FY 2021 IPPS Final Rule Home Page

This is the home page for the FY 2021 Hospital Inpatient PPS final rule. The list below centralizes any IPPS file(s) related to the final rule. The list contains the final rule (display version or published Federal Register version) and a subsequent published correction notices (if applicable), all tables, additional data and analysis files and the impact file. For files related to the Long-Term Care Hospital PPS, please visit http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html.

FY 2021 Final Rule

1. CMS-1735-F
   
   Date of Display: September 2, 2020
   
   Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2021 Rates; Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible Hospitals and Critical Access Hospitals
   
   Waiver of the 60-day Delayed Effective Date for the FY 2021 IPPS Final Rule: The United States is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that has now been detected in more than 190 locations internationally, including in all 50 States and the District of Columbia. The virus has been named “SARS CoV 2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID 19”). Due to the significant devotion of resources to the COVID-19 response, as discussed and for the reasons discussed in section XI.D. of the preamble of this final rule, we waived the 60 day delay in the effective date of the final rule.
    
2. CMS-1735-CN
   
   Date of Display: December 1, 2020
   
   Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2021 Rates; Quality Reporting and Medicare and Medicaid Promoting Interoperability Programs Requirements for Eligible Hospitals and Critical Access Hospitals; Correction

FY 2021 Final Rule and Correction Notice Data Files

1. Impact File FY 2021 Final Rule and Correction Notice (ZIP)
2. AOR/BOR File FY 2021 Final Rule and Correction Notice (ZIP)
3. Case Mix Index File FY 2021 Final Rule (ZIP)
4. HCRIS Data File FY 2021 Final Rule (ZIP)
5. Cost Center HCRIS Lines Supplemental Data File (ZIP)
6. Standardizing File FY 2021 Final Rule (ZIP)
7. FY 2021 Final Rule County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File (ZIP)
8. Wage Index Public Use Files (FY 2021 Final Rule and Correction Notice) (ZIP)
9. FY 2021 IPPS Medicare DSH Supplemental Data File (Final Rule and Correction Notice) (ZIP)
10. Lugar Hospitals in Counties that Qualify for an Outmigration Adjustment for FY 2021: Note, this file will no longer be posted as all relevant information is available in Table 2.
11. Hospital Readmissions Reduction Program Supplemental Data File (ZIP)
12. FY 2022 New Technology Thresholds Final Rule and Correction Notice (ZIP)

FY 2021 Final Rule Tables and Correction Notice Tables

1. Table 1A-1E Operating and Capital National Standardized Amounts (FY 2021 Final Rule and Correction Notice) (ZIP)
2. Tables 2, 3, 4A and 4B (FY 2021 Wage Index Tables Final Rule and Correction Notice) (ZIP)
3. Table 5 (FY 2021 Final Rule and Correction Notice MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay) (ZIP)
4. Tables 6A-6K (FY 2021 ICD-10 Code Updates with MS-DRG Related Assignments) and Tables 6P.1a-6P.4a (Generally, Displays the ICD-10-CM and ICD-10-PCS codes for MS-DRG Issues) (ZIP)
5. Tables 7A and 7B (FY 2021 Final Rule and Correction Notice Number of Discharges, Selected Percentile LOS for MS-DRGs Version 37 and Version 38) (ZIP)
6. Tables 8A, 8B, and 8C (FY 2021 IPPS Operating and Capital Statewide Average CCRs and LTCH Statewide Average CCRs) (ZIP)
7. Table 15 (FY 2021 Hospital Readmissions Reduction Program Payment Adjustment Factors) (ZIP)
8. Table 16A and 16B Hospital Value-Based Purchasing (VBP) Program Adjustment Factors (ZIP):
   • Table 16A: Contains updated proxy adjustment factors under the Hospital VBP Program that were calculated using historical baseline and performance periods. These proxies for the FY 2021 Hospital VBP payment adjustment factors will not be used to adjust hospital payments. This file includes the proxy adjustment factors published for the FY 2021 IPPS Final Rule (CMS-1735-F).
   • Table 16B: Contains the actual payment adjustment factors under the Hospital VBP Program for FY 2021. These actual factors are based on the finalized baseline and performance period for FY 2021 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2021.
9. Table 18 (FY 2021 Final Rule and Correction Notice Medicare DSH Uncompensated Care Payment Factor 3) (ZIP)

FY 2021 MAC Implementation Files

This page contains the following files as described in the Fiscal Year (FY) 2021 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes Change Request (CR) 11879.

1. MAC Implementation File 1 (ZIP) – Certain FY 2021 IPPS factors, including applicable percentage increase, budget neutrality factors, High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors (Note: This file was updated on December 7, 2020).
2. MAC Implementation File 2 (ZIP) - Certain FY 2021 LTCH PPS factors, including High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors (Note: This file was updated on December 7, 2020). 
3. MAC Implementation File 3 (ZIP) - A list of hospitals that will receive the statutory reduction to the annual payment update for FY 2021 under the Hospital Inpatient Quality Reporting (IQR) Program.
4. MAC Implementation File 4 – LUGAR county list (Note: For FY 2021, The LUGAR county list is available in Table 4B which can be found on the FY 2021 IPPS Final Rule Home Page, https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page, listed under the FY 2021 Final Rule Tables).
5. MAC Implementation File 5 (ZIP) – Instructions to Fill Out the PSF for the Wage Index and Reclassification (Note: This file was updated on October 1, 2020). 
6. MAC Implementation File 6 (ZIP) – FY 2021 MS-DRG Grouper Changes.
7. MAC Implementation File 7 (ZIP) – FY 2021 MS-DRGs Subject to the Replaced Devices Policy.
8. MAC Implementation File 8 (ZIP) – FY 2021 New Technology Add-on Payment (Note: This file was updated on September 23, 2020).
9. MAC Implementation File 9 (ZIP) – A list of LTCHs whose FY 2021 LTCH PPS wage index decreased by more than 5-percent along with their FY 2020 LTCH PPS wage index value.