CMS-1767-F

This rule (CMS-1767-F) is on public display at the Office of the Federal Register and will publish on August 1, 2022.

The associated file(s) (ZIP) are described below:

• IRF Wage Index - These files contain the final urban and rural Core-Based Statistical Area FY 2023 IRF wage index tables.  

  • Permanent Cap on Wage Index Decreases
    The FY 2023 IRF PPS final rule establishes a permanent 5% cap on annual wage index decreases to smooth the impact of year-to-year changes in IRF payments related to changes in the IRF wage index.  The wage index files do not contain capped values.  However, the annual IRF Pricer Change Request (CR) provides the methodology that MACs are instructed to use to calculate the capped wage index -  Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2023.

• IRF Rate Setting Rule - This file contains data for each of the 1,118 inpatient rehabilitation facilities used to estimate the final policy updates in the final inpatient rehabilitation prospective payment system regulation. The final methodology used to update the payment data is described in detail in the final rule.
• Case-Mix Groups, Relative Weights, and Average Length Of Stay - Values used in the final rule and the standard deviations from the average lengths of stay
• Tier Comorbidities – ICD-10-CM - This file contains the list of diagnoses (ICD-10-CM codes) that are used to determine placement in tiers for IRF discharges, effective October 1, 2022. It contains the ICD-10-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-10-CM codes are excluded from the tiers. (Updated to reflect ICD-10-CM coding updates for October 1, 2022)
• Tier Comorbidities Changes - This file contains the list of diagnoses (ICD-10-CM codes) that have been added and/or removed from the tier comorbidities. (For ICD-10-CM coding updates, see https://www.cms.gov/medicare/icd-10/2023-icd-10-cm)
• Presumptive Compliance-3 (ICD-10-CM) - This file contains the list of diagnoses (ICD-10-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule, effective for discharges beginning on or after October 1, 2022. (Updated to reflect ICD-10-CM coding updates for October 1, 2022)
• Presumptive Compliance Changes - This file contains the list of diagnoses (ICD-10-CM codes) that have been added and/or removed from the list of diagnoses codes used for determining presumptive compliance with the IRF 60 percent rule. (For ICD-10-CM coding updates, see https://www.cms.gov/medicare/icd-10/2023-icd-10-cm).
• Impairment Group Codes That Meet Presumptive Compliance Criteria-3 (ICD-10-CM)  - This file contains the list of impairment group codes that are used for determining presumptive compliance with the IRF 60 percent rule, effective for discharges beginning on or after October 1, 2022. (There are no ICD-10-CM coding updates to this file for October 1, 2022).