FY 2026 IPPS Final Rule Home Page

This is the home page for the FY 2026 Hospital Inpatient PPS final rule. The list below centralizes any IPPS file(s) related to the final rule. The list contains the final rule (display version or published Federal Register version) and a subsequent published correction notices (if applicable), all tables, additional data and analysis files and the impact file. Please see the the Long-Term Care Hospital PPS page for related files.

FY 2026 IPPS Final Rule

1. CMS-1833-F
   
   Date of Display: July 31, 2025
   
   Date of Publication: August 4, 2025
   
   Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2026 Rates; Changes to the FY 2025 IPPS Rates Due to Court Decision; Requirements for Quality Programs; and Other Policy Changes; Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization.

FY 2026 Final Rule Data and Supplemental Files 

1. FY 2026 Impact File (ZIP): This file contains data elements by provider that were used in calculating the FY 2026 rates and impacts.
2. AOR/BOR File (ZIP): This zip file for the FY 2026 final rule contains one excel spreadsheet with multiple tabs: one for the After Outliers Removed (AOR) and one for the Before Outliers Removed (BOR). There are also two tabs containing the variable descriptions. The variables in these files are used in the calculations of the relative weights as well as other calculations for the inpatient PPS. This file also contains the arithmetic and geometric mean lengths of stay which was previously included in Tables 7A and 7B. All text files in the zip file are for 508 compliance.
3. Case Mix Index File (ZIP): This file contains the non-transfer adjusted case mix index (CMI) based on the MS-DRGs billed on the claim in the year the claim was incurred (that is, during FY 2024, using the V41 Grouper).
4. FY 2026 HCRIS Data File (ZIP): CMS uses hospital cost report data from the Medicare Cost Report, Hospital Form 2552-10, to calculate the Cost-to-Charge Ratios (CCRs) used in the cost based MS-DRG relative weight methodology.  The database for the Medicare cost reports is the Healthcare Cost Report Information System (HCRIS).  The CCRs used in the calculation of the MS DRG relative weights for the FY 2026 IPPS Final Rule are derived from the March 31, 2025 quarterly update of the FY 2023 HCRIS.  (HCRIS is updated on a quarterly basis).
5. Cost Center HCRIS Lines Supplemental Data File (ZIP): This supplemental data file shows the cost report lines that are used for the Cost Center CCR calculations, which are part of the MS-DRG Relative Weights calculations. In addition, the FY 2026 normalization factor is included on the second tab.
6. Standardizing File (ZIP): This file is used to standardize charges for the rate building process.
7. County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File (ZIP): This file contains two tabs: A crosswalk of county codes to CBSAs (including the revised CBSA delineations for FY 2026) and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
8. FY 2026 Final Rule Wage Index Public Use Files (ZIP): Open attached Zip file. Main zip file contains 4 Excel spreadsheets files. All text files in the zip file are for 508 compliance. Included in the zip file is a PDF files with a description of each Excel spreadsheet:
   • FY 2026 Wage Index Data PUFs (S3 Part II and Occ Mix Data)
   • FY 2026 Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2026 Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2026 AHW by Provider Area Listing
9. FY 2026 Imputed State Floors Public Use File (ZIP): Contains multiple tabs demonstrating step by step calculation of the imputed floor.
10. FY 2026 Medicare DSH Supplemental Data File (Final Rule) (ZIP): This spreadsheet has 4 tabs (text files for each tab are included for Section 508 compliance):   The first tab is the File Layout for second tab of the spreadsheet. The second tab contains the FY 2026 final rule Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. The third tab contains a list of hospitals that have undergone a merger where the data of the merging hospitals have been combined to calculate the Factor 3 for the surviving hospital for FY 2026. The fourth tab contains the Medicare DSH estimates to support the calculation of the final Factor 1.
11. Hospital Readmissions Reduction Program Supplemental Data File (ZIP): This file contains the final FY 2026 payment adjustment factors CMS applies to discharges that occur on or after October 1, 2025. It also contains information on the number of discharges used to determine the ratio of condition/procedure-specific payments to total base operating diagnosis-related group (DRG) payments.
12. FY 2027 New Technology Add-On Payment Thresholds (ZIP): Contains the cost thresholds by MS-DRG for the cost criteria for new technology add-on payments for applications for FY 2027.
13. Share of IPPS Discharges with Given Characteristic By Provider (ZIP): This file contains the percentage of IPPS discharges at each hospital where: the patient was dually eligibility for Medicaid and Medicare and/or the patient was enrolled to receive the Medicare low income subsidy (LIS), the patient was receiving ESRD Medicare coverage, the patient qualified for Medicare due to disability, the patient was living in a rural area, or the patient was living in an area with an area deprivation index (ADI) greater than or equal to 85.  It also contains the percentage of IPPS discharges where the claim for the discharge contained an ICD-10-CM Z code indicating a “social determinant of health” (SDOH) or the claim contained a behavioral health diagnosis code.
14. Outlier Reconciliation Public Use File (ZIP): Contains data used to identify hospitals that would have met the criteria to be referred for outlier reconciliation under CR 13566 as if they had been in place at the time of final cost report settlement as well as the data for these hospitals that was used in the calculation of the outlier reconciliation amounts used for the FY 2026 outlier threshold.
15. Traditional Wage Index Impact Information (ZIP): Shows the effect of including or excluding particular wage index polices from the computation of the FY 2026 wage index instead of the impact of the wage index changes from FY 2025 to FY 2026 shown in Table I of the Regulatory Impact Analysis in Appendix A of the Final Rule. 

FY 2026 Final Rule Tables

1. Table 1A-1E (ZIP): This excel spreadsheet contains the final FY 2026 Operating and Capital National Standardized Amounts.
2. FY 2026 Tables 2, 3 and 4A and 4B (Wage Index Tables)(Final Rule) (ZIP):
   • Table 2- Case-Mix Index and Wage Index Table by CMS Certification Number (CCN)
   • Table 3- Wage Index Table by CBSA
   • Table 4A - List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act
   • Table 4B - Counties Redesignated under Section 1886(d)(8)(B) of the Act (LUGAR COUNTIES)
3. Table 5 (ZIP): MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
4. Tables 6A-6K and Tables 6P.1a-6P.8a (ZIP): Table 6A-New Diagnosis Codes; Table 6B-New Procedure Codes; Table 6C-Invalid Diagnosis Codes; Table 6D – Invalid Procedure Codes; Table 6E-Revised Diagnosis Code Titles; Table 6F – Revised Procedure Code Titles; Table 6G.1- Secondary Diagnosis Order Additions to the CC Exclusions List; Table 6G.2- Principal Diagnosis Order Additions to the CC Exclusions List; Table 6H.1- Secondary Diagnosis Order Deletions to the CC Exclusions List; Table 6H.2- Principal Diagnosis Order Deletions to the CC Exclusions List; Table 6I. – Complete MCC List; Table 6I.1- Additions to the MCC List; Table 6J. – Complete CC List; Table 6J.1- Additions to the CC List; and Table 6J.2 – Deletions to the CC List; Table 6K. – Complete CC Exclusions List. Tables 6P.1a-6P.8a (ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1833-F TABLE 6P ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes.xlsx” for a complete description of all tables.  
5. Tables 8A, 8B, and 8C (ZIP): Tables 8A and 8B contain the FY 2026 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the FY 2026 LTCH statewide average cost-to-charge-ratios.
6. Table 10 (ZIP): Relevant ICD-10 Codes for Certain FY 2026 New Technology Add-On Payments.
7. Table 15 (ZIP): FY 2026 Hospital Readmissions Reduction Program Payment Adjustment Factors: This table contains the final FY 2026 payment adjustment factors CMS applies to discharges occurring on or after October 1, 2025.
8. Tables 16A and 16B Hospital Value-Based Purchasing (VBP) Program Adjustment Factors:
   • Table 16A (ZIP): Contains updated proxy adjustment factors under the Hospital VBP Program that were calculated using historical baseline and performance periods. These proxies for the FY 2026 Hospital VBP payment adjustment factors will not be used to adjust hospital payments. This file includes the proxy adjustment factors published for the FY 2026 IPPS Final Rule (CMS-1833-F).
   • Table 16B (ZIP):  Contains the actual payment adjustment factors under the Hospital VBP Program for FY 2026. These actual factors are based on the finalized baseline and performance period for FY 2026 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2026. (Updated 09/17/2025).
9. Table 18 (ZIP): FY 2026 Medicare DSH Uncompensated Care Payment Factor 3. 

FY 2026 MAC Implementation Files

This page contains the following files as described in the Fiscal Year (FY) 2026 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes Change Request (CR) 14203. 

1. MAC Implementation File 1 (ZIP) – Certain FY 2026 IPPS factors, including applicable percentage increase, budget neutrality factors, High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors.
2. MAC Implementation File 2 (ZIP) – Certain FY 2026 LTCH PPS factors, including High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors.
3. MAC Implementation File 3 (ZIP) – A list of hospitals that will receive the statutory reduction to the annual payment update for FY 2026 under the Hospital Inpatient Quality Reporting (IQR) Program.
4. MAC Implementation File 4 – Reserved for Future Use
5. MAC Implementation File 5 (ZIP) – Instructions to Fill Out the PSF for the Wage Index and Reclassification.
6. MAC Implementation File 6 (ZIP) –FY 2026 MS-DRG Grouper Changes.
7. MAC Implementation File 7 (ZIP) – FY 2026 MS-DRGs Subject to the Replaced Devices Policy.
8. MAC Implementation File 8 (ZIP) – FY 2026 New Technology Add-on Payment.
9. MAC Implementation File 9 (ZIP) – Instructions to Fill Out the PSF for LTCHs receiving a capped LTCH PPS wage index value or a capped applicable IPPS comparable wage index value in FY 2026.