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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 -- Services Rendered after January 1, 2004

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§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 Occurring 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; effective 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; effective 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 Occurring on or After 3/01/2011
Title 42, Code of Federal Regulations, § 412.2
Amended; effective 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 12/01/2011
Discharges Occurring on or After 03/15/2013
Discharges Occurring on or After 03/05/2015
Discharges Occurring on 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)
Title 42, Code of Federal Regulations, § 412.2
Amended; effective October 1, 2010
Title 42, Code of Federal Regulations, § 412.23(e)
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 Occurring 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, Section 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, Section 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, Section 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, Section 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, Section 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, Section 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
Discharges Occurring On or After 12/01/2021
Title 42, Code of Federal Regulations, § 412.2
Amended; effective October 1, 2010
Amended; effective October 1, 2010
Amended; effective October 1, 2020
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
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
Effective October 1, 2002 and revised as of October 1, 2003
Title 42, Code of Federal Regulations, Section 412.64
Amended effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Amended; effective October 1, 2021
Title 42, Code of Federal Regulations, § 412.87
Amended effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, Section 412.88
Amended effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, Section 412.92(a)
Amended effective October 1, 2005
Amended; effective October 1, 2005
Amended; effective October 1, 2005
Amended; effective October 1, 2005
Title 42, Code of Federal Regulations, Section 412.92(d)
Amended effective October 1, 2008
Amended; effective October 1, 2008
Amended; effective October 1, 2008
Title 42, Code of Federal Regulations, Section 412.106
Amended effective October 1, 2019
Amended; effective October 1, 2020
Amended; effective October 1, 2020
Amended; effective October 1, 2021
Title 42, Code of Federal Regulations, Section 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 12/01/2022
Title 42, Code of Federal Regulations, § 412.2
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, § 412.23(e)
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
Title 42, Code of Federal
Amended; effective Discharges Occurring On or After 12/01/2022
Regulations, § 412.64
October 1, 2022
Title 42, Code of Federal Regulations, Section 412.87
Amended; effective October 1, 2020
Title 42, Code of Federal Regulations, Section 412.88
Amended; effective October 1, 2020
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, 2022
Title 42, Code of Federal Regulations, Section 412.316(b)
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 1/1/2004
Discharges Occurring on or After 11/29/2004
Discharges Occurring on or After 7/1/2005
Discharges Occurring on or After 12/1/2005
Applicable FR Notices
(A) August 1, 2003 (CMS-1470-F; 68 FR 45346) final rule (B) October 6, 2003 (CMS-1470-CN; 68 FR 57732) correction notice
(A) August 11, 2004 (CMS-1428-F; 69 FR 48916) final rule (B) October 7, 2004 (CMS-1428-CN2; 69 FR 60242) correction notice (C) 69 FR 78526 (CMS-1428-F2) correction notice
(A) August 11, 2004 (CMS-1428-F; 69 FR 48916) final rule (B) October 7, 2004 (CMS-1428-CN2; 69 FR 60242) correction notice (C) 69 FR 78526 (CMS-1428-F2) correction notice
(A) August 12, 2005 (CMS-1500-F; 70 FR 47278) final rule (B) September 30, 2005 70 FR 57161 (CMS-1500-CN) correction notice
Capital wage index
Tables 4A-4C beginning on (A) page 57736
Tables 4A1--4C2 beginning on (C) page 78619
Tables 4A-4C beginning 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 payment rate
$414.18 ((B) page 57735, Table 1D)
$416.73 ($413.83 x 1.007)
$420.06 ($416.73 x 1.008)
Complex Spinal Surgery DRGs
496, 497, 498, 519, 520, 531, 532
496, 497, 498, 519, 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 Operating Rate
$3,136.39 ((B) page 57735, Table 1A)
$4,569.83 ($4,423.84 x 1.033)
$4,738.91 ($4,569.83 x 1.037)
Operating Wage Index
Tables 4A-4C beginning on (A) page 57736; PIF: Operating Wage Index location (WIGRN)
Tables 4A1-4C2 beginning on (C) page 78619; PIF: Final Wage Index location (WIGRN)
Tables 4A-4C beginning on (A) page 47580 as corrected by Tables 4A-4C beginning on (B) page 57163; PIF: Post Reclass Wage Index location
Labor-Related Portion
Table 1A beginning on B page 57735
For wage indexes greater than 1.0, the labor-related portion is 71.066% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 49070
For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 47393
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs
DRGs 12, 14, 24, 25, 89, 90, 113, 121, 122, 130, 131, 236, 239, 243, 263, 264, 277, 278, 296, 297, 320, 321, 429, 462, 483, or 468 (A) beginning at page 45413
DRGs 12, 14, 24, 25, 88, 89, 90, 113, 121, 122, 127, 130, 131, 236, 239, 277, 278, 294, 296, 297, 320, 321, 395, 429, 468, 541 or 542 (B) beginning at page 60246
DRGs designated with a “yes” in “FY06 Final Rule Post-acute Care DRG” column in Table 5 (A) beginning at page 47617 and (B) beginning at page 57163
Post-acute care transfer qualifying DRGs
DRGs 209, 210 or 211 (A) beginning at page 45413
DRGs 7, 8, 210, 211, 233, 234, 471, 497, 498, 544, 545, 549, or 550 (A) beginning at page 47617 and (B) beginning at page 57163
Discharges Occurring on or After 12/1/2006
Discharges Occurring on or After 3/1/2007
Discharges Occurring on or After 1/1/2008
Discharges Occurring on or After 12/1/2008
Applicable FR Notices
(A) August 18, 2006 (CMS-1488-F; 71 FR 47870) (B) October 11, 2006 (CMS-1488-N; 71 FR 59886) additional notice
(A) August 18, 2006 (CMS-1488-F; 71 FR 47870) (B) October 11, 2006 (CMS-1488-N; 71 FR 59886) additional notice (C) January 5, 2007 (CMS-1488-CN2; 72 fr 569) correction notice
(A) August 22, 2007 (CMS-1533-FC; 72 FR 47130) final rule (B) October 10, 2007 72 FR 57634 (CMS-1533-CN2) correction notice
(A) August 19, 2008 (CMS-1390-F; 73 FR 48434) final rule (B) October 3, 2008 73 FR 57888 (CMS-1390-N) correction notice
Capital wage index
Tables 4A-1 - 4C-1 (for discharges before 4/1/2007) and Tables 4A-2-4C2 (for discharges occurring on or after 4/1/2007) beginning on (B) page 59975
Tables 4A-4C beginning on (B) page 57698
Tables 4A-4C beginning on (B) page 57956
Capital market basket
1.10% ((A) page 48163)
1.3% ((A) page 47426)
1.4% ((A) page 48776)
Capital standard federal payment rate
$424.68 ($420.06 x 1.0110)
$430.20 ($424.68 x 1.013)
$436.22 ($430.20 x 1.014)
Complex Spinal Surgery DRGs
028, 029, 030, 453, 454, 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 Operating Rate
$4,900.03 ($4,738.91 x 1.034)
$5,061.73 ($4,900.03 x 1.033)
$5,243.95 ($5,061.73 x 1.036)
Operating Wage Index
Tables 4A-1 - 4C-1 (for discharges before 4/1/2007) and Tables 4A-2-4C2 (for discharges occurring on 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)
Tables 4A-4C beginning on (B) page 57698; PIF: Post Reclass Wage Index location
Tables 4A-4C beginning on (B) page 57956; PIF: Post Reclass Wage Index location
Labor-Related Portion
For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 48029
For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 47344
For wage indexes greater than 1.0, the labor-related portion is 69.731% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 48592
Post-acute care transfer to a rehabilitation hospital or unit or long-term hospital qualifying DRGs
DRGs designated with a “yes” in the “FY 07 Final Rule Post-acute Care DRG” column in Table 5 (B) beginning at page 60013
DRGs designated with a “yes” in the “FY 07 Final Rule Post-acute Care DRG” column in Table 5 (B) beginning at page 60013 and (C) beginning at page 573
Medicare-Severity DRGs designated with a “yes” in the “FY08 Final Rule Post-Acute DRG” column in Table 5 (A) beginning at page 47539 and (B) at page 57727
Medicare-Severity DRGs designated with a “yes” in the “FY09 Final Rule Post-Acute DRG” column in Table 5 (A) beginning at page 48899
Post-acute care transfer qualifying DRGs
DRGs 7, 8, 210, 211, 233, 234, 471, 497, 498, 545, 549, or 550 (B) beginning at page 60013
DRGs 7, 8, 210, 211, 233, 234, 471, 497, 498, 544, 545, 549, or 550 (B) beginning at page 60013 and (C) beginning at page 573
Medicare- Severity DRGs designated with a “yes” in the “FY08 Final Rule Special Pay DRG” column in Table 5 (A) beginning at page 47539 and (B) at page 57727
Medicare-Severity DRGs designated with a “yes” in the “FY09 Final Rule Special Pay DRG” column in Table 5 (A) beginning at page 48899
Discharges Occurring on or After 12/1/2009
Discharges Occurring on or After 3/01/2011
Discharges Occurring on or After 12/01/2011
Discharges Occurring on or After 1/1/2013 but Before 1/1/2014
Applicable FR Notices
(A)August 27, 2009 (CMS-1406-F; FR 43754) final rule (B) October 7, 2009 (CMS-1406-CN; 74 FR 51496) correction notice
(A) August 16, 2010 (CMS-1498-F; FR 50042) final Rule (B) October 1, 2011 (CMS-1498-F; 75 FR 60640) correction
(A) August 18, 2011 (CMS-1518-F; FR 51476) final Rule (B) September 26, 2011 (CMS-1518-CN3; 76 FR 59263) correction
Capital wage index
Tables 4A-4C beginning on page (A) 44085 as corrected by Tables 4A-4C beginning on (B) page 51505 for certain areas
Tables 4A-C Beginning on page (A) 50511
Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01overview.asp
Capital market basket
1.2% ((B) page 51498)
1.2%, (A) page 50442
1.5%, (A) page 51806
Capital standard federal payment rate
$441.46 ($436.22 x 1.012)
$446.75 ($441.46 X 1.012)
$453.46 (446.75 X 1.015)
Complex Spinal Surgery DRGs
028, 029, 030, 453 454, 455, 456
Fixed Loss Outlier Threshold
$23,140 ((A) page 44011)
$23,075, (A) page 50441
$22,385, (A) page 51795
National Standard Operating Rate
$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 Wage Index
Tables 4A-4C beginning on page (A) 44085 as corrected by Tables 4A-4C beginning on (B) page 51505 for certain areas; PIF: Post Reclass Wage Index location
Tables 4A-C Beginning on page (A) 50511; PIF: FY 2011 Wage Index location
Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2012 Wage Index location
Labor-Related Portion
For wage indexes greater than 1.0, the labor-related portion is 68.802% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62%. (A) page 43856
For wage indexes greater than 1.0, the labor-related portion is 68.8% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 50422
For wage indexes greater than 1.0, the labor-related portion is 68.8% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 51786
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 2010 Final Rule Post-Acute DRG” column in Table 5 (A) beginning at page 44126
Medicare-Severity DRGs designated with a “yes” in the “FY 2011 Final Rule Post-Acute DRG” Column in Table 5 (A) beginning at page 50547
Medicare-Severity DRGs designated with a “yes” in the “FY 2012 Final Rule Post-Acute DRG” Column in Table 5 https://www.cms.gov/AcuteInpatientPPS/
Post-acute care transfer qualifying DRGs
Medicare-Severity DRGs designated with a “yes” in the “FY2010 Final Rule Special Pay DRG” column in Table 5 (A) beginning at page 44126
Medicare-Severity DRGs designated with a “yes” in the “FY 2011 Final Rule Special Pay DRG” column in Table 5 (A) Beginning at page 50547
Medicare-Severity DRGs designated with a “yes” in the “FY 2012 Final Rule Special Pay DRG” column in Table 5 https://www.cms.gov/AcuteInpatientPPS/
Discharges Occurring on or After 3/15/2013
Discharges Occurring on or After 03/05/2015
Discharges Occurring on or After 03/05/2015
Discharges Occurring on 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 (CMS-1588-F; 77 FR 53258) final rule (B) October 3, 2012 (CMS-1588-CN2; 77 FR 60315; correction notice) (C) October 29, 2012 (CMS-1588-CN3; 77 FR 65495; correction notice)
(A) August 19, 2013 (CMS-1599-F; 78 FR 50496) Final Rule (B) October 3, 2013 (CMS-1599-CN2; 78 FR 61197; corrections) (C) October 3, 2013 (CMS-1599-IFC; 78 FR 61191; 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
(A) August 22, 2014 (CMS-1607-F; 79 FR 49854) Final Rule (B) October 3, 2014 (CMS-1607-CN; 79 FR 59675; Corrections)
(A) August 17, 2015 (CMS-1632-F and IFC; 80 FR 49326; Final Rule) (B) October 5, 2015 (CMS-1632-CN; 80 FR 60055; Correction)
Capital wage index
Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp
Tables 4A -- 4C-CN2 at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp
Tables 4A-1 Through 4C-2CN at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/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 payment rate
$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)
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 Operating Rate
$5,805.19 ($5,658.08 x 1.026)
$5,950.32 ($5,805.19 x 1.025)
$6,122.88 ($5,950.32 x 1.029)
$6,269.83 ($6,122.88 x 1.024)
Operating Wage Index
Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2013 Wage Index location
Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2014 Wage Index location
Tables 4A-1 Through 4C-2CN at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/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.
Labor-Related Portion
For wage indexes greater than 1.0, the labor-related portion is 68.8% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 53685
For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 50972
For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 49991
For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 49505
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 2013 Final Rule Post-Acute DRG” Column in Table 5 https://www.cms.gov/AcuteInpatientPPS/
Medicare-Severity DRGs designated with a “yes” in the “FY 2014 FR Post-Acute DRG” Column in Table 5 https://www.cms.gov/AcuteInpatientPPS/
Medicare-Severity DRGs designated with a “yes” in the “FINAL Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp
Medicare-Severity DRGs designated with a “yes” in the “FY 2016 Final Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutePPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp
Post-acute care transfer qualifying DRGs
Medicare-Severity DRGs designated with a “yes” in the “FY 2013 Final Rule Special Pay DRG” column in Table 5 https://www.cms.gov/AcuteInpatientPPS/
Medicare-Severity DRGs designated with a “yes” in the “FY 2014 FR Special Pay DRG” column in Table 5 https://www.cms.gov/AcuteInpatientPPS/
Medicare-Severity DRGs designated with a “yes” in the “FY 2015 NPRM Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp
Medicare-Severity DRGs designated with a “yes” in the “FY 2016 Final Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/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 After 01/01/2017
Discharges Occurring on or After 12/01/2017
Discharges Occurring On or After 12/01/2018
Discharges Occurring On or After 11/01/2019
Applicable FR Notices
(A) August 22, 2016 (CMS-1655-F; 81 FR 56762) final rule (B) October 5, 2016 (CMS-1655-F; 81 FR 68947; final rule; correction)
(A) August 14, 2017 (CMS-1677-F; 82 FR 37990 (B) October 4, 2017 (CMS-1677-CN; 82 FR 46138; Final rule; correction)
(A) August 17, 2018 (CMS-1694-F; 83 FR 41144) (B) October 3, 2018 (CMS-1694-CN2; 83 FR 49836; Correction)
(A) August 16, 2019 (CMS-1716-F; 84 FR 42044 (B) October 8, 2019 (CMS-1716-CN2; 84 FR 53603; correction)
Capital wage index
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 (CN), at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/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 payment rate
$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)
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 Rate
$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)
Operating Wage Index
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 (CN) at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Labor-Related Portion
For wage indexes greater than 1.0, the labor-related portion is 69.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 57276
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 38157
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 41713
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 42325
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 2017 FINAL Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp
Medicare-Severity DRGs designated with a “yes” in the “FY 2018 Final Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp
Medicare-Severity DRGs designated with a “yes” in the “FY 2019 FINAL Post-Acute DRG” Column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Medicare-Severity DRGs designated with a “yes” in the “FY 2020 FINAL Post-Acute DRG” Column in Table 5, (Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Post-acute care transfer qualifying DRGs
Medicare-Severity DRGs designated with a “yes” in the “FY 2017 FINAL Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp
Medicare-Severity DRGs designated with a “yes” in the FY 2018 Final Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html?redirect=/AcuteInpatientPPS/01_overview.asp
Medicare-Severity DRGs designated with a “yes” in the “FY 2019 FINAL Special Pay DRG” column in Table 5 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Medicare-Severity DRGs designated with a “yes” in the “FY 2020 FINAL Special Pay DRG” column in Table 5, (Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
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 else where 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
Discharges Occurring On or After 12/01/2021
Discharges Occurring On or After 12/01/2022
Applicable FR Notices
September 18, 2020 (CMS-1735-F; 85 FR 58432)
(A) September 18, 2020 (CMS-1735-F; 85 FR 58432 final rule)
(B) December 7, 2020 (CMS-1735-CN; 85 FR 78748; correction notice)
(A) August 13, 2021 (CMS-1752-F; 86 FR 44774 final rule)
(B) October 20, 2021 (CMS-1752-F2; 86 FR 58019; correcting amendment)
(A) August 10, 2022 (CMS-1771-F; 87 FR 48780 final rule)
(B) November 4, 2022 (CMS-1771-F2; 87 FR 66558; correcting amendment)
(C) December 13, 2022 (CMS-1771-CN; 87 FR 76109)
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
CA Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Reg
Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page
Capital market basket
1.1% (A) page 59048
1.1% (A) page 59048
1.1% (A) page 45554
2.5% (A) page 49437
Capital standard federal payment rate
$509.35 ($503.81 x 1.011)
$509.35 ($503.81 x 1.011)
$514.95 ($509.35 x 1.011)
$527.82 ($514.95 x 1.025)
Complex Spinal Surgery DRGs
N/A
N/A
N/A
N/A
Fixed Loss Outlier Threshold
$30,006 (A) page 59039
$29,064 (B) page 78754
$30,988 (A) page 45543
$38,788 (B) page 66563 and (C) page 76111
National Standard Operating Rate
$7,177.10 ($7,008.89 x 1.024)
$7,177.10 ($7,008.89 x 1.024)
$7,370.88 ($7177.10 x 1.027)
$7,673.09 ($7,370.99 x 1.041)
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
CA Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page
Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page
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 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
For wage indexes greater than 1.0, the labor-related portion is 67.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% (A) page 45194
For wage indexes greater than 1.0, the labor-related portion is 67.6% of the standard operating rate. For wage indexes less than or equal to 1.0, the labor-related portion is 62% page (A) 49431
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 DRG” column in CN Table 5 Final Rule and Correction Notice) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS
Medicare-Severity DRGs designated with a “yes” in the “FY 2022 Final Post-Acute DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Reg
Medicare-Severity DRGs designated with a “yes” in the “FY 2023 Final Post-Acute DRG” column in Table 5. https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page
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
Medicare-Severity DRGs designated with a “yes” in the “FY 2022 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page#Reg
Medicare-Severity DRGs designated with a “yes” in the “FY 2023 Final Special Pay DRG” column in Table 5 https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page
Uncompensated Care Adjustment
0.6786 (A) page 58813
0.7286 (A) page 58814
0.6857 (A) page 45232
0.6571 (A) page 49033
(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 Occurring on or After 12/1/2006
Applicable Payment Impact File (PIF)
FY2004 Final Rule Impact File
FY2005 Final Rule Impact File
FY2006 Final Rule Impact File
FY2007 Final Rule Impact File
Capital geographic adjustment factor
PIF: Capital Wage Index
PIF: POST RECLASS GAF
PIF: WICGRN
PIF: Post Reclass GAF_a (for first half FY 2007) and Post Reclass GAF_b (for capital second half FY 2007)
Large Urban Add-on
PIF: Post-Reclassification Urban/Rural location
PIF: Standardized payment location
PIF:URSPA
PIF:URSPA
Capital Disproportionate Share Adjustment Factor
PIF: Capital Disproportionate Share Adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) Adjustment location (CAPITAL DSH ADJ.)
PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG)
Capital Indirect Medical Education Adjustment Factor
PIF: Capital IME Adjustment location (TCHCP)
PIF: IME adjustment factor for capital PPS location (IME ADJUSTMENT-CAPITAL)
PIF: IME adjustment factor for capital PPS location (TCHCP)
PIF: IME adjustment factor for capital PPS location (TCHCP)
Operating Wage Index
Tables 4A-4C beginning on (A) page 57736; PIF: Operating Wage Index location (WIGRN)
Tables 4A1-4C2 beginning on (C) page 78619; PIF: Final Wage Index location (WIGRN)
Tables 4A-4C beginning on (A) page 47580 as corrected by Tables 4A-4C beginning on (B) page 57163; PIF: Post Reclass Wage Index location
Tables 4A-1 - 4C-1 (for discharges before 4/1/2007) and Tables 4A-2-4C2 (for discharges occurring on 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 hall FY 2007)
Operating Disproportionate Share Adjustment Factor
PIF: Operating DSH Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (OPERATING DSH ADJ.)
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
Operating Indirect Medical Education Adjustment
PIF: Operating IME Adjustment location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (IME ADJUSTMENT OPERATING)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
Sole Community Hospital -- Hospital Specific Rate
PIF: Hospital -- Specific Rate location (HSPPUB)
PIF: Sole Community Hospital Cost/Case 1982/1987 and Sole Community Hospital Cost/Case 1996 locations
PIF: 82/87 Hospital Specific Rate Updated to FY 2006 (OLDHSPPS) and 1996 Hospital Specific Rate Updated to FY 2006 (HSP96) locations
PIF: 82/87/96 Hospital Specific Rate Updated to FY 2007 for SCH Providers location (HSP Rate)
Cost-to-Charge Ratio
PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR)
PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR)
PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR)
PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR)
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 Occurring on or After 3/01/2011
Applicable Payment Impact File (PIF)
FY2008 Final Rule
FY2009 Final Rule
FY2010 Correction Notice
FY 2011 Final Rule
Capital Geographic Adjustment Factor
Post Reclass GAF
Post Reclass GAF
Post Reclass GAF
FY 2011 GAF
Capital Disproportionate Share Adjustment Factor
PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) Adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
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)
PIF: IME adjustment factor for capital PPS location (TCHCP)
Operating Wage Index
Tables 4A-4C beginning on (B) page 57698; PIF: Post Reclass Wage Index location
Tables 4A-4C beginning on (B) page 57956; PIF: Post Reclass Wage Index location
Tables 4A-4C beginning on page (A) 44085 as corrected by Tables 4A-4C beginning on (B) page 51505 for certain areas; PIF: Post Reclass Wage Index location
Tables 4A-C Beginning on page (A) 50511; PIF: FY 2011 Wage Index location
Operating Disproportionate Share Adjustment Factor
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
Operating Indirect Medical Education Adjustment
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
Sole Community Hospital -- Hospital Specific Rate
PIF: 82/87/96 Hospital Specific Rate Updated to FY 2008 for SCH Providers location (HSP Rate)
PIF: 82/87/96 Hospital Specific Payment (HSP) Rate Updated to FY 2009 for SCH Providers location (HSP Rate)
PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY 2010 for SCH Providers location (FY10HSP Rate)
PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2011 for SCH Providers location (FY11 HSP Rate)
Cost-to-Charge Ratio
PIF: Operating Cost-to-Charge Ratio location (OPCCR) and Capital Cost-to-Charge location (CPCCR)
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)
Discharges Occurring on or After 12/01/2011
Discharges Occurring on or After 03/15/2013
Discharges Occurring on or After 03/05/2015
Discharges Occurring on 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 Impact File (PIF)
FY 2012 Final Rule-IPPS Impact File
FY 13 FR Impact File--updated October 2012
FY 2014 Impact file--updated January 2014 to reflect changes from the September 2013 correction notice and interim final rule with comment
FY 15 Impact File (August 22, 2014 Final Rule and October 3, 2014 Correction Notice)
Capital Geographic Adjustment Factor
FY 2012 GAF
FY 2013 GAF
FY 2014 GAF--Updated September 2013
FY 2015 GAF--Updated October 2014
Capital Disproportionate Share Adjustment Factor
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
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)
PIF: IME adjustment factor for capital PPS location (TCHCP)
Operating Wage Index
Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2012 Wage Index location
Tables 4A-C at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2013 Wage Index location
Tables 4A-C--CN2 at https://www.cms.gov/AcuteInpatientPPS/01_overview.asp; PIF: FY 2014 Wage Index location
Tables 4A-1 Through 4C-2CN at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Operating Disproportionate Share Adjustment Factor
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share (DSH) Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share Hospital (DSH) Adjustment Factor location (DSHOPG)
PIF: Operating Disproportionate Share Hospital (DSH) Adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3133 of the Affordable Care Act. Factor location (DSHOPG)
Operating Indirect Medical Education Adjustment
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS location (TCHOP)
Sole Community Hospital--Hospital Specific Rate
PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2012 for SCH Providers location (FY12 HSP Rate)
PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2013 for SCH Providers location (FY13 HSP Rate)
PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2014 for SCH and MDH Providers with the -0.2% adjustment for presumptive inpatient hospital status policy. Location (FY14 HSP Rate)
PIF: 82/87/96/06 Hospital Specific Payment (HSP) Rate Updated to FY2015 for SCH and MDH Providers. Location (FY14 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)
PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge location (Capital CCR)
Discharges Occurring on or After 03/01/2016
Discharges Occurring on or After 01/01/2017
Discharges Occurring on or After 12/01/2017
Discharges Occurring On or After 12/01/2018
Applicable Payment Impact File (PIF)
FY 16 Impact File (August 17, 2015 Final Rule and October 5, 2015 Correction Notice)
FY 17 Impact File (August 22, 2016 Final Rule and October 5, 2016 Correction Notice)
FY 18 Impact File (August 14, 2017 Final Rule and October 4, 2017 Correction Notice)
FY 19 Impact File (August 17, 2018 Final Rule and October 3, 2018 Correction Notice)
Capital Geographic Adjustment Factor
FY 2016 GAF--Updated October 2015
FY 2017 GAF--Updated October 2016
FY 2018 GAF--Updated October 2017
FY 2019 GAF--Updated October 2018
Capital Disproportionate Share Adjustment Factor
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
PIF: FY 2018 Capital Disproportionate Share (DSH) adjustment location (DSHCPG)
PIF: FY 2019 Capital Disproportionate Share Share (DSH) adjustment (DSHCPP)
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)
PIF: IME adjustment factor for capital PPS location (TCHCP)
Operating Wage Index
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/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.
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Table 3 at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
Operating Disproportionate Share Adjustment Factor
PIF: Operating Disproportionate Share Hospital (DSH) Adjustment. Reflects a 75% reduction to the DSH adjustment required under section 3133 of the Affordable Care Act. Factor location (DSHOPG)
PIF: Operating Disproportionate Share Hospital (DSH) Adjustment. Reflects a 75% reduction to the DSH adjustment required under Section 3133 of the Affordable Care Act. Factor location (DSHOPG)
PIF: Estimated FY 2018 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 2019 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 PPS location (TCHOP)
PIF: IME Adjustment Factor for Operating PPS 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 2016 for SCH and MDH providers. HSP Rate is based on the March 2015 update of the Provider Specific File (PSF). Location (HSP Rate)
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2017 for SCH and MDH providers. HSP Rate is based on the March 2016 update of the Provider Specific File (PSF). Location (HSP Rate)
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2018 for SCH providers. HSP Rate is based on the March 2017 update of the Provider Specific File (PSF). Location (HSP Rate)
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2019 for SCH providers. HSP Rate is based on the March 2018 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)
PIF: Operating Cost-to-Charge Ratio location (Operating CCR) and Capital Cost-to-Charge 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
Discharges Occurring On or After 12/01/2021
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)
FY 22 Impact File (Final Rule and Correcting Amendment)
Capital Geographic Adjustment Factor
FY 2020 GAF--Updated October 2019
FY 2012 GAF--Updated October 2020
FY 2021 GAF--Updated October 2020
FY 2022 GAF--Updated October 2021
Capital Disproportionate Share Adjustment Factor
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP)
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP)
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)
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
Table 3 at https://www.cms.gov/medicare/acute-inpatientpps/fy-2022-ipps-final-rule-home-page#Reg
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)
PIF: Estimated FY 2022 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)
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)
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2022 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-Change 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)
Discharges Occurring On or After 12/01/2022
Applicable Payment Impact File (PIF)
FY 2023 Impact File (Final Rule and Correcting Amendment)
Capital Geographic Adjustment Factor
FY 2023 GAF-Updated October 2022
Capital Disproportionate Share Adjustment Factor
PIF: Capital Disproportionate Share (DSH) adjustment location (DSHCPP)
Capital Indirect Medical Education Adjustment Factor
PIF: IME adjustment factor for capital PPS location (TCHCP)
Operating Wage Index
Table 3 at https://www.cms.gov/medicare/acute-inpatient-pps/fy-2023-ipps-final-rule-home-page
Operating Disproportionate Share Adjustment Factor
PIF: Estimated FY 2023 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)
Sole Community Hospital -- Hospital Specific Rate
PIF: Hospital Specific Payment (HSP) Rate updated to FY 2023 for SCH providers. HSP Rate is based on the March 2022 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)
Note: Authority cited: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 4603.2 and 5307.1, 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) (Register 2020, No. 52).
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).
17. Editorial correction of subsections (a)(1), (b)(1) and (c)(1) (Register 2021, No. 49).
18. Amendment of subsections (a)(1), (b)(1) and (c)(1) filed 12-1-2021; operative 12-1-2021 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. 49).
19. Amendment of subsections (a)(1), (b)(1) and (c)(1) and amendment of Note filed 12-29-2022; operative 12-1-2022 pursuant to Labor Code section 5307.1(g)(2). Exempt from the APA pursuant to Labor Code section 5307.1(g)(2) and submitted to OAL for filing and printing only pursuant to Government Code section 11343.8 (Register 2022, No. 52).


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