FY 2023 IPPS Final Rule Home Page

This is the home page for the FY 2023 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 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 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS

On January 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic. Section 3710 of the CARES Act directs the Secretary to increase the weighting factor of the assigned Diagnosis-Related Group (DRG) by 20 percent for an individual diagnosed with COVID-19 discharged during the COVID-19 Public Health Emergency (PHE) period. Therefore, this 20 percent increase would not be applicable for IPPS discharges occurring on or after May 12, 2023.  

FY 2023 Final Rule

1. CMS-1771-F

Date of Display: August 1, 2022

Date of Publication: August 10, 2022

Title: Medicare Program; Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment  System and Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation

2. CMS-1771-F2

Date of Display: November 3, 2022

Date of Publication: November 4, 2022

Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation; Corrections

3. CMS-1771-CN

Date of Display: December 12, 2022

Date of Publication: December 13, 2022

Title: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation; Correction

4. CMS-1772-FC

Date of Display: November 1, 2022

Date of Publication: November 23, 2022

Title: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating; COVID–19

This final rule with comment period includes payment adjustments to hospitals under the IPPS and OPPS for the additional resource costs they incur to acquire domestic NIOSH-approved surgical N95 respirators.  The payment adjustments will commence for cost reporting periods beginning on or after January 1, 2023.

FY 2023 Final Rule and Correcting Amendment Data Files

1. FY 2023 Final Rule and Correcting Amendment Impact File (ZIP): This file contains data elements by provider that were used in calculating the FY 2023 rates and impacts.
2. AOR/BOR File (ZIP): Since we are finalizing to calculate the relative weights for FY 2023 by calculating two sets of weights (and then averaging the two sets of relative weights), one including all claims and one excluding COVID-19 claims, we are providing an AOR/BOR file for each calculation. The excel spreadsheet in each zip file contains multiple tabs: Tabs for the After Outliers Removed (AOR) and tabs for the Before Outliers Removed (BOR). There are also two tabs containing the variable descriptions. The variables in these files are used in the calculations of the relative weights as well as other calculations for the inpatient PPS. This file also contains the arithmetic and geometric mean lengths of stay which was previously included in Tables 7A and 7B.
3. Case Mix Index File (ZIP): This file contains the non-transfer adjusted case mix index (CMI) based on the MS-DRGs billed on the claim in the year the claim was incurred (that is, during FY 2021, using the V38 Grouper).
4. FY 2023 Final Rule: HCRIS Data File (ZIP): CMS uses hospital cost report data from the Medicare Cost Report, Hospital Form 2552-10, to calculate the Cost-to-Charge Ratios (CCRs) used in the cost based MS-DRG relative weight methodology.  The database for the Medicare cost reports is the Healthcare Cost Report Information System (HCRIS).  The CCRs used in the calculation of the MS DRG relative weights for the FY 2023 IPPS Final Rule are derived from the March 31, 2022 quarterly update of the FY 2020 HCRIS.  (HCRIS is updated on a quarterly basis).
5. Cost Center HCRIS Lines Supplemental Data File (ZIP): This supplemental data file shows the cost report lines that are used for the Cost Center CCR calculations, which are part of the MS-DRG Relative Weights calculations.
6. Standardizing File (ZIP): This file is used to standardize charges for the rate building process.
7. Supplemental Weights File (ZIP): Since we calculated the relative weights for FY 2023 by calculating two sets of weights (and then averaging the two sets of relative weights), one including and one excluding COVID-19 claims we are providing a supplemental file with the following: MS-DRG weights including all claims, MS-DRG weights excluding COVID-19 claims, averaged weights, and weights with cap. Note: We have also provided two AOR/BOR files, one including all claims and one excluding COVID-19 claims in the Data Files above.
8. County to CBSA Crosswalk File and Urban CBSAs and Constituent Counties for Acute Care Hospitals File (ZIP): This file contains two tabs: A crosswalk of county codes to CBSAs (including the revised CBSA delineations for FY 2023) and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
9. FY 2023 Final Rule Wage Index Public Use Files (ZIP): Open Attached Zip file. Attached is a PDF with a description of each zip file. Main zip file contains 6 zip files:
   • FY 2023 Final Rule Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2023 Final Rule Average Hourly Wage by Provider and CBSA Public Use File
   • FY 2023 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2023 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2023 Final Rule AHW by Provider Area Listing
10. FY 2023 IPPS Final Rule and Correcting Amendment: Medicare DSH Supplemental Data File (ZIP) (Note: This file was updated on November 17, 2022): This spreadsheet has 6 tabs (text files for each tab are included for Section 508 compliance):   The first tab is the File Layout for the second tab of the spreadsheet. The second tab contains the Correcting Amendment FY 2023 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. The third tab contains the Correcting Amendment list of hospitals that have undergone a merger where the data of the merging hospitals have been combined to calculate the Factor 3 for the surviving hospital for FY 2023. The remaining tabs are from the final rule.
11. Hospital Readmissions Reduction Program Supplemental Data File (ZIP): This file contains the final FY 2023 payment adjustment factors CMS applies to discharges that occur on or after October 1, 2022. It also contains information on the number of discharges used to determine the ratio of condition/procedure-specific payments to total base operating diagnosis-related (DRG) payments.
12. FY 2024 New Technology Thresholds Final Rule (ZIP): Contains the cost thresholds by MS-DRG for the cost criteria for new technology add-on payments for applications for FY 2024.
13. Health Professional Shortage Area (HPSA) Public IDs and Scores (ZIP): Contains the HPSA Public IDs and their corresponding scores current as of November 1, 2022. This information is to assist hospitals in the graduate medical education section 126 application process for the distribution of additional residency positions for the coming year.

FY 2023 Final Rule and Correcting Amendment Tables

1. Table 1A-1E Final Rule and Correcting Amendment (ZIP): This excel spreadsheet contains the FY 2023 Operating and Capital National Standardized Amounts.
2. FY 2023 Final Rule Tables 2, 3 and 4A and 4B (Wage Index Tables) (ZIP): Table 2- Case-Mix Index and Wage Index Table by CMS Certification Number (CCN); Table 3- Wage Index Table by CBSA; Table 4A - List of Counties Eligible for the Out-Migration Adjustment under Section 1886(d)(13) of the Act; Table 4B   Counties Redesignated under Section 1886(d)(8)(B) of the Act (LUGAR COUNTIES)
3. Table 5 (ZIP): MS-DRGs, Relative Weighting Factors and Geometric and Arithmetic Mean Length of Stay
4. Tables 6A-6K and Tables 6P.1a-6P.1f (ZIP): Table 6A-New Diagnosis Codes; Table 6B-New Procedure Codes; Table 6C-Invalid Diagnosis Codes; Table 6D-Invalid Procedure Codes; Table 6E-Revised Diagnosis Code Titles; Table 6G.1- Secondary Diagnosis Order Additions to the CC Exclusions List; Table 6G.2- Principal Diagnosis Order Additions to the CC Exclusions List; Table 6H.1- Secondary Diagnosis Order Deletions to the CC Exclusions List; Table 6H.2- Principal Diagnosis Order Deletions to the CC Exclusions List; Table 6I – Complete MCC List; Table 6I.1- Additions to the MCC List; Table 6I.2- Deletions to the MCC List; Table 6J – Complete CC List; Table 6J.1- Additions to the CC List; Table 6J.2- Deletions to the CC List; Table 6K-Complete List of CC Exclusions;
   Tables 6P.1a-6P.1f (ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes): See summary tab in excel spreadsheet called “CMS-1771-F TABLE 6P ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes.xlsx” for complete description of all tables.
5. Tables 8A, 8B, and 8C (ZIP): Tables 8A and 8B contain the FY 2023 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the FY 2023 LTCH statewide average cost-to-charge-ratios.
6. Table 15 (ZIP): FY 2023 Hospital Readmissions Reduction Program Payment Adjustment Factors: This table contains the final FY 2023 payment adjustment factors CMS applies to discharges occurring on or after October 1, 2022.
7. Table 16A and 16B: Hospital Value-Based Purchasing (VBP) Program Adjustment Factors: Note, this table is not necessary for FY 2023.
8. Table 18 Final Rule and Correcting Amendment (ZIP): FY 2023 Medicare DSH Uncompensated Care Payment Factor 3.

FY 2023 MAC Implementation Files

This page contains the following files as described in the Fiscal Year (FY) 2023 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes Change Request (CR) 12814.

1. MAC Implementation File 1 (ZIP)– Certain FY 2023 IPPS factors, including applicable percentage increase, budget neutrality factors, High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors. 
2. MAC Implementation File 2 (ZIP)- Certain FY 2023 LTCH PPS factors, including High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors.
3. MAC Implementation File 3 (ZIP) - A list of hospitals that will receive the statutory reduction to the annual payment update for FY 2023 under the Hospital Inpatient Quality Reporting (IQR) Program.
4. MAC Implementation File 4 – LUGAR county list (Note: For FY 2023, The LUGAR county list is available in Table 4B, listed under the FY 2023 Final Rule Tables).
5. MAC Implementation File 5 (ZIP) – Instructions to Fill Out the PSF for the Wage Index and Reclassification. 
6. MAC Implementation File 6 – MS-DRG Grouper Changes. Note, this table is not necessary for FY 2023.
7. MAC Implementation File 7 (ZIP) – FY 2023 MS-DRGs Subject to the Replaced Devices Policy. 
8. MAC Implementation File 8 (ZIP) – FY 2023 New Technology Add-on Payment.
9. MAC Implementation File 9 (ZIP) – Instructions to Fill Out the PSF for LTCHs receiving a capped LTCH PPS wage index value or a capped applicable IPPS comparable wage index value in FY 2023.
10. MAC Implementation File 10 (PDF) - Attachments for implementing the requirements of the Extension of the Medicare-Dependent Hospital Program for CR 12970