PROPOSED NEW TECHNOLOGY ADD-ON PAYMENTS THRESHOLDS1 FOR APPLICATIONS FOR FY 2027									
MS?DRG	Threshold								
001	"$906,406"								
002	"$414,502"								
003	"$613,434"								
004	"$386,872"								
005	"$359,555"								
006	"$214,752"								
007	"$494,898"								
008	"$249,596"								
010	"$147,030"								
011	"$190,959"								
012	"$167,488"								
013	"$119,258"								
014	"$362,025"								
016	"$189,611"								
017	"$132,953"								
018	"$1,877,524"								
019	"$281,643"								
020	"$269,941"								
021	"$189,533"								
022	"$151,300"								
023	"$201,593"								
024	"$149,057"								
025	"$168,365"								
026	"$125,863"								
027	"$111,075"								
028	"$203,211"								
029	"$131,411"								
030	"$97,337"								
031	"$149,704"								
032	"$96,250"								
033	"$83,261"								
034	"$152,927"								
035	"$105,328"								
036	"$90,590"								
037	"$131,987"								
038	"$84,031"								
039	"$69,997"								
040	"$141,085"								
041	"$103,571"								
042	"$88,283"								
052	"$77,719"								
053	"$54,752"								
054	"$66,752"								
055	"$57,134"								
056	"$74,651"								
057	"$56,663"								
058	"$69,342"								
059	"$60,846"								
060	"$53,077"								
061	"$125,975"								
062	"$99,706"								
063	"$87,468"								
064	"$82,313"								
065	"$60,935"								
066	"$50,200"								
067	"$73,443"								
068	"$57,855"								
069	"$58,048"								
070	"$69,819"								
071	"$56,699"								
072	"$50,640"								
073	"$66,505"								
074	"$55,903"								
075	"$80,804"								
076	"$47,374"								
080	"$73,470"								
081	"$52,483"								
082	"$87,958"								
083	"$67,540"								
084	"$55,431"								
085	"$87,215"								
086	"$66,304"								
087	"$55,108"								
088	"$70,292"								
089	"$63,527"								
090	"$54,491"								
091	"$71,170"								
092	"$56,202"								
093	"$51,475"								
094	"$118,391"								
095	"$103,434"								
096	"$103,434"								
097	"$127,501"								
098	"$91,599"								
099	"$71,227"								
100	"$76,782"								
101	"$53,020"								
102	"$62,275"								
103	"$55,195"								
113	"$99,377"								
114	"$67,712"								
115	"$74,606"								
116	"$77,515"								
117	"$61,596"								
121	"$52,404"								
122	"$35,505"								
123	"$56,044"								
124	"$63,979"								
125	"$48,740"								
135	"$92,332"								
136	"$63,558"								
137	"$65,289"								
138	"$54,931"								
139	"$67,350"								
140	"$160,940"								
141	"$100,295"								
142	"$82,670"								
143	"$127,932"								
144	"$82,152"								
145	"$66,702"								
146	"$77,500"								
147	"$57,743"								
148	"$47,009"								
149	"$51,664"								
150	"$58,835"								
151	"$39,064"								
152	"$56,472"								
153	"$42,416"								
154	"$67,038"								
155	"$52,120"								
156	"$43,132"								
157	"$69,782"								
158	"$50,818"								
159	"$42,713"								
163	"$162,702"								
164	"$111,393"								
165	"$94,367"								
166	"$128,413"								
167	"$85,195"								
168	"$74,299"								
173	"$133,570"								
175	"$65,020"								
176	"$48,612"								
177	"$67,539"								
178	"$51,884"								
179	"$41,508"								
180	"$75,608"								
181	"$58,240"								
182	"$48,676"								
183	"$69,446"								
184	"$58,699"								
185	"$48,509"								
186	"$68,585"								
187	"$54,916"								
188	"$43,898"								
189	"$59,641"								
190	"$56,074"								
191	"$46,660"								
192	"$36,747"								
193	"$62,054"								
194	"$45,573"								
195	"$36,719"								
196	"$71,892"								
197	"$52,359"								
198	"$43,051"								
199	"$73,392"								
200	"$56,671"								
201	"$40,195"								
202	"$52,556"								
203	"$37,694"								
204	"$50,215"								
205	"$70,623"								
206	"$52,419"								
207	"$213,450"								
208	"$108,093"								
209	"$403,166"								
212	"$413,574"								
213	"$206,366"								
215	"$356,646"								
216	"$367,527"								
217	"$269,550"								
218	"$269,550"								
219	"$289,506"								
220	"$222,241"								
221	"$198,127"								
228	"$194,182"								
229	"$138,961"								
231	"$352,776"								
232	"$271,327"								
233	"$304,338"								
234	"$236,668"								
235	"$232,847"								
236	"$184,828"								
239	"$154,768"								
240	"$104,861"								
241	"$65,986"								
242	"$137,798"								
243	"$105,457"								
244	"$94,443"								
245	"$181,953"								
250	"$115,750"								
251	"$94,044"								
252	"$129,230"								
253	"$113,088"								
254	"$87,193"								
255	"$99,789"								
256	"$73,167"								
257	"$56,235"								
258	"$114,679"								
259	"$89,960"								
260	"$128,635"								
261	"$90,195"								
262	"$83,558"								
263	"$111,352"								
264	"$109,230"								
265	"$132,785"								
266	"$227,511"								
267	"$187,948"								
268	"$249,144"								
269	"$163,158"								
270	"$188,435"								
271	"$141,467"								
272	"$108,799"								
273	"$169,269"								
274	"$139,372"								
275	"$288,568"								
276	"$237,179"								
277	"$198,794"								
278	"$185,514"								
279	"$145,979"								
280	"$70,468"								
281	"$56,818"								
282	"$51,837"								
283	"$77,775"								
284	"$45,524"								
285	"$35,369"								
286	"$95,660"								
287	"$69,311"								
288	"$93,668"								
289	"$71,834"								
290	"$53,524"								
291	"$58,162"								
292	"$44,784"								
293	"$32,877"								
296	"$73,850"								
297	"$41,960"								
298	"$29,612"								
299	"$66,367"								
300	"$53,174"								
301	"$42,274"								
302	"$56,515"								
303	"$41,385"								
304	"$58,945"								
305	"$48,181"								
306	"$62,639"								
307	"$50,536"								
308	"$58,873"								
309	"$42,602"								
310	"$34,334"								
311	"$44,746"								
312	"$52,695"								
313	"$47,139"								
314	"$76,396"								
315	"$52,673"								
316	"$42,955"								
317	"$250,679"								
318	"$122,280"								
319	"$169,912"								
320	"$110,628"								
321	"$142,103"								
322	"$110,697"								
323	"$194,475"								
324	"$158,336"								
325	"$145,347"								
326	"$165,258"								
327	"$106,188"								
328	"$82,711"								
329	"$160,774"								
330	"$105,953"								
331	"$85,076"								
332	"$132,124"								
333	"$102,188"								
334	"$81,956"								
335	"$135,003"								
336	"$96,940"								
337	"$80,603"								
344	"$100,952"								
345	"$73,668"								
346	"$67,329"								
347	"$93,912"								
348	"$67,991"								
349	"$54,520"								
350	"$106,936"								
351	"$81,682"								
352	"$69,931"								
353	"$116,132"								
354	"$84,505"								
355	"$73,764"								
356	"$156,035"								
357	"$103,128"								
358	"$74,491"								
359	"$162,730"								
360	"$128,308"								
368	"$71,991"								
369	"$57,531"								
370	"$45,865"								
371	"$71,034"								
372	"$54,588"								
373	"$41,807"								
374	"$80,369"								
375	"$61,090"								
376	"$54,007"								
377	"$76,978"								
378	"$56,002"								
379	"$39,987"								
380	"$80,807"								
381	"$59,497"								
382	"$50,099"								
383	"$68,569"								
384	"$55,592"								
385	"$68,578"								
386	"$54,318"								
387	"$41,188"								
388	"$64,048"								
389	"$45,710"								
390	"$33,619"								
391	"$61,256"								
392	"$47,488"								
393	"$67,785"								
394	"$52,488"								
395	"$40,986"								
397	"$105,836"								
398	"$81,397"								
399	"$69,844"								
402	"$159,514"								
403	"$183,507"								
404	"$123,322"								
405	"$188,167"								
406	"$125,849"								
407	"$103,121"								
408	"$134,163"								
409	"$99,987"								
410	"$86,181"								
411	"$135,264"								
412	"$106,463"								
413	"$91,118"								
414	"$133,434"								
415	"$97,223"								
416	"$73,860"								
417	"$110,936"								
418	"$91,443"								
419	"$79,901"								
420	"$126,786"								
421	"$85,006"								
422	"$73,550"								
423	"$151,673"								
424	"$99,486"								
425	"$74,980"								
426	"$356,728"								
427	"$247,673"								
428	"$207,632"								
429	"$321,966"								
430	"$217,892"								
432	"$79,779"								
433	"$57,436"								
434	"$43,763"								
435	"$79,812"								
436	"$60,650"								
437	"$54,000"								
438	"$70,564"								
439	"$50,931"								
440	"$40,210"								
441	"$71,649"								
442	"$52,988"								
443	"$43,099"								
444	"$74,922"								
445	"$60,941"								
446	"$53,813"								
447	"$236,187"								
448	"$160,943"								
450	"$198,523"								
451	"$131,835"								
456	"$297,988"								
457	"$217,333"								
458	"$159,757"								
461	"$230,020"								
462	"$123,660"								
463	"$151,649"								
464	"$105,620"								
465	"$77,739"								
466	"$177,841"								
467	"$133,843"								
468	"$112,920"								
469	"$125,963"								
470	"$91,109"								
471	"$180,940"								
472	"$126,137"								
473	"$109,493"								
474	"$134,682"								
475	"$89,033"								
476	"$61,199"								
477	"$126,535"								
478	"$103,263"								
479	"$88,381"								
480	"$120,173"								
481	"$97,797"								
482	"$81,713"								
483	"$115,917"								
485	"$129,354"								
486	"$95,696"								
487	"$79,579"								
488	"$86,273"								
489	"$68,495"								
492	"$137,233"								
493	"$107,541"								
494	"$91,695"								
495	"$139,194"								
496	"$86,889"								
497	"$70,740"								
498	"$100,098"								
499	"$66,222"								
500	"$113,828"								
501	"$81,344"								
502	"$71,031"								
503	"$103,114"								
504	"$80,089"								
505	"$78,044"								
506	"$69,028"								
507	"$88,389"								
508	"$75,396"								
510	"$119,465"								
511	"$98,316"								
512	"$83,488"								
513	"$72,793"								
514	"$59,023"								
515	"$123,851"								
516	"$94,840"								
517	"$78,636"								
518	"$142,363"								
519	"$93,042"								
520	"$78,700"								
521	"$122,483"								
522	"$101,616"								
533	"$64,598"								
534	"$42,508"								
535	"$59,582"								
536	"$43,933"								
537	"$51,566"								
538	"$40,781"								
539	"$71,175"								
540	"$57,723"								
541	"$41,788"								
542	"$70,544"								
543	"$54,454"								
544	"$41,957"								
545	"$80,392"								
546	"$56,010"								
547	"$47,746"								
548	"$76,754"								
549	"$58,022"								
550	"$49,116"								
551	"$71,572"								
552	"$54,632"								
553	"$58,516"								
554	"$42,564"								
555	"$60,358"								
556	"$46,268"								
557	"$66,432"								
558	"$48,914"								
559	"$68,076"								
560	"$52,547"								
561	"$39,531"								
562	"$63,874"								
563	"$48,757"								
564	"$68,367"								
565	"$54,288"								
566	"$44,674"								
570	"$95,724"								
571	"$71,317"								
572	"$59,227"								
573	"$166,388"								
574	"$113,124"								
575	"$73,510"								
576	"$167,737"								
577	"$105,696"								
578	"$78,971"								
579	"$107,622"								
580	"$76,258"								
581	"$72,435"								
582	"$91,105"								
583	"$83,365"								
584	"$92,773"								
585	"$90,769"								
592	"$67,523"								
593	"$52,680"								
594	"$39,373"								
595	"$70,847"								
596	"$50,851"								
597	"$70,912"								
598	"$56,362"								
599	"$45,755"								
600	"$51,721"								
601	"$32,798"								
602	"$60,980"								
603	"$43,011"								
604	"$68,029"								
605	"$53,075"								
606	"$62,132"								
607	"$45,503"								
614	"$100,039"								
615	"$80,927"								
616	"$117,871"								
617	"$80,929"								
618	"$68,140"								
619	"$107,352"								
620	"$82,100"								
621	"$77,351"								
622	"$109,726"								
623	"$73,009"								
624	"$61,670"								
625	"$121,564"								
626	"$82,445"								
627	"$77,540"								
628	"$125,539"								
629	"$89,289"								
630	"$72,517"								
637	"$63,472"								
638	"$47,612"								
639	"$35,727"								
640	"$59,307"								
641	"$43,399"								
642	"$59,562"								
643	"$68,553"								
644	"$53,500"								
645	"$42,709"								
650	"$194,258"								
651	"$163,298"								
652	"$153,141"								
653	"$181,580"								
654	"$126,901"								
655	"$103,036"								
656	"$128,768"								
657	"$93,588"								
658	"$84,639"								
659	"$98,824"								
660	"$69,708"								
661	"$62,996"								
662	"$114,123"								
663	"$73,919"								
664	"$61,697"								
665	"$120,042"								
666	"$80,251"								
667	"$63,693"								
668	"$112,937"								
669	"$76,033"								
670	"$59,223"								
671	"$81,919"								
672	"$64,176"								
673	"$141,340"								
674	"$93,797"								
675	"$77,353"								
682	"$63,675"								
683	"$47,933"								
684	"$35,228"								
686	"$74,111"								
687	"$54,812"								
688	"$44,637"								
689	"$56,471"								
690	"$44,558"								
693	"$62,926"								
694	"$48,353"								
695	"$55,173"								
696	"$38,088"								
697	"$55,390"								
698	"$67,401"								
699	"$51,775"								
700	"$38,402"								
707	"$100,099"								
708	"$86,350"								
709	"$89,758"								
710	"$68,591"								
711	"$85,769"								
712	"$63,481"								
713	"$73,084"								
714	"$61,246"								
715	"$94,742"								
716	"$77,512"								
717	"$84,646"								
718	"$71,727"								
722	"$73,331"								
723	"$56,740"								
724	"$40,591"								
725	"$56,589"								
726	"$40,202"								
727	"$64,808"								
728	"$44,688"								
729	"$53,300"								
730	"$37,051"								
734	"$101,365"								
735	"$78,372"								
736	"$142,249"								
737	"$101,347"								
738	"$81,877"								
739	"$141,150"								
740	"$93,599"								
741	"$82,099"								
742	"$89,047"								
743	"$70,261"								
744	"$83,525"								
745	"$60,784"								
746	"$77,050"								
747	"$56,211"								
748	"$70,924"								
749	"$107,083"								
750	"$79,549"								
754	"$73,000"								
755	"$56,006"								
756	"$52,540"								
757	"$63,578"								
758	"$52,594"								
759	"$37,977"								
760	"$53,050"								
761	"$38,931"								
768	"$44,749"								
769	"$62,791"								
770	"$55,856"								
776	"$33,321"								
779	"$37,310"								
783	"$73,226"								
784	"$51,782"								
785	"$46,333"								
786	"$65,464"								
787	"$53,322"								
788	"$45,123"								
794	"$31,615"								
796	"$51,026"								
797	"$48,602"								
798	"$47,113"								
799	"$176,660"								
800	"$122,555"								
801	"$88,243"								
802	"$129,037"								
803	"$83,932"								
804	"$74,593"								
805	"$40,763"								
806	"$28,173"								
807	"$25,340"								
808	"$82,553"								
809	"$59,824"								
810	"$54,355"								
811	"$65,540"								
812	"$50,959"								
813	"$65,039"								
814	"$77,060"								
815	"$54,791"								
816	"$42,774"								
817	"$70,924"								
818	"$57,784"								
819	"$49,742"								
820	"$200,043"								
821	"$97,008"								
822	"$71,207"								
823	"$161,383"								
824	"$100,757"								
825	"$74,868"								
826	"$173,681"								
827	"$106,367"								
828	"$86,267"								
829	"$114,157"								
830	"$80,505"								
831	"$51,319"								
832	"$32,294"								
833	"$24,458"								
834	"$149,785"								
835	"$77,388"								
836	"$59,491"								
837	"$125,026"								
838	"$73,619"								
839	"$61,006"								
840	"$102,849"								
841	"$69,698"								
842	"$54,948"								
843	"$78,814"								
844	"$60,232"								
845	"$51,250"								
846	"$84,694"								
847	"$58,780"								
848	"$41,635"								
849	"$93,664"								
850	"$239,243"								
853	"$160,916"								
854	"$88,970"								
855	"$73,362"								
856	"$143,255"								
857	"$86,622"								
858	"$68,124"								
862	"$72,018"								
863	"$50,852"								
864	"$52,014"								
865	"$62,644"								
866	"$46,986"								
867	"$76,609"								
868	"$53,185"								
869	"$41,449"								
870	"$233,176"								
871	"$78,333"								
872	"$55,676"								
876	"$106,616"								
880	"$50,835"								
881	"$35,653"								
882	"$43,278"								
883	"$47,461"								
884	"$57,919"								
885	"$46,484"								
886	"$55,489"								
887	"$54,347"								
894	"$32,756"								
895	"$46,616"								
896	"$68,983"								
897	"$44,158"								
901	"$128,165"								
902	"$79,503"								
903	"$62,496"								
904	"$120,609"								
905	"$71,755"								
906	"$75,960"								
907	"$133,855"								
908	"$85,821"								
909	"$67,967"								
913	"$70,144"								
914	"$52,755"								
915	"$69,931"								
916	"$36,487"								
917	"$65,578"								
918	"$45,614"								
919	"$72,373"								
920	"$52,910"								
921	"$40,252"								
922	"$69,346"								
923	"$51,146"								
927	"$542,697"								
928	"$191,426"								
929	"$108,116"								
933	"$111,199"								
934	"$65,745"								
935	"$64,387"								
939	"$120,918"								
940	"$98,817"								
941	"$89,339"								
945	"$67,369"								
946	"$62,410"								
947	"$56,937"								
948	"$44,093"								
949	"$47,312"								
950	"$29,007"								
951	"$29,657"								
955	"$251,620"								
956	"$134,334"								
957	"$268,657"								
958	"$163,116"								
959	"$111,954"								
963	"$102,221"								
964	"$70,866"								
965	"$54,921"								
969	"$197,147"								
970	"$110,131"								
974	"$98,169"								
975	"$61,326"								
976	"$50,033"								
977	"$58,838"								
981	"$153,767"								
982	"$101,666"								
983	"$82,369"								
987	"$118,273"								
988	"$76,816"								
989	"$64,965"								
1Geometric mean plus the lesser of .75 of the national adjusted operating standardized payment amount (increased to reflect the difference between costs and charges) or .75 of one standard deviation of mean charges by Medicare Severity Diagnosis Related Group (MS-DRG)									
