"								
549	"$54,846"								
550	"$46,981"								
551	"$66,104"								
552	"$50,613"								
553	"$54,441"								
554	"$38,880"								
555	"$57,473"								
556	"$42,799"								
557	"$60,734"								
558	"$43,782"								
559	"$63,186"								
560	"$48,622"								
561	"$35,456"								
562	"$59,955"								
563	"$44,908"								
564	"$63,705"								
565	"$50,657"								
566	"$40,969"								
570	"$87,968"								
571	"$66,129"								
572	"$55,137"								
573	"$150,225"								
574	"$103,135"								
575	"$75,808"								
576	"$154,068"								
577	"$98,621"								
578	"$72,977"								
579	"$101,375"								
580	"$71,168"								
581	"$64,680"								
582	"$76,512"								
583	"$70,689"								
584	"$79,750"								
585	"$77,823"								
592	"$61,712"								
593	"$48,278"								
594	"$34,545"								
595	"$67,592"								
596	"$45,598"								
597	"$65,123"								
598	"$53,130"								
599	"$33,699"								
600	"$47,526"								
601	"$30,091"								
602	"$57,085"								
603	"$40,022"								
604	"$63,261"								
605	"$48,755"								
606	"$58,438"								
607	"$41,400"								
614	"$96,980"								
615	"$76,933"								
616	"$119,218"								
617	"$77,055"								
618	"$58,325"								
619	"$98,634"								
620	"$75,840"								
621	"$72,212"								
622	"$105,846"								
623	"$68,615"								
624	"$50,722"								
625	"$107,982"								
626	"$76,341"								
627	"$67,992"								
628	"$119,994"								
629	"$84,178"								
630	"$69,289"								
637	"$58,845"								
638	"$43,649"								
639	"$32,311"								
640	"$53,938"								
641	"$39,490"								
642	"$53,662"								
643	"$63,418"								
644	"$49,848"								
645	"$38,592"								
650	"$171,215"								
651	"$144,772"								
652	"$134,755"								
653	"$170,349"								
654	"$114,422"								
655	"$96,111"								
656	"$118,045"								
657	"$87,072"								
658	"$76,698"								
659	"$92,336"								
660	"$65,791"								
661	"$58,884"								
662	"$99,954"								
663	"$66,925"								
664	"$57,219"								
665	"$110,957"								
666	"$73,664"								
667	"$56,922"								
668	"$102,283"								
669	"$70,732"								
670	"$53,565"								
671	"$73,238"								
672	"$55,430"								
673	"$114,432"								
674	"$89,010"								
675	"$71,738"								
682	"$59,171"								
683	"$44,759"								
684	"$32,357"								
686	"$68,278"								
687	"$50,286"								
688	"$43,108"								
689	"$52,119"								
690	"$40,530"								
693	"$59,193"								
694	"$44,752"								
695	"$51,662"								
696	"$34,678"								
697	"$51,891"								
698	"$61,649"								
699	"$48,144"								
700	"$35,834"								
707	"$90,354"								
708	"$78,821"								
709	"$83,769"								
710	"$61,735"								
711	"$84,666"								
712	"$56,788"								
713	"$66,127"								
714	"$54,047"								
715	"$88,889"								
716	"$73,446"								
717	"$74,821"								
718	"$63,620"								
722	"$68,503"								
723	"$52,839"								
724	"$37,686"								
725	"$53,447"								
726	"$37,577"								
727	"$60,982"								
728	"$40,322"								
729	"$48,353"								
730	"$34,507"								
734	"$93,226"								
735	"$69,717"								
736	"$140,400"								
737	"$89,913"								
738	"$73,268"								
739	"$130,848"								
740	"$85,467"								
741	"$70,739"								
742	"$79,811"								
743	"$62,902"								
744	"$77,154"								
745	"$56,167"								
746	"$68,567"								
747	"$52,721"								
748	"$68,324"								
749	"$96,851"								
750	"$66,747"								
754	"$66,754"								
755	"$51,874"								
756	"$48,172"								
757	"$62,120"								
758	"$49,018"								
759	"$35,222"								
760	"$49,331"								
761	"$35,927"								
768	"$48,038"								
769	"$60,042"								
770	"$45,984"								
776	"$31,775"								
779	"$43,880"								
783	"$62,144"								
784	"$46,911"								
785	"$38,955"								
786	"$58,326"								
787	"$44,978"								
788	"$37,296"								
793	"$36,016"								
794	"$15,572"								
796	"$50,505"								
797	"$41,680"								
798	"$35,269"								
799	"$172,595"								
800	"$106,641"								
801	"$86,859"								
802	"$113,867"								
803	"$80,045"								
804	"$65,626"								
805	"$35,147"								
806	"$25,302"								
807	"$22,231"								
808	"$75,769"								
809	"$54,128"								
810	"$48,795"								
811	"$59,969"								
812	"$45,861"								
813	"$61,253"								
814	"$71,228"								
815	"$51,013"								
816	"$40,202"								
817	"$79,475"								
818	"$56,405"								
819	"$48,138"								
820	"$191,520"								
821	"$91,641"								
822	"$67,614"								
823	"$149,259"								
824	"$92,962"								
825	"$67,879"								
826	"$153,199"								
827	"$98,498"								
828	"$79,570"								
829	"$104,848"								
830	"$73,857"								
831	"$43,899"								
832	"$28,554"								
833	"$21,996"								
834	"$138,905"								
835	"$72,825"								
836	"$50,580"								
837	"$119,345"								
838	"$65,058"								
839	"$53,666"								
840	"$92,473"								
841	"$64,388"								
842	"$52,301"								
843	"$70,830"								
844	"$54,894"								
845	"$45,639"								
846	"$74,327"								
847	"$52,558"								
848	"$36,000"								
849	"$86,563"								
853	"$150,682"								
854	"$83,737"								
855	"$73,561"								
856	"$128,743"								
857	"$79,467"								
858	"$60,898"								
862	"$66,504"								
863	"$47,252"								
864	"$46,928"								
865	"$60,188"								
866	"$45,304"								
867	"$70,013"								
868	"$49,966"								
869	"$38,569"								
870	"$219,963"								
871	"$73,262"								
872	"$51,586"								
876	"$98,802"								
880	"$46,608"								
881	"$31,465"								
882	"$36,667"								
883	"$42,745"								
884	"$54,337"								
885	"$41,903"								
886	"$46,375"								
887	"$50,609"								
894	"$27,464"								
895	"$45,428"								
896	"$62,818"								
897	"$38,181"								
901	"$118,024"								
902	"$73,266"								
903	"$58,076"								
904	"$106,503"								
905	"$68,977"								
906	"$73,083"								
907	"$120,737"								
908	"$80,112"								
909	"$63,605"								
913	"$62,821"								
914	"$49,183"								
915	"$65,717"								
916	"$32,724"								
917	"$61,075"								
918	"$41,723"								
919	"$66,348"								
920	"$49,494"								
921	"$36,519"								
922	"$64,268"								
923	"$46,885"								
927	"$630,475"								
928	"$173,368"								
929	"$101,280"								
933	"$75,904"								
934	"$62,263"								
935	"$58,500"								
939	"$107,661"								
940	"$84,668"								
941	"$76,098"								
945	"$65,912"								
946	"$57,286"								
947	"$51,878"								
948	"$40,512"								
949	"$41,831"								
950	"$27,108"								
951	"$27,542"								
955	"$217,595"								
956	"$125,130"								
957	"$237,868"								
958	"$149,434"								
959	"$105,017"								
963	"$94,096"								
964	"$65,069"								
965	"$50,549"								
969	"$190,401"								
970	"$83,500"								
974	"$91,053"								
975	"$55,849"								
976	"$46,837"								
977	"$56,029"								
981	"$143,958"								
982	"$93,797"								
983	"$73,205"								
987	"$109,665"								
988	"$71,855"								
989	"$57,273"								
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)									
