FINAL NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1 FOR APPLICATIONS FOR FY 2028									
MS?DRG	Threshold								
001	"$963,012"								
002	"$400,133"								
003	"$659,960"								
004	"$409,457"								
005	"$377,026"								
006	"$222,569"								
007	"$600,866"								
008	"$259,921"								
010	"$278,647"								
011	"$206,197"								
012	"$182,870"								
013	"$118,356"								
014	"$367,195"								
016	"$197,912"								
017	"$114,180"								
018	"$2,018,747"								
019	"$316,925"								
020	"$283,922"								
021	"$197,200"								
022	"$136,145"								
023	"$213,650"								
024	"$162,439"								
025	"$181,174"								
026	"$136,594"								
027	"$119,865"								
028	"$220,918"								
029	"$143,047"								
030	"$105,372"								
031	"$151,217"								
032	"$99,530"								
033	"$89,761"								
034	"$158,125"								
035	"$110,304"								
036	"$94,455"								
037	"$143,195"								
038	"$88,824"								
039	"$74,287"								
040	"$146,908"								
041	"$108,056"								
042	"$92,521"								
052	"$80,023"								
053	"$55,465"								
054	"$70,495"								
055	"$60,208"								
056	"$79,001"								
057	"$59,738"								
058	"$76,364"								
059	"$63,719"								
060	"$56,499"								
061	"$132,688"								
062	"$104,809"								
063	"$93,889"								
064	"$86,480"								
065	"$63,781"								
066	"$52,641"								
067	"$77,815"								
068	"$62,164"								
069	"$61,093"								
070	"$72,989"								
071	"$59,748"								
072	"$51,303"								
073	"$71,100"								
074	"$59,011"								
075	"$83,553"								
076	"$54,926"								
080	"$76,952"								
081	"$51,164"								
082	"$93,039"								
083	"$71,793"								
084	"$59,681"								
085	"$92,495"								
086	"$70,181"								
087	"$58,524"								
088	"$78,299"								
089	"$68,374"								
090	"$58,591"								
091	"$74,931"								
092	"$59,612"								
093	"$53,671"								
094	"$123,151"								
095	"$98,010"								
096	"$103,558"								
097	"$136,330"								
098	"$95,537"								
099	"$76,508"								
100	"$81,217"								
101	"$55,843"								
102	"$65,423"								
103	"$57,839"								
113	"$99,147"								
114	"$73,257"								
115	"$78,024"								
116	"$76,640"								
117	"$63,857"								
121	"$56,426"								
122	"$35,403"								
123	"$59,656"								
124	"$65,050"								
125	"$51,618"								
135	"$102,575"								
136	"$68,006"								
137	"$65,629"								
138	"$57,983"								
139	"$65,938"								
140	"$170,945"								
141	"$107,212"								
142	"$90,091"								
143	"$139,967"								
144	"$86,762"								
145	"$72,553"								
146	"$82,790"								
147	"$64,049"								
148	"$48,967"								
149	"$55,072"								
150	"$63,355"								
151	"$43,034"								
152	"$58,916"								
153	"$45,605"								
154	"$71,808"								
155	"$55,364"								
156	"$42,107"								
157	"$74,415"								
158	"$54,672"								
159	"$44,458"								
163	"$171,548"								
164	"$117,418"								
165	"$98,939"								
166	"$138,106"								
167	"$91,160"								
168	"$78,536"								
173	"$137,450"								
175	"$68,587"								
176	"$51,564"								
177	"$72,308"								
178	"$55,424"								
179	"$43,844"								
180	"$80,141"								
181	"$61,475"								
182	"$50,876"								
183	"$72,600"								
184	"$62,076"								
185	"$50,891"								
186	"$72,979"								
187	"$58,482"								
188	"$44,390"								
189	"$62,409"								
190	"$58,390"								
191	"$48,841"								
192	"$38,573"								
193	"$64,691"								
194	"$47,411"								
195	"$37,972"								
196	"$76,083"								
197	"$56,125"								
198	"$46,586"								
199	"$77,158"								
200	"$59,789"								
201	"$40,611"								
202	"$55,329"								
203	"$39,518"								
204	"$53,486"								
205	"$75,437"								
206	"$55,397"								
207	"$223,759"								
208	"$114,784"								
209	"$425,746"								
210	"$133,845"								
211	"$94,505"								
212	"$452,499"								
213	"$220,043"								
215	"$370,632"								
216	"$390,248"								
217	"$286,688"								
218	"$286,688"								
219	"$302,949"								
220	"$235,546"								
221	"$192,783"								
228	"$205,759"								
229	"$155,179"								
231	"$381,662"								
232	"$288,138"								
233	"$329,756"								
234	"$251,266"								
235	"$246,105"								
236	"$198,024"								
239	"$162,336"								
240	"$111,320"								
241	"$71,754"								
242	"$139,330"								
243	"$108,254"								
244	"$97,141"								
245	"$197,920"								
250	"$124,605"								
251	"$102,811"								
252	"$137,557"								
253	"$119,774"								
254	"$91,383"								
255	"$103,630"								
256	"$76,961"								
257	"$60,552"								
263	"$138,718"								
265	"$133,035"								
266	"$234,297"								
267	"$196,725"								
268	"$270,995"								
269	"$172,062"								
270	"$198,789"								
271	"$150,706"								
272	"$112,506"								
273	"$185,209"								
274	"$146,990"								
275	"$302,980"								
276	"$255,276"								
277	"$208,919"								
278	"$238,121"								
279	"$172,527"								
280	"$74,937"								
281	"$60,103"								
282	"$55,436"								
283	"$83,415"								
284	"$49,340"								
285	"$36,407"								
286	"$101,887"								
287	"$73,281"								
288	"$96,873"								
289	"$71,825"								
290	"$49,290"								
291	"$61,339"								
292	"$48,019"								
293	"$34,268"								
296	"$77,574"								
297	"$51,396"								
298	"$37,446"								
299	"$69,731"								
300	"$55,866"								
301	"$44,642"								
302	"$60,711"								
303	"$43,793"								
304	"$63,433"								
305	"$51,813"								
306	"$66,691"								
307	"$53,138"								
308	"$62,296"								
309	"$45,272"								
310	"$36,886"								
311	"$45,578"								
312	"$55,770"								
313	"$49,411"								
314	"$81,073"								
315	"$55,550"								
316	"$45,136"								
317	"$294,437"								
318	"$132,878"								
319	"$172,557"								
320	"$107,260"								
321	"$148,367"								
322	"$116,595"								
323	"$210,704"								
324	"$168,051"								
325	"$157,561"								
326	"$173,686"								
327	"$111,651"								
328	"$88,955"								
329	"$167,692"								
330	"$112,580"								
331	"$91,316"								
332	"$138,961"								
333	"$98,029"								
334	"$88,309"								
335	"$141,360"								
336	"$102,449"								
337	"$85,149"								
344	"$109,423"								
345	"$76,747"								
346	"$73,048"								
347	"$99,159"								
348	"$68,228"								
349	"$59,723"								
350	"$113,468"								
351	"$86,784"								
352	"$75,199"								
353	"$120,441"								
354	"$90,597"								
355	"$79,404"								
356	"$162,814"								
357	"$107,692"								
358	"$81,005"								
359	"$170,340"								
360	"$133,324"								
361	"$129,434"								
362	"$92,017"								
368	"$76,835"								
369	"$60,194"								
370	"$46,555"								
371	"$73,684"								
372	"$57,048"								
373	"$42,978"								
374	"$84,781"								
375	"$64,376"								
376	"$55,059"								
377	"$81,237"								
378	"$59,042"								
379	"$43,129"								
380	"$84,219"								
381	"$63,083"								
382	"$48,696"								
383	"$71,358"								
384	"$58,506"								
385	"$72,668"								
386	"$56,801"								
387	"$41,664"								
388	"$67,164"								
389	"$48,313"								
390	"$35,273"								
391	"$63,828"								
392	"$49,387"								
393	"$71,636"								
394	"$55,377"								
395	"$42,373"								
397	"$114,078"								
398	"$86,090"								
399	"$74,826"								
400	"$93,467"								
402	"$168,741"								
403	"$184,678"								
404	"$133,866"								
405	"$198,678"								
406	"$133,797"								
407	"$108,845"								
408	"$135,456"								
409	"$107,848"								
410	"$93,059"								
411	"$131,264"								
412	"$108,750"								
413	"$104,019"								
414	"$145,350"								
415	"$100,819"								
416	"$79,922"								
417	"$118,194"								
418	"$98,113"								
419	"$85,722"								
420	"$125,787"								
421	"$90,038"								
422	"$82,131"								
423	"$158,162"								
424	"$106,135"								
425	"$92,810"								
426	"$328,497"								
427	"$247,632"								
428	"$225,140"								
429	"$332,564"								
430	"$227,542"								
432	"$85,003"								
433	"$60,134"								
434	"$41,487"								
435	"$84,692"								
436	"$63,813"								
437	"$54,885"								
438	"$73,019"								
439	"$53,620"								
440	"$41,511"								
441	"$76,231"								
442	"$56,127"								
443	"$45,320"								
444	"$78,949"								
445	"$64,280"								
446	"$56,334"								
447	"$256,044"								
448	"$172,160"								
449	"$125,706"								
450	"$205,026"								
451	"$139,719"								
456	"$283,882"								
457	"$202,410"								
458	"$160,058"								
461	"$186,992"								
462	"$128,809"								
463	"$172,072"								
464	"$128,097"								
465	"$107,677"								
469	"$128,640"								
470	"$95,906"								
471	"$198,262"								
472	"$134,157"								
473	"$116,587"								
474	"$144,979"								
475	"$94,254"								
476	"$65,154"								
477	"$133,801"								
478	"$109,135"								
479	"$90,624"								
480	"$126,336"								
481	"$103,640"								
482	"$86,351"								
483	"$125,895"								
488	"$96,271"								
489	"$71,031"								
492	"$149,422"								
493	"$116,170"								
494	"$98,181"								
495	"$130,815"								
496	"$85,802"								
497	"$68,171"								
498	"$133,852"								
499	"$101,935"								
500	"$121,689"								
501	"$87,214"								
502	"$76,270"								
503	"$111,125"								
504	"$84,550"								
505	"$84,550"								
506	"$68,760"								
507	"$88,815"								
508	"$70,455"								
510	"$133,407"								
511	"$105,351"								
512	"$91,340"								
513	"$77,460"								
514	"$62,626"								
515	"$131,730"								
516	"$101,624"								
517	"$83,595"								
518	"$151,006"								
519	"$99,829"								
520	"$84,885"								
521	"$128,088"								
522	"$106,361"								
523	"$443,036"								
524	"$334,576"								
525	"$258,221"								
533	"$66,230"								
534	"$45,846"								
535	"$62,503"								
536	"$46,795"								
537	"$53,372"								
538	"$42,915"								
539	"$75,760"								
540	"$60,909"								
541	"$44,969"								
542	"$72,974"								
543	"$57,088"								
544	"$43,637"								
545	"$84,330"								
546	"$59,773"								
547	"$45,190"								
548	"$81,266"								
549	"$59,028"								
550	"$51,185"								
551	"$75,418"								
552	"$58,141"								
553	"$61,543"								
554	"$45,290"								
555	"$63,126"								
556	"$48,493"								
557	"$69,883"								
558	"$51,910"								
559	"$72,628"								
560	"$55,095"								
561	"$42,942"								
562	"$67,695"								
563	"$52,060"								
564	"$72,165"								
565	"$57,618"								
566	"$47,134"								
570	"$98,071"								
571	"$74,536"								
572	"$63,384"								
573	"$181,245"								
574	"$119,785"								
575	"$84,749"								
576	"$170,882"								
577	"$118,512"								
578	"$83,841"								
579	"$112,776"								
580	"$81,395"								
581	"$76,390"								
582	"$90,412"								
583	"$90,412"								
584	"$92,930"								
585	"$96,580"								
592	"$71,716"								
593	"$55,128"								
594	"$37,932"								
595	"$76,994"								
596	"$54,093"								
597	"$75,540"								
598	"$59,263"								
599	"$48,304"								
600	"$53,347"								
601	"$34,068"								
602	"$64,114"								
603	"$45,383"								
604	"$70,883"								
605	"$55,681"								
606	"$64,547"								
607	"$46,878"								
614	"$101,833"								
615	"$82,510"								
616	"$120,406"								
617	"$82,459"								
618	"$62,199"								
619	"$109,683"								
620	"$86,037"								
621	"$83,675"								
622	"$122,027"								
623	"$84,474"								
624	"$70,760"								
625	"$126,526"								
626	"$88,639"								
627	"$81,305"								
628	"$133,763"								
629	"$93,078"								
630	"$77,834"								
637	"$66,795"								
638	"$50,979"								
639	"$38,305"								
640	"$63,299"								
641	"$46,677"								
642	"$61,144"								
643	"$72,563"								
644	"$56,254"								
645	"$43,965"								
650	"$202,981"								
651	"$177,852"								
652	"$158,600"								
653	"$189,266"								
654	"$134,711"								
655	"$105,519"								
656	"$139,186"								
657	"$98,635"								
658	"$88,975"								
659	"$102,234"								
660	"$73,029"								
661	"$66,091"								
662	"$118,956"								
663	"$79,125"								
664	"$64,269"								
665	"$132,370"								
666	"$88,950"								
667	"$67,933"								
668	"$117,428"								
669	"$81,730"								
670	"$64,363"								
671	"$88,553"								
672	"$61,408"								
673	"$150,027"								
674	"$96,800"								
675	"$79,438"								
682	"$67,370"								
683	"$50,193"								
684	"$37,373"								
686	"$75,455"								
687	"$56,431"								
688	"$47,162"								
689	"$59,285"								
690	"$46,840"								
693	"$64,797"								
694	"$50,953"								
695	"$57,736"								
696	"$38,835"								
697	"$56,570"								
698	"$70,782"								
699	"$54,433"								
700	"$39,656"								
707	"$106,270"								
708	"$89,049"								
709	"$92,006"								
710	"$81,800"								
711	"$90,905"								
712	"$71,116"								
713	"$78,515"								
714	"$66,743"								
715	"$109,016"								
716	"$87,762"								
717	"$91,460"								
718	"$75,377"								
722	"$73,443"								
723	"$57,943"								
724	"$35,258"								
725	"$59,770"								
726	"$42,866"								
727	"$65,542"								
728	"$47,483"								
729	"$54,567"								
730	"$38,783"								
731	"$150,037"								
732	"$103,450"								
733	"$86,816"								
734	"$83,572"								
735	"$70,188"								
742	"$93,845"								
743	"$77,181"								
744	"$92,513"								
745	"$65,811"								
746	"$78,895"								
747	"$61,227"								
748	"$75,740"								
749	"$110,340"								
750	"$78,879"								
754	"$77,545"								
755	"$60,222"								
756	"$54,630"								
757	"$68,399"								
758	"$56,049"								
759	"$45,787"								
760	"$55,689"								
761	"$43,113"								
768	"$46,344"								
769	"$65,375"								
770	"$61,262"								
776	"$35,605"								
779	"$51,368"								
783	"$79,149"								
784	"$53,090"								
785	"$47,491"								
786	"$69,122"								
787	"$54,061"								
788	"$47,315"								
793	"$70,622"								
796	"$89,846"								
797	"$48,644"								
798	"$49,116"								
799	"$192,396"								
800	"$138,646"								
801	"$103,837"								
802	"$134,716"								
803	"$92,190"								
804	"$77,469"								
805	"$46,179"								
806	"$31,248"								
807	"$26,736"								
808	"$86,293"								
809	"$62,410"								
810	"$55,891"								
811	"$69,222"								
812	"$54,285"								
813	"$68,728"								
814	"$81,238"								
815	"$58,223"								
816	"$48,668"								
817	"$76,937"								
818	"$73,130"								
819	"$30,050"								
820	"$221,741"								
821	"$101,234"								
822	"$71,546"								
823	"$169,173"								
824	"$105,994"								
825	"$78,835"								
826	"$179,613"								
827	"$114,377"								
828	"$92,239"								
829	"$119,762"								
830	"$84,488"								
831	"$54,404"								
832	"$35,255"								
833	"$25,590"								
834	"$161,345"								
835	"$86,116"								
836	"$59,968"								
837	"$131,373"								
838	"$79,197"								
839	"$61,492"								
840	"$109,390"								
841	"$73,619"								
842	"$58,573"								
843	"$82,514"								
844	"$65,269"								
845	"$51,277"								
846	"$90,129"								
847	"$62,331"								
848	"$38,992"								
849	"$99,312"								
850	"$245,492"								
853	"$170,310"								
854	"$93,885"								
855	"$77,755"								
856	"$149,227"								
857	"$91,998"								
858	"$72,369"								
862	"$74,730"								
863	"$53,709"								
864	"$53,943"								
865	"$62,571"								
866	"$50,310"								
867	"$80,933"								
868	"$54,859"								
869	"$43,045"								
870	"$246,475"								
871	"$82,452"								
872	"$58,500"								
876	"$111,294"								
880	"$54,063"								
881	"$37,327"								
882	"$45,706"								
883	"$48,768"								
884	"$61,159"								
885	"$49,656"								
886	"$52,242"								
887	"$54,401"								
894	"$36,296"								
895	"$49,166"								
896	"$72,045"								
897	"$46,298"								
901	"$148,895"								
902	"$83,815"								
903	"$65,227"								
904	"$131,090"								
905	"$79,641"								
906	"$80,683"								
907	"$141,861"								
908	"$90,314"								
909	"$73,832"								
913	"$72,144"								
914	"$56,823"								
915	"$73,077"								
916	"$40,329"								
917	"$69,932"								
918	"$49,291"								
919	"$74,971"								
920	"$55,489"								
921	"$41,294"								
922	"$71,908"								
923	"$54,414"								
927	"$786,651"								
928	"$208,608"								
929	"$108,270"								
933	"$92,155"								
934	"$61,204"								
935	"$72,484"								
939	"$120,792"								
940	"$97,580"								
941	"$92,238"								
945	"$68,528"								
946	"$66,668"								
947	"$59,927"								
948	"$45,760"								
949	"$51,602"								
950	"$36,970"								
951	"$30,993"								
955	"$252,167"								
956	"$145,126"								
957	"$279,176"								
958	"$172,325"								
959	"$116,448"								
963	"$106,147"								
964	"$74,768"								
965	"$59,068"								
969	"$229,823"								
970	"$111,533"								
974	"$105,834"								
975	"$64,418"								
976	"$51,124"								
977	"$65,413"								
981	"$163,132"								
982	"$106,576"								
983	"$84,376"								
987	"$124,590"								
988	"$81,469"								
989	"$65,840"								
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)									
