"ALTERNATIVES CONSIDERED NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1,2 FOR APPLICATIONS FOR FY 2023"											
MS?DRG	Number of Cases	Threshold									
001	1845	"$781,855"									
002	72	"$414,989"									
003	12664	"$493,671"									
004	13297	"$322,074"									
005	1231	"$307,500"									
006	407	"$185,979"									
007	648	"$399,651"									
008	319	"$199,520"									
010	27	"$140,220"									
011	1767	"$154,921"									
012	1690	"$134,961"									
013	422	"$89,612"									
014	1073	"$281,860"									
016	2076	"$178,565"									
017	93	"$107,300"									
018	265	"$1,274,499"									
019	86	"$218,684"									
020	1750	"$279,323"									
021	510	"$190,852"									
022	220	"$116,279"									
023	12912	"$169,036"									
024	4387	"$131,282"									
025	21029	"$139,948"									
026	8179	"$105,673"									
027	8463	"$91,720"									
028	2196	"$164,456"									
029	3339	"$107,737"									
030	1095	"$83,841"									
031	957	"$121,793"									
032	1980	"$80,765"									
033	2249	"$71,678"									
034	1342	"$128,157"									
035	3657	"$87,048"									
036	4876	"$75,129"									
037	3086	"$114,254"									
038	9529	"$72,250"									
039	17209	"$59,470"									
040	3689	"$116,855"									
041	5683	"$89,736"									
042	2014	"$77,243"									
052	919	"$62,059"									
053	191	"$46,655"									
054	11479	"$54,434"									
055	3137	"$47,774"									
056	11589	"$63,121"									
057	24680	"$47,679"									
058	754	"$60,045"									
059	2130	"$49,597"									
060	1591	"$43,475"									
061	5359	"$111,478"									
062	9097	"$91,696"									
063	1746	"$84,248"									
064	73122	"$67,109"									
065	92014	"$51,460"									
066	25562	"$41,135"									
067	967	"$60,021"									
068	3909	"$49,782"									
069	29039	"$46,635"									
070	17979	"$59,446"									
071	16222	"$47,238"									
072	3006	"$39,498"									
073	6217	"$53,719"									
074	13132	"$46,545"									
075	497	"$67,536"									
076	125	"$44,071"									
077	1914	"$61,500"									
078	2494	"$50,998"									
079	411	"$40,954"									
080	843	"$64,952"									
081	502	"$42,223"									
082	7456	"$73,700"									
083	9671	"$55,900"									
084	4077	"$45,447"									
085	7917	"$72,193"									
086	14182	"$54,346"									
087	6575	"$44,879"									
088	468	"$61,690"									
089	1343	"$53,300"									
090	520	"$48,876"									
091	14634	"$58,967"									
092	19321	"$46,464"									
093	5606	"$40,635"									
094	1355	"$104,332"									
095	1243	"$79,477"									
096	338	"$80,323"									
097	1844	"$110,829"									
098	1349	"$69,672"									
099	321	"$56,607"									
100	23907	"$63,980"									
101	32422	"$43,579"									
102	1077	"$52,436"									
103	6583	"$44,272"									
113	429	"$77,241"									
114	107	"$61,808"									
115	684	"$61,772"									
116	376	"$63,627"									
117	106	"$52,701"									
121	532	"$43,531"									
122	141	"$32,031"									
123	2828	"$44,837"									
124	916	"$52,724"									
125	2646	"$39,634"									
135	228	"$83,243"									
136	64	"$54,199"									
137	593	"$54,620"									
138	268	"$45,476"									
139	263	"$57,980"									
140	679	"$132,088"									
141	2284	"$84,552"									
142	1207	"$70,664"									
143	626	"$101,954"									
144	1388	"$68,893"									
145	958	"$57,084"									
146	1062	"$63,871"									
147	767	"$50,241"									
148	169	"$40,803"									
149	12434	"$40,274"									
150	881	"$50,024"									
151	1830	"$32,795"									
152	2498	"$46,036"									
153	5555	"$33,371"									
154	1782	"$55,762"									
155	3392	"$43,784"									
156	1038	"$34,222"									
157	1517	"$57,762"									
158	2634	"$42,681"									
159	690	"$34,578"									
163	10201	"$146,953"									
164	14167	"$95,907"									
165	6782	"$79,202"									
166	8522	"$109,069"									
167	5124	"$71,417"									
168	1865	"$62,124"									
175	29482	"$58,550"									
176	23753	"$41,816"									
177	180209	"$60,851"									
178	31857	"$47,562"									
179	6021	"$36,826"									
180	17041	"$63,905"									
181	7800	"$50,604"									
182	397	"$43,186"									
183	4551	"$57,773"									
184	9278	"$49,253"									
185	2281	"$38,540"									
186	8465	"$57,611"									
187	5074	"$47,808"									
188	805	"$35,848"									
189	109661	"$50,836"									
190	87573	"$48,009"									
191	42628	"$39,508"									
192	13682	"$31,975"									
193	131019	"$53,009"									
194	79057	"$39,642"									
195	17361	"$31,055"									
196	7587	"$60,069"									
197	2258	"$44,789"									
198	480	"$35,163"									
199	6168	"$62,867"									
200	9049	"$48,220"									
201	1469	"$33,800"									
202	27869	"$43,614"									
203	5168	"$31,796"									
204	6920	"$39,680"									
205	8956	"$58,852"									
206	7966	"$42,589"									
207	25927	"$185,771"									
208	53231	"$86,237"									
215	3874	"$316,675"									
216	6253	"$318,216"									
217	2051	"$222,789"									
218	388	"$214,543"									
219	12905	"$254,542"									
220	10913	"$186,094"									
221	1624	"$156,019"									
222	1932	"$250,760"									
223	341	"$199,833"									
224	1898	"$239,246"									
225	1390	"$186,598"									
226	4875	"$210,297"									
227	3485	"$167,254"									
228	3280	"$164,738"									
229	3704	"$121,546"									
231	875	"$305,581"									
232	631	"$225,992"									
233	11014	"$260,296"									
234	11394	"$193,349"									
235	10910	"$201,724"									
236	16497	"$153,200"									
239	9635	"$119,277"									
240	7261	"$83,188"									
241	563	"$58,988"									
242	16941	"$121,127"									
243	21032	"$93,371"									
244	11244	"$82,493"									
245	961	"$159,836"									
246	45046	"$126,558"									
247	72309	"$97,537"									
248	1639	"$127,740"									
249	1989	"$96,209"									
250	3922	"$104,318"									
251	4268	"$83,078"									
252	30059	"$105,737"									
253	20611	"$96,876"									
254	8375	"$75,212"									
255	2083	"$82,380"									
256	1649	"$61,793"									
257	113	"$49,702"									
258	521	"$100,523"									
259	677	"$79,514"									
260	2396	"$112,968"									
261	2887	"$79,144"									
262	978	"$70,853"									
263	225	"$83,349"									
264	9077	"$91,520"									
265	522	"$108,903"									
266	20025	"$207,857"									
267	32982	"$169,351"									
268	3104	"$211,685"									
269	12901	"$137,434"									
270	17948	"$160,384"									
271	13219	"$121,298"									
272	4343	"$94,308"									
273	7188	"$144,474"									
274	25252	"$122,432"									
280	84959	"$59,442"									
281	38940	"$47,904"									
282	16755	"$42,703"									
283	9477	"$62,634"									
284	922	"$37,819"									
285	193	"$28,983"									
286	40848	"$80,969"									
287	39681	"$60,480"									
288	1183	"$78,127"									
289	635	"$58,996"									
290	48	"$40,500"									
291	385807	"$49,812"									
292	20965	"$37,351"									
293	3798	"$27,640"									
294	235	"$48,885"									
295	20	"$41,282"									
296	2973	"$60,942"									
297	300	"$37,488"									
298	113	"$22,105"									
299	17238	"$54,109"									
300	22334	"$44,794"									
301	5602	"$34,049"									
302	2974	"$46,536"									
303	9514	"$33,658"									
304	14349	"$48,014"									
305	24458	"$37,714"									
306	3384	"$52,483"									
307	2531	"$41,578"									
308	57731	"$49,938"									
309	68672	"$35,492"									
310	40792	"$27,444"									
311	4083	"$34,620"									
312	54986	"$42,262"									
313	29431	"$38,622"									
314	38297	"$65,398"									
315	15961	"$44,586"									
316	2361	"$35,507"									
319	1291	"$139,484"									
320	375	"$90,512"									
326	9007	"$146,571"									
327	8906	"$92,351"									
328	6206	"$70,797"									
329	32638	"$140,100"									
330	44532	"$91,927"									
331	22288	"$72,917"									
332	171	"$114,002"									
333	533	"$88,140"									
334	562	"$69,147"									
335	4866	"$117,356"									
336	8077	"$83,938"									
337	3690	"$67,867"									
338	644	"$99,061"									
339	2302	"$72,916"									
340	1766	"$60,955"									
341	629	"$85,105"									
342	2051	"$66,985"									
343	2050	"$56,935"									
344	1064	"$90,047"									
345	1772	"$64,034"									
346	876	"$56,080"									
347	764	"$79,945"									
348	1740	"$58,550"									
349	811	"$47,587"									
350	1256	"$89,743"									
351	2974	"$65,859"									
352	1942	"$56,751"									
353	2232	"$99,588"									
354	5927	"$71,883"									
355	3909	"$62,331"									
356	6496	"$126,235"									
357	4991	"$85,117"									
358	965	"$60,565"									
368	2785	"$67,992"									
369	2869	"$51,096"									
370	282	"$36,642"									
371	13580	"$58,611"									
372	18835	"$45,055"									
373	3976	"$34,387"									
374	10875	"$66,340"									
375	11032	"$51,565"									
376	856	"$44,177"									
377	64825	"$63,907"									
378	107533	"$46,894"									
379	10843	"$32,746"									
380	5659	"$67,603"									
381	6751	"$51,104"									
382	1156	"$39,575"									
383	923	"$57,964"									
384	2834	"$46,233"									
385	2776	"$60,578"									
386	6968	"$45,540"									
387	2683	"$34,203"									
388	17218	"$55,008"									
389	42337	"$38,467"									
390	22982	"$28,970"									
391	36744	"$52,121"									
392	106056	"$39,089"									
393	24296	"$58,143"									
394	32974	"$44,517"									
395	6897	"$33,361"									
405	3884	"$165,258"									
406	4655	"$105,530"									
407	1543	"$85,729"									
408	862	"$116,368"									
409	768	"$85,239"									
410	276	"$66,021"									
411	132	"$112,025"									
412	172	"$95,116"									
413	94	"$73,290"									
414	1385	"$118,541"									
415	2150	"$81,369"									
416	912	"$63,199"									
417	11455	"$93,391"									
418	19227	"$75,616"									
419	11227	"$65,715"									
420	669	"$104,052"									
421	601	"$71,325"									
422	173	"$61,481"									
423	1176	"$123,215"									
424	562	"$87,481"									
425	84	"$69,300"									
432	15805	"$64,637"									
433	10570	"$47,312"									
434	471	"$32,612"									
435	12609	"$64,896"									
436	6283	"$51,043"									
437	504	"$45,712"									
438	12287	"$59,714"									
439	20737	"$41,698"									
440	9181	"$32,588"									
441	18730	"$61,839"									
442	13971	"$42,670"									
443	1859	"$34,201"									
444	11826	"$63,200"									
445	15909	"$51,626"									
446	5689	"$44,145"									
453	3859	"$258,999"									
454	19724	"$177,603"									
455	20082	"$147,519"									
456	1407	"$244,291"									
457	3863	"$180,963"									
458	1476	"$136,971"									
459	3263	"$187,017"									
460	37760	"$121,251"									
461	186	"$173,494"									
462	4266	"$106,957"									
463	4769	"$127,478"									
464	7063	"$91,135"									
465	2074	"$70,428"									
466	4992	"$149,926"									
467	21029	"$113,382"									
468	15762	"$93,507"									
469	9534	"$102,479"									
470	213043	"$74,035"									
471	3297	"$154,858"									
472	14271	"$105,690"									
473	8885	"$91,936"									
474	3485	"$108,633"									
475	3256	"$73,513"									
476	574	"$49,196"									
477	3113	"$104,298"									
478	5877	"$85,239"									
479	1257	"$71,250"									
480	28347	"$101,109"									
481	73891	"$81,144"									
482	18468	"$68,939"									
483	61325	"$86,593"									
485	1346	"$107,159"									
486	2810	"$81,049"									
487	770	"$67,932"									
488	2145	"$72,669"									
489	2145	"$59,159"									
492	6130	"$111,385"									
493	18237	"$85,886"									
494	10180	"$73,818"									
495	457	"$108,405"									
496	1656	"$73,709"									
497	1021	"$59,393"									
498	931	"$85,807"									
499	201	"$56,351"									
500	2307	"$94,180"									
501	4690	"$67,931"									
502	2193	"$58,154"									
503	981	"$83,231"									
504	2558	"$67,978"									
505	923	"$64,728"									
506	400	"$60,132"									
507	360	"$73,648"									
508	147	"$63,709"									
509	29	"$61,180"									
510	1024	"$94,581"									
511	3048	"$78,936"									
512	1795	"$69,869"									
513	1591	"$63,012"									
514	425	"$50,874"									
515	3948	"$101,187"									
516	11318	"$78,022"									
517	8700	"$64,322"									
518	2263	"$112,711"									
519	7253	"$78,001"									
520	4908	"$63,740"									
521	15098	"$104,961"									
522	47117	"$85,396"									
533	829	"$51,883"									
534	2284	"$33,432"									
535	7197	"$48,839"									
536	19876	"$33,815"									
537	820	"$41,553"									
538	241	"$32,089"									
539	2688	"$59,938"									
540	2716	"$48,698"									
541	411	"$35,761"									
542	6824	"$60,268"									
543	12380	"$47,233"									
544	2982	"$34,555"									
545	3271	"$68,784"									
546	3282	"$48,911"									
547	891	"$39,911"									
548	565	"$66,953"									
549	1132	"$50,834"									
550	328	"$41,193"									
551	12378	"$59,410"									
552	43242	"$45,189"									
553	2129	"$49,394"									
554	9282	"$34,388"									
555	1874	"$52,768"									
556	7322	"$39,204"									
557	3868	"$55,070"									
558	8976	"$38,781"									
559	2848	"$56,921"									
560	4732	"$42,707"									
561	2046	"$32,507"									
562	6160	"$53,765"									
563	21032	"$38,926"									
564	4492	"$57,575"									
565	6654	"$44,892"									
566	1379	"$37,356"									
570	2865	"$78,812"									
571	5348	"$59,838"									
572	1063	"$52,319"									
573	638	"$128,014"									
574	1210	"$89,830"									
575	153	"$65,650"									
576	436	"$139,221"									
577	1358	"$86,140"									
578	676	"$66,002"									
579	4088	"$88,857"									
580	7378	"$64,832"									
581	2538	"$60,279"									
582	425	"$66,936"									
583	458	"$66,936"									
584	577	"$71,542"									
585	635	"$72,842"									
592	2632	"$55,399"									
593	3654	"$42,844"									
594	361	"$31,746"									
595	919	"$59,102"									
596	2041	"$42,307"									
597	1311	"$60,493"									
598	1107	"$48,887"									
599	48	"$33,757"									
600	680	"$41,002"									
601	238	"$27,313"									
602	22530	"$52,016"									
603	73258	"$35,409"									
604	3230	"$57,450"									
605	11025	"$44,357"									
606	1736	"$51,964"									
607	4409	"$36,006"									
614	1787	"$89,890"									
615	1058	"$70,556"									
616	2963	"$110,679"									
617	13340	"$71,554"									
618	65	"$55,981"									
619	741	"$93,751"									
620	2830	"$72,628"									
621	8837	"$68,341"									
622	2016	"$95,055"									
623	5163	"$65,403"									
624	159	"$45,941"									
625	682	"$101,294"									
626	1133	"$72,746"									
627	987	"$62,032"									
628	2945	"$107,395"									
629	4836	"$77,910"									
630	145	"$65,697"									
637	32913	"$53,302"									
638	44363	"$38,527"									
639	6383	"$29,142"									
640	76436	"$48,838"									
641	74431	"$35,179"									
642	1555	"$48,116"									
643	11004	"$58,740"									
644	12386	"$45,049"									
645	3854	"$35,580"									
650	2454	"$151,226"									
651	1252	"$136,090"									
652	8909	"$124,603"									
653	1485	"$156,275"									
654	3787	"$107,283"									
655	1251	"$84,869"									
656	2656	"$108,574"									
657	6705	"$79,752"									
658	5187	"$71,199"									
659	8855	"$85,545"									
660	17606	"$61,041"									
661	10911	"$53,929"									
662	742	"$95,296"									
663	1466	"$62,086"									
664	452	"$53,093"									
665	604	"$101,325"									
666	1363	"$68,036"									
667	388	"$50,244"									
668	1897	"$91,045"									
669	4341	"$65,045"									
670	1061	"$48,824"									
671	311	"$65,722"									
672	161	"$56,237"									
673	14881	"$99,569"									
674	6586	"$81,997"									
675	392	"$66,580"									
682	88349	"$53,852"									
683	98455	"$39,946"									
684	9934	"$29,591"									
686	1604	"$61,592"									
687	2116	"$45,762"									
688	183	"$39,995"									
689	71205	"$47,525"									
690	98430	"$36,306"									
693	1290	"$53,260"									
694	5938	"$39,567"									
695	1119	"$48,197"									
696	4976	"$31,709"									
697	435	"$47,251"									
698	63749	"$55,984"									
699	32560	"$43,492"									
700	2506	"$34,079"									
707	2879	"$81,782"									
708	4614	"$71,013"									
709	443	"$82,851"									
710	165	"$58,312"									
711	369	"$73,860"									
712	87	"$46,191"									
713	4031	"$60,386"									
714	1153	"$46,311"									
715	377	"$73,595"									
716	76	"$68,900"									
717	1555	"$67,206"									
718	411	"$57,583"									
722	802	"$58,775"									
723	1176	"$46,936"									
724	55	"$35,462"									
725	769	"$50,881"									
726	2472	"$33,792"									
727	1289	"$53,660"									
728	3392	"$37,251"									
729	509	"$45,339"									
730	74	"$26,838"									
734	583	"$84,394"									
735	302	"$65,669"									
736	558	"$124,023"									
737	2420	"$83,276"									
738	442	"$66,233"									
739	450	"$121,986"									
740	2056	"$78,646"									
741	1294	"$65,109"									
742	3253	"$72,563"									
743	3944	"$56,676"									
744	1151	"$70,406"									
745	159	"$51,756"									
746	1155	"$62,913"									
747	1083	"$47,955"									
748	979	"$60,736"									
749	726	"$89,812"									
750	111	"$65,812"									
754	1684	"$61,022"									
755	2121	"$48,079"									
756	188	"$46,325"									
757	798	"$54,313"									
758	997	"$44,062"									
759	272	"$31,648"									
760	1354	"$42,561"									
761	176	"$31,013"									
768	146	"$34,827"									
769	77	"$55,423"									
770	53	"$44,868"									
776	456	"$29,396"									
779	43	"$33,475"									
783	185	"$59,320"									
784	418	"$43,955"									
785	376	"$35,091"									
786	616	"$54,856"									
787	1449	"$41,847"									
788	1412	"$35,381"									
793	1	"$107,291"									
795	1	"$2,639"									
796	25	"$56,456"									
797	81	"$35,110"									
798	89	"$35,110"									
799	409	"$160,940"									
800	211	"$97,908"									
801	88	"$81,067"									
802	547	"$104,210"									
803	696	"$76,748"									
804	413	"$61,331"									
805	458	"$34,103"									
806	1743	"$23,376"									
807	2941	"$20,208"									
808	7661	"$69,435"									
809	11657	"$49,562"									
810	1319	"$43,001"									
811	28106	"$54,647"									
812	44515	"$40,567"									
813	15316	"$55,334"									
814	1473	"$62,618"									
815	2153	"$47,039"									
816	467	"$37,036"									
817	62	"$78,950"									
818	68	"$57,927"									
819	29	"$43,604"									
820	1102	"$168,900"									
821	1031	"$85,908"									
822	840	"$60,137"									
823	2290	"$132,641"									
824	1999	"$83,580"									
825	569	"$61,757"									
826	726	"$146,664"									
827	1394	"$92,864"									
828	765	"$74,928"									
829	1816	"$91,676"									
830	323	"$66,416"									
831	654	"$43,291"									
832	872	"$25,463"									
833	390	"$18,960"									
834	4351	"$125,719"									
835	2110	"$65,202"									
836	378	"$46,940"									
837	1745	"$114,761"									
838	1140	"$61,712"									
839	699	"$50,447"									
840	8014	"$84,217"									
841	5960	"$58,793"									
842	1074	"$47,228"									
843	2114	"$63,265"									
844	1617	"$50,924"									
845	258	"$44,073"									
846	3008	"$73,277"									
847	10431	"$50,863"									
848	156	"$41,579"									
849	252	"$76,274"									
853	82940	"$138,129"									
854	22295	"$76,980"									
855	175	"$61,508"									
856	7656	"$120,425"									
857	7144	"$71,691"									
858	856	"$56,769"									
862	10837	"$61,705"									
863	8699	"$43,360"									
864	8921	"$40,190"									
865	2571	"$50,924"									
866	4823	"$38,499"									
867	2303	"$65,217"									
868	1588	"$46,817"									
869	282	"$32,630"									
870	42600	"$194,183"									
871	586532	"$65,331"									
872	128754	"$46,748"									
876	559	"$83,782"									
880	6104	"$41,608"									
881	3067	"$27,249"									
882	1664	"$30,927"									
883	1017	"$37,543"									
884	18909	"$47,903"									
885	59958	"$35,913"									
886	253	"$41,549"									
887	293	"$47,851"									
894	3700	"$23,572"									
895	2913	"$41,125"									
896	9364	"$57,813"									
897	24837	"$33,086"									
901	1023	"$104,317"									
902	1676	"$69,170"									
903	411	"$53,813"									
904	943	"$99,142"									
905	198	"$64,201"									
906	493	"$66,749"									
907	9411	"$109,931"									
908	7940	"$73,269"									
909	2251	"$59,098"									
913	744	"$58,160"									
914	2045	"$43,406"									
915	2098	"$60,161"									
916	2794	"$28,660"									
917	24739	"$54,821"									
918	11975	"$35,248"									
919	13436	"$61,333"									
920	10982	"$45,540"									
921	1900	"$33,045"									
922	1571	"$57,462"									
923	1512	"$39,362"									
927	170	"$463,217"									
928	1093	"$151,275"									
929	224	"$85,745"									
933	114	"$69,656"									
934	395	"$51,786"									
935	1495	"$52,609"									
939	586	"$97,005"									
940	1216	"$77,781"									
941	530	"$70,376"									
945	2173	"$60,215"									
946	628	"$54,717"									
947	7153	"$47,543"									
948	21146	"$35,948"									
949	957	"$42,247"									
950	184	"$28,716"									
951	4271	"$24,060"									
955	487	"$194,822"									
956	6058	"$114,601"									
957	2286	"$220,374"									
958	1668	"$137,434"									
959	139	"$91,665"									
963	2932	"$86,131"									
964	4259	"$60,133"									
965	648	"$46,991"									
969	326	"$179,853"									
970	61	"$89,185"									
974	3715	"$82,749"									
975	1450	"$53,240"									
976	233	"$40,692"									
977	948	"$50,833"									
981	24451	"$129,761"									
982	11791	"$84,645"									
983	2159	"$68,373"									
987	8747	"$100,830"									
988	6764	"$66,692"									
989	917	"$54,859"									
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 2020 MedPAR file; MS-DRGs are from GROUPER Version39.0.											
