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This information is provided free of charge by the Department of Industrial Relations from its web site at www.dir.ca.gov. These regulations are for the convenience of the user and no representation or warranty is made that the information is current or accurate. See full disclaimer at https://www.dir.ca.gov/od_pub/disclaimer.html.
 
Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director - Administrative Rules
Article 5.3. Official Medical Fee Schedule

New Query


§ 9789.25. Federal Regulations, Federal Register Notices, and Payment Impact File by Date of Discharge.


(a) Federal Regulations by Date of Discharge
(1) The Federal Regulations can be accessed at: http://www.cms.gov/AcuteInpatientPPS/ and the referenced sections are incorporated by reference and will be made available upon request to the Administrative Director.
Discharges Occurring on or After 1/1/2004
Discharges Occurring on or After 11/29/2004
Discharges Occurring on or After 12/1/2005
Discharges Occuring on or After 12/1/2006
Title 42, Code of Federal Regulations, §412.2
Effective October 1, 2003
Title 42, Code of Federal Regulations, §412.23(e)
Effective date October 1, 2002 and revised as of October 1, 2003
Title 42, Code of Federal Regulations, §412.23(f)
Effective October 1, 2002 and revised as of October 1, 2003
Title 42, Code of Federal Regulations, Section 412.64
Effective October 1, 2004
Title 42, Code of Federal Regulations, Section 412.87
Effective September 7, 2001 and revised as of October 1, 2003
Amended; effective October 1, 2004
Title 42, Code of Federal Regulations, Section 412.88
Effective September 7, 2001 and amended August 1, 2002 and August 1, 2003 and revised as of October 1, 2003
Amended; effective October 1, 2004
Title 42, Code of Federal Regulations, §412.92(a)
Effective October 1, 2002 and revised as of October 1, 2003
Amended; October 1, 2005
Title 42, Code of Federal Regulations, §412.92(d)
Effective October 1, 2002 and revised as of October 1, 2003
Amended; effective October 1, 2005
Title 42, Code of Federal Regulations, Section 412.316(b)
Effective November 11, 2003, large urban add-on is an additional 3%
Amended; effective October 1, 2004, large urban add-on is an additional 3%
Amended; effective October 1, 2004, large urban add-on is an additional 3%
Amended; October 1, 2006, large urban add-on is an additional 3%
Discharges Occurring on or After 1/1/2008
Discharges Occurring on or After 12/1/2008
Discharges Occurring on or After 12/1/2009
Discharges Occuring on or After 3/1/2011
Title 42, Code of Federal Regulations, §412.2
Amended; October 1, 2010
Title 42, Code of Federal Regulations, §412.23(e)
Amended; effective October 1, 2009
Amended; effective October 1, 2010
Title 42, Code of Federal Regulations, §412.23(f)
Title 42, Code of Federal Regulations, Section 412.64
Title 42, Code of Federal Regulations, Section 412.87
Amended; effective October 1, 2008
Amended; effective October 1, 2009
Title 42, Code of Federal Regulations, Section 412.88
Amended; effective October 1, 2007
Title 42, Code of Federal Regulations, Section 412.92(a)
Title 42, Code of Federal Regulations, Section 412.92(d)
Amended; effective October 1, 2008
Title 42, Code of Federal Regulations, Section 412.316(b)
Amended; effective October 1, 2007, large urban add-on is eliminated
Discharges Occurring on or After 12/1/2011
Discharges Occurring on or After 3/15/2013
Discharges Occurring on or After 3/5/2015
Discharges Occuring on or After 3/5/2015 (These 2015 factors are updated by AD Order dated 02/05/2015, and supersedes 2014 factors adopted under the OMFS rulemaking filed with the Secretary of State on 02/04/2015)
Title 42, Code of Federal Regulations, §412.2
Amended; effective October 1, 2010
Title 42, Code of Federal Regulations, §412.23(e)
Amended; Amended; effective October 1, 2011
Amended; effective October 1, 2014
Title 42, Code of Federal Regulations, §412.23(f)
Effective October 1, 2002 and revised as of October 1, 2003
Title 42, Code of Federal Regulations, §412.64
Amended; effective October 1, 2011
Amended
Amended
Amended; effective October 1, 2014
Title 42, Code of Federal Regulations, Section 412.87
Amended; effective October 1, 2009
Title 42, Code of Federal Regulations, Section 412.88
Amended; effective October 1, 2007
Title 42, Code of Federal Regulations, Section 412.92(a)
Amended; effective October 1, 2005
Title 42, Code of Federal Regulations, Section 412.92(d)
Amended; effective October 1, 2008
Title 42, Code of Federal Regulations, Section 412.106
Amended; effective October 1, 2013
Amended; effective October 1, 2014
Title 42, Code of Federal Regulations, Section 412.316(b)
Amended; effective October 1, 2007
Discharges Occurring on or After 3/01/2016
Discharges Occurring on or After 01/01/2017
Discharges Occurring on or After 12/01/2017
Discharges Occuring on or After 12/01/2018
Title 42, Code of Federal Regulations, §412.2
Amended; effective October 1, 2010
Amended; effective October 1, 2010
Amended; effective October 1, 2010
Amended; effective October 1, 2010
Title 42, Code of Federal Regulations, §412.23(e)
Amended; effective October 1, 2015
Amended; effective October 1, 2015
Amended; effective October 1, 2017
Amended; effective October 1, 2018
Title 42, Code of Federal Regulations, §412.23(f)
Effective October 1, 2002 and revised as of October 1, 2003
Effective October 1, 2002 and revised as of October 1, 2003
Effective October 1, 2002 and revised as of October 1, 2003
Effective October 1, 2002 and revised as of October 1, 2003
Title 42, Code of Federal Regulations, §412.64
Amended; effective October 1, 2015
Amended; effective October 1, 2016
Amended; effective October 1, 2017
Amended; effective October 1, 2018
Title 42, Code of Federal Regulations, §412.87
Amended; effective October 1, 2009
Amended; effective October 1, 2009
Amended; effective October 1, 2017
Amended; effective October 1, 2017
Title 42, Code of Federal Regulations, §412.88
Amended; effective October 1, 2007
Amended; effective October 1, 2007
Amended; effective October 1, 2007
Amended; effective October 1, 2007
Title 42, Code of Federal Regulations, §412.92(a)
Amended; effective October 1, 2005
Amended; effective October 1, 2005
Amended; effective October 1, 2005
Amended; effective October 1, 2018
Title 42, Code of Federal Regulations, §412.92(d)
Amended; effective October 1, 2008
Amended; effective October 1, 2008
Amended; effective October 1, 2008
Amended; effective October 1, 2018
Title 42, Code of Federal Regulations, §412.106
Amended; effective October 1, 2015
Amended; effective October 1, 2016
Amended; effective October 1, 2017
Amended; effective October 1, 2018
Title 42, Code of Federal Regulations, §412.316(b)
Amended; effective October 1, 2007
Amended; effective October 1, 2007
Amended; effective October 1, 2007
Amended; effective October 1, 2007
Discharges Occurring On or After 11/01/2019
Discharges Occurring On or After 12/01/2020
Discharges Occurring On or After 03/15/2021
Title 42, Code of Federal Regulations, § 412.2
Amended; effective October 1, 2010
Amended; effective October 1, 2010
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, § 412.23(e)
Amended; effective October 1, 2015
Amended; effective October 1, 2015
Amended; effective October 1, 2015
Title 42, Code of Federal Regulations, § 412.23(f)
Effective October 1, 2002 and revised as of October 1, 2003
Effective October 1, 2002 and revised as of October 1, 2003
Effective October 1, 2002 and revised as of October 1, 2003
Title 42, Code of Federal Regulations, § 412.64
Amended; effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, § 412.87
Amended; effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, § 412.88
Amended; effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, § 412.92(a)
Amended; effective October 1, 2005
Amended; effective October 1, 2005
Amended; effective October 1, 2005
Title 42, Code of Federal Regulations, § 412.92(d)
Amended; effective October 1, 2008
Amended; effective October 1, 2008
Amended; effective October 1, 2008
Title 42, Code of Federal Regulations, § 412.106
Amended; effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, § 412.316(b)
Amended; effective October 1, 2007
Amended; effective October 1, 2007
Amended; effective October 1, 2007
(b) Federal Register Notices by Date of Discharge
(1) The Federal Register Notices can be accessed at: http://www.cms.gov/AcuteInpatientPPS/ and the referenced sections are incorporated by reference and will be made available upon request to the Administrative Director.
Discharges Occurring on or After 1/01/2004
Discharges Occurring on or After 11/29/2004
Discharges Occurring on or After 7/01/2005
Discharges Occuring on or After 12/01/2005
Applicable FR Notices
(A) August 1, 2003
(A) August 11, 2004
(A) August 11, 2004
(A) August 12, 2005
(CMS-1470-F;
(CMS-1428-F;
(CMS-1428-F;
(CMS-1500-F;
68 FR 45346) final rule
69 FR 48916) final rule
69 FR 48916) final rule
70 FR 47278) final rule
(B) October 6, 2003
(B) October 7, 2004
(B) October 7, 2004
(B) September 30, 2005
(CMS-1470-CN;
(CMS-1428-CN2;
(CMS-1428-CN2;
70 FR 57161
68 FR 57732)
69 FR 60242)
69 FR 60242)
(CMS-1500-CN)
correction notice
correction notice
correction notice
correction notice
(C) 69 FR 78526
(C) 69 FR 78526
(CMS-1428-F2)
(CMS-1428-F2)
correction notice
correction notice
Capital wage index
Tables 4A-4C beginning
Tables 4A1-4C2 beginning
Tables 4A-4C beginning
on (A) page 57736
on (C) page 78619
on (A) page 47580
as corrected by
Tables 4A-4C beginning
on (B) page 57163
Capital market basket
Not applicable
0.7% ((A) page 49285)
0.8% ((A) page 47500)
Capital standard federal
$414.18
$416.73
$420.06 ($416.73 x 1.008)
payment rate
((B) page 57735, Table 1D)
($413.83 x 1.007)
Complex Spinal
496, 497, 498, 519,
496, 497, 498, 519,
Surgery DRGs
520, 531,532
520, 531, 532, 546
(page 47308 of (A))
Fixed Loss Outlier Threshold
$ 31,000 ((A) page 45477)
$ 25,800 ((A) page 49278)
$23,600 ((A) page 47494)
National Standard
$3,136.39
$4,569.83
$4,738.91
Operating Rate
((B) page 57735, Table 1A)
($4,423.84 x 1.033)
($4,569.83 x 1.037)
Operating Wage Index
Tables 4A-4C beginning
Tables 4A1-4C2 beginning
Tables 4A-4C beginning
on (A) page 57736; PIF:
on (C) page 78619; PIF:
on (A) page 47580 as
Operating Wage Index
Final Wage Index
corrected by Tables 4A-4C
location (WIGRN)
location (WIGRN)
beginning on (B)
page 57163; PIF:
Post Reclass Wage
Index location
Labor-Related Portion
Table 1A beginning
For wage indexes
For wage indexes
on B page 57735
greater than 1.0, the
greater than 1.0, the
labor-related portion
labor-related portion
is 71.066% of the
is 69.731% of the
standard operating rate.
standard operating rate.
For wage indexes
For wage indexes
less than or equal to 1.0,
less than or equal to 1.0,
the labor-related portion
the labor-related portion
is 62 %. (A) page 49070
is 62 %. (A) page 47393
Post-acute care transfer to
DRGs 12, 14, 24, 25, 89, 90,
DRGs 12, 14, 24, 25, 88,
DRGs designated with
a rehabilitation hospital or
113, 121, 122, 130, 131, 236,
89, 90, 113, 121, 122, 127,
a “yes” in “FY06 Final
unit or long-term hospital
239, 243, 263, 264, 277, 278,
130, 131, 236, 239, 277,
Rule Post-acute Care DRG”
qualifying DRGs
296, 297, 320, 321, 429, 462,
278, 294, 296, 297, 320,
column in Table 5 (A)
483, or 468 (A) beginning at
321, 395, 429, 468, 541
beginning at page 47617
page 45413
or 542 (B) beginning at
and (B) beginning at
page 60246
page 57163
Post-acute care transfer
DRGs 209, 210 or 211 (A)
DRGs 7, 8, 210, 211, 233,
qualifying DRGs
beginning at page 45413
234, 471, 497, 498, 544, 545,
549, or 550 (A) beginning
at page 47617 and (B)
beginning at page 57163
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
or After 12/1/2006
or After 3/1/2007
or After 1/1/2008
or After 12/1/2008
Applicable FR Notices
(A) August 18, 2006
(A) August 18, 2006
(A) August 22, 2007
(A) August 19, 2008
(CMS-1488-F;
(CMS-1488-F;
(CMS-1533-FC;
(CMS-1390-F;
71 FR 47870)
71 FR 47870)
72 FR 47130) final rule
73 FR 48434) final rule
(B) October 11, 2006
(B) October 11, 2006
(B) October 10, 2007
(B) October 3, 2008
(CMS-1488-N;
(CMS-1488-N;
72 FR 57634
73 FR 57888
71 FR 59886)
71 FR 59886)
(CMS-1533-CN2)
(CMS-1390-N)
additional notice
additional notice
correction notice
correction notice
(C) January 5, 2007
(CMS-1488-CN2; 72 fr 569)
correction notice
Capital wage index
Tables 4A-1 - 4C-1
Tables 4A-4C beginning
Tables 4A-4C beginning
(for discharges before 4/1/2007)
on (B) page 57698
on (B) page 57956
and Tables 4A-2-4C2
(for discharges occurring
on or after 4/1/2007)
beginning on (B) page 59975
Capital market basket
1.10% ((A) page 48163)
1.3% ((A) page 47426)
1.4% ((A) page 48776)
Capital standard federal
$424.68 ($420.06 x 1.0110)
$430.20 ($424.68 x 1.013).
$436.22 ($430.20 x 1.014)
payment rate
Complex Spinal
028, 029, 030, 453, 454,
Surgery DRGs
455, 456, 457, 458, 459,
460, 471, 472, 473
Fixed Loss Outlier Threshold
$24,485 ((A) page 59890)
$22,185 ((A) Page 66887)
$20,045 ((A) page 57891)
National Standard
$4,900.03
$5,061.73
$5,243.95
Operating Rate
($4,738.91 x 1.034)
($4,900.03 x 1.033)
($5,061.73 x 1.036)
Operating Wage Index
Tables 4A-1 - 4C-1 (for
Tables 4A-4C beginning
Tables 4A-4C beginning
discharges before 4/1/2007)
on (B) page 57698; PIF:
on (B) page 57956; PIF:
and Tables 4A-2-4C2 (for
Post Reclass Wage Index
Post Reclass Wage Index
discharges occurring on
location
location
or after 4/1/2007) beginning on
(B) page 59975; PIF: Post
Reclass Wage Index_a
(for first half FY 2007) and
Post Reclass Wage Index_b
(for second half FY 2007)
Labor-Related Portion
For wage indexes greater
For wage indexes greater
For wage indexes greater
than 1.0, the labor-related
than 1.0, the labor-related
than 1.0, the labor-related
portion is 69.731% of the
portion is 69.731% of the
portion is 69.731% of the
standard operating rate.
standard operating rate.
standard operating rate.
For wage indexes less than
For wage indexes less than
For wage indexes less than
or equal to 1.0, the
or equal to 1.0, the
or equal to 1.0, the
labor-related portion
labor-related portion
labor-related portion
is 62 %. (A) page 48029
is 62%. (A) page 47344
is 62%. (A) page 48592
Post-acute care transfer to a
DRGs designated with a
DRGs designated with
Medicare Severity DRGs
Medicare Severity DRGs
rehabilitation hospital or
“yes” in the “FY 07 Final Rule
a “yes” in the “FY 07
designated with a “yes”
designated with a “yes”
unit or long-term hospital
Post-acute Care DRG” column
Final Rule Post-acute
in the “FY08 Final Rule
in the “FY09 Final Rule
qualifying DRGs
in Table 5 (B) beginning
Care DRG”column in
Post-Acute DRG” column
Post-Acute DRG” column
at page 60013
Table 5 (B) beginning at
in Table 5 (A) beginning
in Table 5 (A) beginning
page 60013 and (C)
at page 47539 and (B)
at page 48899
beginning at page 573
at page 57727
Post-acute care transfer
DRGs 7, 8, 210, 211, 233,
DRGs 7, 8, 210, 211, 233,
Medicare-Severity DRGs
Medicare-Severity DRGs
qualifying DRGs
234, 471, 497, 498, 545,
234, 471, 497, 498, 544,
designated with a “yes”
designated with a “yes”
549, or 550 (B) beginning
545, 549, or 550 (B)
in the “FY08 Final Rule
in the “FY09 Final Rule
at page 60013
beginning at page 60013
Special Pay DRG” column
Special Pay DRG” column
and (C) beginning
in Table 5 (A) beginning
in Table 5 (A) beginning
at page 573
at page 47539 and (B)
at page 48899
at page 57727
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
or After 1/1/2013 but
or After 12/1/2009
or After 3/01/2011
or After 12/01/2011
Before 1/1/2014
Applicable FR Notices
(A)August 27, 2009
(A) August 16, 2010
(A) August 18, 2011
(CMS-1406-F; FR 43754)
(CMS-1498-F; FR 50042)
(CMS-1518-F; FR 51476)
final rule
final Rule
final Rule
(B) October 7, 2009
(B) October 1, 2011
(B) September 26, 2011
(CMS-1406-CN;
(CMS-1498-F;
(CMS-1518-CN3;
74 FR 51496)
75 FR 60640)
76 FR 59263)
correction notice
correction
correction
Capital wage index
Tables 4A-4C beginning
Tables 4A-C Beginning
Tables 4A-C at
on page (A)44085 as
on page (A) 50511
https://www.cms.gov/
corrected by Tables 4A-4C
AcuteInpatientPPS/01
beginning on (B) page 51505
_overview.asp
for certain areas
Capital market basket
1.2% ((B) page 51498)
1.2%, (A) page 50442
1.5%, (A) page 51806
Capital standard federal
$441.46 ($436.22 x 1.012)
$446.75 ($441.46 X 1.012
$453.46 (446.75 X 1.015)
payment rate
Complex Spinal Surgery
028, 029, 030, 453,
DRGs
454, 455, 456
Fixed Loss Outlier Threshold
$23,140 ((A) page 44011)
$23,075, (A) page 50441
$22,385, (A) page 51795
National Standard
$5,354.08 ($5,243.95 x 1.021)
$5,493.28 ($5,354.08 x 1.026)
$5,658.08 ($5,493.28 x 1.03)
Operating Rate
Operating Wage Index
Tables 4A-4C beginning
Tables 4A-C Beginning
Tables 4A-C at
on page (A)44085 as
on page (A) 50511;
https://www.cms.gov/
corrected by Tables 4A-4C
PIF: FY 2011 Wage
AcuteInpatientPPS/01
beginning on (B) page 51505
Index Location
_overview.asp;
for certain areas; PIF: Post
PIF: FY 2012 Wage
Reclass Wage Index location
Index Location
Labor-Related Portion
For wage indexes greater
For wage indexes greater
For wage indexes greater
than 1.0, the labor-related
than 1.0, the labor-related
than 1.0, the labor-related
portion is 68.802% of the
portion is 68.8% of the
portion is 68.8% of the
standard operating rate.
standard operating rate.
standard operating rate.
For wage indexes less than
For wage indexes less than
For wage indexes less than
or equal to 1.0, the
or equal to 1.0, the
or equal to 1.0, the
labor-related portion
labor-related portion
labor-related portion
is 62%. (A) page 43856
is 62% (A) page 50422
is 62% (A) page 51786
Post-acute care transfer to
Medicare-Severity DRGs
Medicare-Severity DRGs
Medicare-Severity DRGs
a rehabilitation hospital or
designated with a “yes” in
designated With a “yes” in
designated With a “yes” in
unit or long-term hospital
the “FY 2010 Final Rule
the “FY 2011 Final Rule
the “FY 2012 Final Rule
qualifying DRGs
Post-Acute DRG” column
Post-Acute DRG” Column
Post-Acute DRG” Column in
in Table 5 (A) beginning
in Table 5 (A) beginning
Table 5 https://www.cms.gov/
at page 44126
at page 50547
AcuteInpatientPPS/
Post-acute care transfer
Medicare-Severity DRGs
Medicare-Severity DRGs
Medicare-Severity DRGs
qualifying DRGs
designated with a “yes” in
designated With a “yes” in
designated With a “yes” in
the “FY2010 Final Rule
the “FY 2011 Final Rule
the “FY 2012 Final Rule
Special Pay DRG” column
Special Pay DRG” column
Special Pay DRG” column in
in Table 5 (A) beginning
in Table 5 (A) Beginning
Table 5 https://www.cms.gov/
at page 44126
at page 50547
AcuteInpatientPPS/
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
Discharges Occuring on
or After 3/15/2013
or After 03/05/2015
or After 03/05/2015
or After 03/01/2016
(These 2015 factors are updated
by AD Order dated 02/05/2015, and
supersedes 2014 factors adopted
under the OMFS rulemaking filed
with the Secretary of State on 02/04/2015)
Applicable FR Notices
(A) August 31, 2012
(A) August 19, 2013
(A) August 22, 2014
(A) August 17, 2015 (CMS-
(CMS-1588-F;
(CMS-1599-F;
(CMS-1607-F; 79 FR 49854
1632-F and IFC; 80 FR
77 FR 53258) final rule
78 FR 50496) Final Rule
Final Rule
49326; Final Rule)
(B) October 3, 2012
(B) October 3, 2013
(B) October 3, 2014
(B) October 5, 2015
(CMS-1588-CN2;
(CMS-1599-CN2;
(CMS-1607-CN; 79 FR
(CMS-1632-CN; 80 FR
77 FR 60315;
78 FR 61197;
59675; Corrections)
60055; Correction)
correction notice)
corrections)
(C) October 29, 2012
(C) October 3, 2013
(CMS-1588-CN3;
(CMS-1599-IFC;
77 FR 65495;
78 FR 61191;
correction notice)
interim final rule)
(D) January 2, 2014
(CMS-1599-CN3;
79 FR 61; corrections)
(E) January 10, 2014
(CMS-1599-CN4;
79 FR 1741; corrections)
(F) March 18, 2014
(CMS-1599-IFC2;
79 FR 15022;
Interim final rule)
Capital wage index
Tables 4A-C at
Tables 4A-4C-CN2 at
Tables 4A-1 Through 4C-2CN at
Table 3 at https://www.cms.
https://www.cms.gov/
https://www.cms.gov/
https://www.cms.gov/Medicare/
gov/Medicare/Medicare-
AcuteInpatientPPS/01
AcuteInpatientPPS/01
Medicare-Fee-for-Service-Payment/
Fee-for-Service-Payment/
_overview.asp
_overview.asp
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
Note: Table 3 contains
information by CBSA and
information from the
following tables that have
been provided in previous
fiscal years: Tables 3A, 3B
4A, 4B, 4C, 4D, and 4F.
Capital market basket
1.2% (A) page 53703
1.2% (A) page 50507
1.5% (A) page 50390
1.3% (A) page 49795
Capital standard federal
$458.90 ($453.46 x 1.012)
$464.41 ($458.90 x 1.012)
$471.37 ($464.41 x 1.015)
$477.50 ($471.37 x 1.013).
payment rate
Complex Spinal Surgery DRGs
N/A
N/A
Fixed Loss Outlier Threshold
$21,821 ((A) page 53696)
$21,748 ((A) page 50983)
$24,626 (B) page 59680
$22,539 (B) page 60058
National Standard
$5,805.19
$5,950.32
$6,122.88
$6,269.83
Operating Rate
($5,658.08 x 1.026)
($5,805.19 x 1.025)
($5,950.32 x 1.029)
($6,122.88 x 1.024)
Operating Wage Index
Tables 4A-C at
Tables 4A-C at
https://www.cms.gov/
https://www.cms.gov/
Tables 4A-1 Through 4C-2CN at
Table 3 at https://www.cms.
AcuteInpatientPPS/01
AcuteInpatientPPS/01
https://www.cms.gov/Medicare/
gov/Medicare/Medicare-
_overview.asp; PIF:
_overview.asp; PIF:
Medicare-Fee-for-Service-Payment/
Fee-for-Service-Payment/
FY 2013 Wage Index
FY 2014 Wage Index
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
Location
Location
Note: Table 3 contains
information by CBSA and
information from the
following tables that have
been provided in previous
fiscal years: Tables 3A, 3B
4A, 4B, 4C, 4D, and 4F.
Labor-Related Portion
For wage indexes greater
For wage indexes greater
For wage indexes greater
For wage indexes greater
than 1.0, the labor-related
than 1.0, the labor-related
than 1.0, the labor-related
than 1.0, the labor-related
portion is 68.8% of the
portion is 69.6% of the
portion is 69.6% of the
portion is 69.6% of the
standard operating rate.
standard operating rate.
standard operating rate.
standard operating rate.
For wage indexes less than
For wage indexes less than
For wage indexes less than
For wage indexes less than
or equal to 1.0, the
or equal to 1.0, the
or equal to 1.0, the
or equal to 1.0, the
labor-related portion
labor-related portion
labor-related portion
labor-related portion
is 62%. (A) page 53685
is 62%. (A) page 50972
is 62%. (A) page 49991
is 62% (A) page 49505
Post-acute care transfer to a
Medicare-Severity
Medicare-Severity
Medicare-Severity
Medicare-Severity DRGs
rehabilitation hospital or
DRGs designated with a “yes”
DRGs designated with a “yes”
DRGs designated with a “yes”
designated with a “yes” in
unit or long-term hospital
in the “FY 2013 Final Rule
in the “FY 2014 FR
in the “FINAL Post-Acute DRG”
the “FY 2016 Final Post-
qualifying DRGs
Post-Acute Care DRG”
Post-Acute DRG”
Column in Table 5
Acute DRG” Column in
Column in Table 5
Column in Table 5
https://www.cms.gov/
Table 5
https://www.cms.gov/
https://www.cms.gov/
Medicare/Medicare-Fee
https://www.cms.gov/
AcuteInpatientPPS/
AcuteInpatientPPS/
-for-Service-Payment/
Medicare/Medicare Fee-
AcuteInpatientPPS/index.html?redirect=/
for-Service-Payment/
AcuteInpatientPPS/01_overview.asp
AcuteInpatientPPS/index.html?
redirect=/AcuteInpatient
PPS/01_overview.asp
Post-acute care transfer
Medicare-Severity
Medicare-Severity
Medicare-Severity
Medicare-Severity DRGs
qualifying DRGs
DRGs designated With a “yes”
DRGs designated With a “yes”
DRGs designated With a “yes”
designated with a “yes” in
in the “FY 2013 Final Rule
in the “FY 2014 FR
in the “FY 2015 NPRM
the “FY 2016 Final Special
Special Pay DRG”
Special Pay DRG”
Special Pay DRG”
Pay DRG” column in
column in Table 5
column in Table 5
column in Table 5
Table 5
https://www.cms.gov/
https://www.cms.gov/
https://www.cms.gov/
https://www.cms.gov/
AcuteInpatientPPS/
AcuteInpatientPPS/
Medicare/Medicare-Fee-
Medicare/Medicare-Fee-
for-Service-Payment/AcuteInpatientPPS/
for-Service-Payment/
index.html?redirect=/
AcuteInpatientPPS/index.html?
AcuteInpatientPPS/
redirect=/AcuteInpatient
01_overview.asp
PPS/01_overview.asp
Uncompensated Care Adjustment
0.943 (A) page 50634
0.7619 (A) page 50014
0.6369 (A) page 49522
Discharges Occurring on or
Discharges Occurring on or
Discharges Occuring On or
Discharges Occurring On or
After 01/01/2017
After 12/01/2017
After 12/01/2018
After 11/01/2019
Applicable FR Notices
(A) August 22, 2016
(A) August 14, 2017
(A) August 17, 2018
(A) August 16, 2019
(CMS-1655-F; 81 FR 56762)
(CMS-1677-F; 82 FR 37990
(CMS-1694-F; 83 FR 41144)
(CMS-1716-F; 84
final rule
(B) October 4, 2017
(B) October 3, 2018
FR 42044
(B) October 5, 2016
(CMS-1677-CN; 82 FR
(CMS-1694-CN2; 83 FR
(B) October 8, 2019
(CMS-1655-F; 81 FR 68947;
46138; Final rule; correction)
49836; Correction)
(CMS-1716-CN2;
final rule; correction)
84 FR 53603;
correction)
Capital wage index
Table 3 at https://www.cms.gov/
Table 3 at https://www.cms.gov/
Table 3 at https://www.cms.gov/
Table 3 (CN), at https://www.cms.gov/
Medicare/Medicare-Fee-for-
Medicare/Medicare-Fee-
Medicare/Medicare-Fee-
Medicare/Medicare-Fee-
Service-Payment/
for-Service-Payment/
for-Service-Payment/
for-Service-Payment/
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
Capital market basket
1.2% (A) page 57295
1.3% (A) page 38174
1.4% (A) page 41730
1.5% (A) page 42640
Capital standard federal
$483.23 ($477.50 x 1.012)
$489.51 ($483.23 x 1.013).
$496.36 ($489.51 x 1.014)
$503.81 ($496.36 x 1.015)
payment rate
Complex Spinal Surgery DRGs
N/A
N/A
N/A
N/A
Fixed Loss Outlier Threshold
$23,573 ((B) page 68952)
$26,537 ((B) page 46143)
$25,743 ((B) page 49844)
$26,552 ((B) page 53609)
National Standard Operating
$6,439.11 ($6,269.83 x 1.027)
$6,612.97 ($6,439.11 x 1.027)
$6,804.75 ($6,612.97 x 1.029)
$7,008.89 ($6,804.75 x 1.030)
Rate
Operating Wage Index
Table 3 at https://www.cms.gov/
Table 3 at https://www.cms.
Table 3 at https://www.cms.
Table 3 (CN), at https://www.cms.
Medicare/Medicare-Fee-for-
gov/Medicare/Medicare-Fee-
gov/Medicare/Medicare-Fee-
gov/Medicare/Medicare-Fee-
Service-Payment/
for-Service-Payment/
for-Service-Payment/
for-Service-Payment/
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
Labor-Related Portion
For wage indexes greater than
For wage indexes greater
For wage indexes greater
For wage indexes greater
1.0, the labor-related portion is
than 1.0, the labor-related
than 1.0, the labor-related
than 1.0, the labor-related
69.6% of the standard operating
portion is 68.3% of the
portion is 68.3% of the
portion is 68.3% of the
rate. For wage indexes less than
standard operating rate.
standard operating rate.
standard operating rate.
or equal to 1.0, the labor-related
For wage indexes less than
For wage indexes less than
For wage indexes less than
portion is 62% (A) page 57276
or equal to 1.0, the labor-
or equal to 1.0, the labor-
or equal to 1.0, the labor-
related portion is 62%
related portion is 62%
related portion is 62%
(A) page 38157
(A) page 41713
(A) page 42325
Post-acute care transfer to a
Medicare-Severity DRGs
Medicare-Severity DRGs
Medicare-Severity DRGs
Medicare-Severity DRGs
rehabilitation hospital or unit or
designated with a “ yes” in the
designated with a “ yes” in
designated with a “yes” in
designated with a “yes” in
long-term hospital qualifying
“FY 2017 FINAL Post-Acute
the “FY 2018 Final Post-
the “FY 2019 FINAL Post-
the “FY 2020 FINAL Post-
DRGs
DRG” Column in Table 5
Acute DRG” Column in
Acute DRG” Column in
Acute DRG” Column in
https://www.cms.gov/Medicare/
Table 5
Table 5
Table 5,
Medicare-Fee-for-Service-
https://www.cms.gov/
https://www.cms.gov/
(Final Rule and
Payment/AcuteInpatientPPS/
Medicare/Medicare-Fee-
Medicare/Medicare-Fee-
Correction Notice
index.html?redirect=/
for-Service-Payment/
for-Service-Payment/
https://www.cms.gov/
AcuteInpatientPPS/01_
Acute InpatientPPS/index.
AcuteInpatientPPS/index.
Medicare/Medicare-Fee-
overview.asp
html?redirect=/
html
for-Service-Payment/
AcuteInpatientPPS/01_
AcuteInpatientPPS/
overview.asp
index.html
Post-acute care transfer
Medicare-Severity DRGs
Medicare-Severity DRGs
Medicare-Severity DRGs
Medicare-Severity DRGs
qualifying DRGs
designated with a “ yes” in the
designated with a “ yes” in
designated with a “yes” in the
designated with a “yes” in the
“FY 2017 FINAL Special Pay
the FY 2018 Final Special
“FY 2019 FINAL Special
“FY 2020 FINAL Special
DRG” column in Table 5
Pay DRG” column in Table 5
Pay DRG” column in Table 5
Pay DRG” column in Table 5,
https://www.cms.gov/Medicare/
https://www.cms.gov/
https://www.cms.gov/
(Final Rule and
Medicare-Fee-for-Service-
Medicare/Medicare-Fee-for-
Medicare/Medicare-Fee-for-
Correction Notice)
Payment/AcuteInpatientPPS/
Service-Payment/
Service-Payment/
https://www.cms.gov/
index.html?redirect=/
Acute InpatientPPS/index.
AcuteInpatientPPS/index.html
Medicare/Medicare-Fee-for-
AcuteInpatientPPS/01_
html?redirect=/
Service-Payment/
overview.asp
AcuteInpatientPPS/01_
AcuteInpatientPPS/ index.html
overview.asp
Uncompensated Care Adjustment
0.5536 (A) page 56950
0.5801 (A) page 38200
0.6751 (A) page 41409
0.6714 (A) page 42358
DRG weights for Covid-19 related discharges in accordance with Section 3710 of the CARES Act and MLN Matters Special Edition Article SE20015, dated April 15, 2020.
N/A
N/A
N/A
For discharges on or after January 27, 2020: The weighting factor of the assigned Diagnosis Related Group (DRG) is increased by 20 percent for an individual diagnosed with COVID-19 discharged during the COVID-19 Public Health Emergency (PHE) period. Discharges of an individual diagnosed with COVID-19 will be identified by the presence of the following International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes:
• B97.29 (Other coronavirus as the cause of diseases classified elsewhere for discharges occurring on or after January 27, 2020, and on or before March 31, 2020.
• U07.1 (COVID-19) for discharges occurring on or after April 1, 2020, through the duration of the COVID-19 public health emergency period.
Providers may refer to the following ICD-10-CM coding guidance for coding encounters related to COVID-19:
• For discharges on or after April 1, 2020, the ICD-10-CM Official Coding and Reporting Guidelines are at https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf
• For discharges prior to April 1, 2020, the ICD-10-CM Official Coding Guideline - Supplement is at: https://www.cdc.gov/nchs/data/icd/ICD-10-CM- Official-CodingGudance-Interim-Advice-coronavirus-feb-20-2020.pdf
Discharges Occurring On or After 12/01/2020
Discharges Occurring On or After 3/15/2021
Applicable FR Notices
September 18, 2020 (CMS-1735-F; 85 FR58432)
(A) September 18, 2020 (CMS-1735-F; 85 FR 58432 final rule)
(B) December 7, 2020 (CMS-1735-CN; 85 FR 78748; correction notice)
Capital wage index
Table 3 at https://www.cms.gov /medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page
CN Table 3 at https://www.cms.gov /Medicare/Medicare-Fee-for-Service- Payment/AcuteInpatientPPS
Capital market basket
1.1
Capital standard federal payment rate
$509.35 ($503.81 x 1.011)
$509.35 ($503.81 x 1.011)
Complex Spinal Surgery DRGs
N/A
N/A
Fixed Loss Outlier Threshold
$30,006 (A) page 59039
$29,064 (B) page 78754
National Standard Operating Rate
$7,177.10 ($7,008.89 x 1.024)
$7,177.10 ($7,008.89 x 1.024)
Operating Wage Index
Table 3 at https://www.cms.gov/medicare/acute- inpatient-pps/fy-2021-ipps-final-rule-home-page
CN Table 3 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ AcuteInpatientPPS
Labor-Related Portion
For wage indexes greater than 1.0, the labor-related portion is 68.3% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 58793
For wage indexes greater than 1.0, the labor-related related portion is 68.3% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 59028
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs
Medicare-Severity DRGs designated with a “yes” in the “FY 2021 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final- rule-home-page
Medicare-Severity DRGs designated with a “yes” in the “FY 2021 CN Post-Acute Acute DRG” column in CN Table 5 Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee- for-Service-Payment/AcuteInpatientPPS
Post-acute care transfer qualifying DRGs
Medicare-Severity DRGs designated with a “yes” in the “FY 2021 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient- pps/fy-2021-ipps-final-rule-home-page
Medicare-Severity DRGs designated with a “yes” in the “FY 2021 CN Special Pay DRG” column in CN Table 5 Final Rule and Correction Notice) https://www.cms.gov/ Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS
Uncompensated Care Adjustment
0.6786 (A) page 58813
0.7286 (A) page 58814
(c) Payment Impact File by Date of Discharge
(1) The Payment Impact File can be accessed at: http://www.cms.gov/AcuteInpatientPPS/ and the referenced sections are incorporated by reference and will be made available upon request to the Administrative Director.
Discharges Occurring on or After 1/1/2004
Discharges Occurring on or After 11/29/2004
Discharges Occurring on or After 12/1/2005
Discharges Occuring on or After 12/1/2006
Applicable Payment Impact
FY2004 Final Rule
FY2005 Final Rule
FY2006 Final Rule
FY2007 Final Rule
File (PIF)
Impact File
Impact File
Impact File
Impact File
Capital geographic
PIF: Capital Wage Index
PIF:POST RECLASS GAF
PIF:WICGRN
PIF:Post Reclass GAF_a
adjustment factor
(for first half FY 2007) and
Post Reclass GAF_b
(for capital second half
FY 2007)
Large Urban Add-on
PIF: Post-Reclassification
PIF: Standardized
PIF:URSPA
PIF:URSPA
Urban/Rural location
payment location
Capital Disproportionate
PIF: Capital Disproportionate
PIF: Capital Disproportionate
PIF: Capital Disproportionate
PIF: Capital
Share Adjustment Factor
Share Adjustment location
Share (DSH) Adjustment
Share (DSH) Adjustment
Disproportionate
(DSHCPG)
location (CAPITAL
location (DSHCPG)
Share (DSH) Adjustment
DSH ADJ.)
location (DSHCPG)
Capital Indirect Medical
PIF: Capital IME Adjustment
PIF: IME adjustment factor
PIF: IME adjustment factor
PIF: IME adjustment factor
Education Adjustment Factor
location (TCHCP)
for capital PPS location (IME
for capital PPS location
for capital PPS location
ADJUSTMENT-CAPITAL)
(TCHCP)
(TCHCP)
Operating Wage Index
Tables 4A-4C beginning
Tables 4A1-4C2 beginning
Tables 4A-4C beginning
Tables 4A-1 - 4C-1 (for
on (A) page 57736; PIF:
on (C) page 78619; PIF:
on (A) page 47580 as
discharges before 4/1/2007)
Operating Wage Index
Final Wage Index location
corrected by Tables 4A-4C
and Tables 4A-2-4C2
location (WIGRN)
(WIGRN)
beginning on (B)
(for discharges occurring
page 57163; PIF: Post
on or after 4/1/2007)
Reclass Wage Index
beginning on (B)
location
page 59975;
PIF: Post Reclass Wage
Index_a (for first half
FY 2007) and Post Reclass
Wage Index_b (for second
half FY 2007)
Operating Disproportionate
PIF: Operating DSH
PIF: Operating
PIF: Operating
PIF: Operating
Share Adjustment Factor
Adjustment Factor location
Disproportionate Share
Disproportionate Share
Disproportionate Share
(DSHOPG)
(DSH) Adjustment Factor
(DSH) Adjustment Factor
(DSH) Adjustment Factor
location (OPERATING
location (DSHOPG)
location (DSHOPG)
DSH ADJ.)
Operating Indirect Medical
PIF: Operating IME
PIF: IME Adjustment Factor
PIF: IME Adjustment
PIF: IME Adjustment Factor
Education Adjustment
Adjustment location (TCHOP)
for Operating PPS location
Factor for Operating
for Operating PPS location
(IME ADJUSTMENT
PPS location (TCHOP)
(TCHOP)
OPERATING)
Sole Community Hospital -
PIF: Hospital - Specific Rate
PIF: Sole Community
PIF: 82/87 Hospital
PIF: 82/87/96 Hospital
Hospital Specific Rate
location (HSPPUB)
Hospital Cost/Case
Specific Rate Updated to
Specific Rate Updated to
1982/1987 and Sole
FY 2006 (OLDHSPPS)
FY 2007 for SCH Providers
Community Hospital
and 1996 Hospital Specific
location (HSP Rate)
Cost/Case 1996 locations
Rate Updated to FY 2006
(HSP96) locations
Cost-to-Charge Ratio
PIF: Operating
PIF: Operating
PIF: Operating
PIF: Operating
Cost-to-Charge Ratio
Cost-to-Charge Ratio
Cost-to-Charge Ratio
Cost-to-Charge Ratio
location (OPCCR) and
location (OPCCR) and
location (OPCCR) and
location (OPCCR) and
Capital Cost-to-Charge
Capital Cost-to-Charge
Capital Cost-to-Charge
Capital Cost-to-Charge
location (CPCCR)
location (CPCCR)
location (CPCCR)
location CPCCR)
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
or After 1/1/2008
or After 12/1/2008
or After 12/1/2009
or After 3/01/2011
Applicable Payment
FY2008 Final Rule
FY2009 Final Rule
FY2010 Correction Notice
FY 2011 Final Rule
Impact File (PIF)
Capital Geographic
Post Reclass GAF
Post Reclass GAF
Post Reclass GAF
FY 2011 GAF
Adjustment Factor
Capital Disproportionate
PIF: Capital
PIF: Capital
PIF: Capital
PIF: Capital
Share Adjustment Factor
Disproportionate
Disproportionate
Disproportionate
Disproportionate
Share (DSH) Adjustment
Share (DSH) Adjustment
Share (DSH) Adjustment
Share (DSH) adjustment
location (DSHCPG)
location (DSHCPG)
location (DSHCPG)
location (DSHCPG)
Capital Indirect Medical
PIF: IME adjustment factor
PIF: IME adjustment factor
PIF: IME adjustment factor
PIF: IME adjustment factor
Education Adjustment Factor
for capital PPS location
for capital PPS location
for capital PPS location
for capital PPS location
(TCHCP)
(TCHCP)
(TCHCP)
(TCHCP)
Operating Wage Index
Tables 4A -4C beginning
Tables 4A-4C beginning
Tables 4A-4C beginning
Tables 4A-C Beginning
on (B) page 57698;
on (B) page 57956;
on page (A)44085 as
on page (A) 50511;
PIF: Post Reclass Wage
PIF: Post Reclass Wage
corrected by Tables
PIF: FY 2011 Wage
Index location
Index location
4A-4C beginning on (B)
Index Location
page 51505 for certain
areas; PIF: Post Reclass
Wage Index location
Operating Disproportionate
PIF: Operating
PIF: Operating
PIF: Operating
PIF: Operating
Share Adjustment Factor
Disproportionate
Disproportionate
Disproportionate
Disproportionate
Share (DSH) Adjustment
Share (DSH) Adjustment
Share (DSH) Adjustment
Share (DSH) Adjustment
Factor location (DSHOPG)
Factor location (DSHOPG)
Factor location (DSHOPG)
Factor location (DSHOPG)
Operating Indirect Medical
PIF: IME Adjustment
PIF: IME Adjustment
PIF: IME Adjustment
PIF: IME Adjustment
Education Adjustment
Factor for Operating
Factor for Operating
Factor for Operating
Factor for Operating
PPS location (TCHOP)
PPS location (TCHOP)
PPS location (TCHOP)
PPS location (TCHOP)
Sole Community Hospital -
PIF: 82/87/96 Hospital
PIF: 82/87/96 Hospital
PIF: 82/87/96 /06 Hospital
PIF: 82/87/96/06 Hospital
Hospital Specific Rate
Specific Rate Updated to
Specific Payment (HSP)
Specific Payment (HSP)
Specific Payment (HSP)
FY 2008 for SCH Providers
Rate Updated to FY 2009
Rate Updated to
Rate Updated to FY2011
location (HSP Rate)
for SCH Providers
FY 2010 for SCH
for SCH Providers
location (HSP Rate)
Providers location
location (FY11 HSP Rate)
(FY10HSP Rate)
Cost-to-Charge Ratio
PIF: Operating
PIF: Operating
PIF: Operating
PIF: Operating
Cost-to-Charge Ratio
Cost-to-Charge Ratio
Cost-to-Charge Ratio
Cost-to-Charge Ratio
location (OPCCR) and
location (Operating CCR)
location (Operating CCR)
location (Operating CCR)
Capital Cost-to-Charge
and Capital Cost-to-Charge
and Capital Cost-to-Charge
and Capital Cost-to-Charge
location (CPCCR)
location (Capital CCR)
location (Capital CCR)
location (Capital CCR)
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
Discharges Occurring On
or After 12/01/2011
or After 03/15/2013
or After 03/05/2015
or After 03/05/2015
(These 2015 factors are updated
by AD Order dated 02/05/2015, and
supersedes 2014 factors adopted
under the OMFS rulemaking filed
with the Secretary of State on 02/04/2015)
Applicable Payment
FY 2012 Final
FY 13 FR Impact File -
FY 2014 Impact
FY 15 Impact File
Impact File (PIF)
Rule-IPPS Impact File
updated October 2012
file - updated
(August 22, 2014 Final
January 2014 to reflect changes
Rule and October 3, 2014
from the September 2013
Correction Notice)
correction notice and interim final
rule with comment
Capital Geographic
FY 2012 GAF
FY 2013 GAF
FY 2014 GAF -
FY 2015 GAF -
Updated September 2013
Updated October 2014
Adjustment Factor
Capital Disproportionate
PIF: Capital Disproportionate
PIF: Capital Disproportionate
PIF: Capital Disproportionate
PIF: Capital Disproportionate
Share Adjustment Factor
Share (DSH) adjustment
Share (DSH) adjustment
Share (DSH) adjustment
Share (DSH) adjustment
location (DSHCPG)
location (DSHCPG)
location (DSHCPG)
location (DSHCPG)
Capital Indirect Medical
PIF: IME adjustment factor
PIF: IME adjustment factor
PIF: IME adjustment factor
PIF: IME adjustment factor
Education Adjustment Factor
for capital PPS location (TCHCP)
for capital PPS location
for capital PPS location
for capital PPS location
(TCHCP)
(TCHCP)
(TCHCP)
Operating Wage Index
Tables 4A-C at
Tables 4A-C at
Tables 4A-C - CN2 at
Tables 4A-1 Through 4C-2CN at
https://www.cms.gov/
https://www.cms.gov/
https://www.cms.gov/
https://www.cms.gov/
AcuteInpatientPPS/01
AcuteInpatientPPS/01
AcuteInpatientPPS/01
Medicare/Medicare-Fee-
_overview.asp; PIF:
_overview.asp; PIF:
_overview.asp; PIF:
for -Service-Payment/
FY 2012 Wage Index Location
FY 2013 Wage Index
FY 2014 Wage Index Location
AcuteInpatientPPS/
Location
index.html
Operating Disproportionate
PIF: Operating Disproportionate
PIF: Operating
PIF: Operating
PIF: Operating
Disproportionate
Disproportionate
Disproportionate
Share Adjustment Factor
Share (DSH) Adjustment
Share (DSH) Adjustment
Share Hospital (DSH) Adjustment
Share Hospital (DSH) Adjustment.
Factor location (DSHOPG)
Factor location (DSHOPG)
Factor location (DSHOPG)
Reflects a 75%
reduction to the DSH
adjustment required
under Section 3133 of
the Affordable Care Act
Factor Location (DSHOPG)
Operating Indirect Medical
PIF: IME Adjustment
PIF: IME Adjustment
PIF: IME Adjustment
PIF: IME Adjustment
Education Adjustment
Factor for Operating PPS
Factor for Operating PPS
Factor for Operating PPS
Factor for Operating PPS
location (TCHOP)
location (TCHOP)
location (TCHOP)
location (TCHOP)
Sole Community Hospital -
PIF: 82/87/96/06 Hospital
PIF: 82/87/96/06 Hospital
PIF: 82/87/96/06 Hospital
PIF: 82/87/96/06 Hospital
Hospital Specific Rate
Specific Payment (HSP)
Specific Payment (HSP)
Specific Payment (HSP)
Specific Payment (HSP)
Rate Updated to FY2012 for
Rate Updated to FY2013 for
Rate Updated to FY2014 for
Rate Updated to FY2015 for
SCH Providers location
SCH Providers location
SCH and MDH Providers with the
SCH and MDH Providers
(FY12 HSP Rate)
(FY13 HSP Rate)
-0.2% adjustment for
Location (FY14 HSP Rate)
presumptive inpatient hospital
status policy. Location (FY14
HSP Rate)
Cost-to-Charge Ratio
PIF: Operating Cost-to-Charge
PIF: Operating Cost-to-
PIF: Operating Cost-to-Charge
PIF: Operating Cost-to
Ratio location (Operating CCR)
Charge Ratio location
Ratio location
Charge Ratio location
and Capital Cost-to-Charge
(Operating CCR)
(Operating CCR)
(Operating CCR)
location (Capital CCR)
and Capital Cost-to-Charge
and Capital Cost-to-Charge
and Capital Cost-to-Charge
location (Capital CCR)
location (Capital CCR)
location (Capital CCR)
Discharges Occurring on
Discharges Occurring on or
Discharges Occurring on or
Discharges Occurring On
or After 03/01/2016
After 01/01/2017
After 12/01/2017
or After 12/01/2018
Applicable Payment
FY 16 Impact File (August 17,
FY 17 Impact File (August 22,
FY 18 Impact File (August 14,
FY 19 Impact File (August
Impact File (PIF)
2015 Final Rule and October 5,
2016 Final Rule and October
2017 Final Rule and October
17, 2018 Final Rule and
2015 Correction Notice)
5, 2016 Correction Notice)
4, 2017 Correction Notice)
October 3, 2018 Correction
Notice)
Capital Geographic Adjustment
FY 2016 GAF - Updated
FY 2017 GAF - Updated
FY 2018 GAF - Updated
FY 2019 GAF - Updated
Factor
October 2015
October 2016
October 2017
October 2018
Capital Disproportionate Share
PIF: Capital Disproportionate
PIF: Capital Disproportionate
PIF: FY 2018 Capital
PIF: FY 2019 Capital
Adjustment Factor
Share (DSH) adjustment
Share (DSH) adjustment
Disproportionate Share
Disproportionate Share
location (DSHCPG)
location (DSHCPG)
(DSH) adjustment location
Share (DSH) adjustment
(DSHCPG)
(DSHCPP)
Capital Indirect Medical
PIF: IME adjustment factor for
PIF: IME adjustment factor
PIF: IME adjustment factor
PIF: IME adjustment factor
Education Adjustment Factor
capital PPS location (TCHCP)
for capital PPS location
for capital PPS location
for capital PPS location
(TCHCP)
(TCHCP)
Operating Wage Index
Table 3 at https://www.csm.gov/
Table 3 at https://www.cms.
Table 3 at https://www.cms.
Table 3 at https://www.
Medicare/Medicare-Fee-for-
gov/Medicare/Medicare-Fee-
gov /Medicare/Medicare-Fee-
cms.gov/Medicare/
Service-Payment/
for-Service-Payment/
for-Service-Payment/
Medicare-Fee-for-
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
AcuteInpatientPPS/index.html
Service-Payment/
Note: Table 3 contains
AcuteInpatientPPS/
information by CBSA and
index.html
information from the following
tables that have been provided in
previous fiscal years: Tables 3A,
3B, 4A, 4B, 4C, 4D, and 4F.
Operating Disproportionate
PIF: Operating Disproportionate
PIF: Operating
PIF: Estimated FY 2018
PIF: Estimated FY 2019
Share Adjustment Factor
Share Hospital (DSH)
Disproportionate
Operating Disproportionate
Operating Disproportionate
Adjustment. Reflects a 75%
Share Hospital (DSH)
Share Hospital (DSH)
Share Hospital (DSH)
reduction to the DSH
Adjustment. Reflects a 75%
adjustment. Reflects a 75%
adjustment. Reflects a 75%
adjustment required under
reduction to the DSH
reduction to the DSH
reduction to the DSH
section 3133 of the Affordable
adjustment required
adjustment required
adjustment required under
Care Act. Factor location
under Section 3133 of
under Section 3333 of
Section 3333 of the
(DSHOPG)
the Affordable Care Act.
the Affordable Care Act
Affordable Care Act
Factor location (DSHOPG)
(DSHOPP)
(DSHOPP)
Operating Indirect Medical
PIF: IME Adjustment Factor for
PIF: IME Adjustment Factor
PIF: IME Adjustment Factor
PIF: IME Adjustment Factor
Education Adjustment
Operating PPS location
for Operating PPS location
for Operating IPPS location
for Operating IPPS location
(TCHOP)
(TCHOP)
(TCHOP)
(TCHOP)
Sole Community Hospital -
PIF: Hospital Specific Payment
PIF: Hospital Specific
PIF: Hospital Specific
PIF: Hospital Specific
Hospital Specific Rate
(HSP) Rate updated to FY 2016
Payment (HSP) Rate updated
Payment (HSP) Rate updated
Payment (HSP) Rate
for SCH and MDH providers.
to FY 2017 for SCH and MDH
to FY 2018 for SCH
updated to FY 2019 for
HSP Rate is based on the March
providers. HSP Rate is based
providers. HSP Rate is based
SCH providers. HSP Rate
2015 update of the Provider
on the March 2016 update of
on the March 2017 update of
is based on the March 2018
Specific File (PSF). Location
the Provider Specific File
the Provider Specific File
update of the Provider
(HSP Rate)
(PSF). Location (HSP Rate)
(PSF). Location (HSP Rate)
Specific File (PSF).
Location (HSP Rate)
Cost-to-Charge Ratio
PIF: Operating Cost-to-Charge
PIF: Operating Cost-to-
PIF: Operating Cost-to-
PIF: Operating Cost-to-
Ratio location (Operating CCR)
Charge Ratio location
Charge Ratio location
Charge Ratio location
and Capital Cost-to-Charge
(Operating CCR) and Capital
(Operating CCR) and Capital
(Operating CCR) and
location (Capital CCR)
Cost-to-Charge location
Cost-to-Charge location
Capital Cost-to-Charge
(Capital CCR)
(Capital CCR)
location (Capital CCR)
Discharges Occurring On or After 11/01/2019
Discharges Occurring On or After 12/01/2020
Discharges Occurring On or After 03/15/2021
Applicable Payment Impact File (PIF)
FY 20 Impact File (Final Rule and Correction Notice)
FY 21 Impact File (Final Rule)
FY 21 Impact File (Final Rule and Correction Notice)
Capital Geographic Adjustment Factor
FY 2020 GAF - Updated October 2019
FY 2012 GAF - Updated October 2020
FY 2021 GAF - Updated October 2020
Capital Disproportionate Share Adjustment Factor
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP)
PIF: Capital Disproportionate Share (DSH) adjustment location
PIF: Capital Disproportionate Share (DSH) adjustment
Capital Indirect Medical Education Adjustment Factor
PIF: IME adjustment factor for capital PPS location (TCHCP)
PIF: IME adjustment factor for capital PPS location (TCHCP)
PIF: IME adjustment factor for capital PPS location (TCHCP)
Operating Wage Index
Table 3 (CN) at https://www.cms.gov/ Medicare/Medicare-Fee-for-Service-Payment/ AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/ medicare/acute-inpatientpps/fy-2021-ipps-final-rule-home-page
Table 3 (CN) at https://www.cms.gov/ Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS
Operating Disproportionate Share Adjustment Factor
PIF: Estimated FY 2020 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP)
PIF: Estimated FY 2021 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP)
PIF: Estimated FY 2021 Operating Disproportionate Share Hospital (DSH) adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act (DSHOPP)
Operating Indirect Medical Education Adjustment
PIF: IME Adjustment Factor for Operating IPPS location (TCHOP)
PIF: IME Adjustment Factor for Operating IPPS location (TCHOP)
PIF: IME Adjustment Factor for Operating IPPS location (TCHOP)
Sole Community Hospital - Hospital Specific Rate
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2020 for SCH providers. HSP Rate is based on the March 2019 update of the Provider Specific File (PSF). Location (HSP Rate)
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2021 for SCH providers. HSP Rate is based on the March 2020 update of the Provider Specific File (PSF). Location (HSP Rate)
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2021 for SCH providers. HSP Rate is based on the March 2020 update of the Provider Specific File (PSF). Location (HSP Rate)
Cost-to-Charge Ratio
PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR)
PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR)
PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR)
Note: Authority cited: Sections 133, 4603.5, 5307.1, 5307.3 and 5318, Labor Code. Reference: Sections 4600, 4603.2, 5307.1 and 5318, Labor Code.
HISTORY
1. New section filed 12-27-2012; operative 1-1-2013 as a file and print only pursuant to Government Code section 11340.9(g) (Register 2012, No. 52).
2. Amendment filed 3-13-2013; operative 3-15-2013. Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2013, No. 11).
3. Amendment filed 2-4-2015; operative 3-5-2015. Submitted to OAL for printing only pursuant to Government Code section 11340.9 (Register 2015, No. 6).
4. Amendment filed 2-25-2015; operative 3-5-2015 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2015, No. 9).
5. Amendment filed 3-14-2016; operative 3-1-2016 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2016, No. 12).
6. Editorial correction of subsection (b) (Register 2016, No. 49).
7. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 1-19-2017; operative 1-1-2017 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 3).
8. Amendment filed 11-28-2017; operative 12-1-2017 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2017, No. 48).
9. Editorial correction of formatting (Register 2018, No. 15).
10. Nonsubstantive action without change filed 4-27-2018 pursuant to section 100, title 1, California Code of Regulations to correct errors in 11-28-2017 filing (Register 2018, No. 17).
11. Editorial correction of subsections (b)(1) and (c)(1) (Register 2018, No. 48).
12. Amendment filed 11-26-2018; operative 12-1-2018 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2018, No. 48).
13. Amendment filed 10-16-2019; operative 11-1-2019 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2019, No. 42).
14. Amendment of subsections (b)(1) and (c)(1) filed 12-12-2019; operative 11-1-2019 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2019, No. 50).
15. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 12-23-2020; operative 12-1-2020 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2)
16. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 4-12-2021; operative 3-15-2021 pursuant to Labor Code section 5307.1(g)(2). Submitted to OAL for filing and printing only pursuant to Labor Code section 5307.1(g)(2) (Register 2021, No. 16).


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