CMS-1608-F

This rule can be viewed from here:  CMS-1608-F

The associated files to this rule, as described below, can be downloaded from here:  FY 2015 IRF PPS Final Rule Data Files (ZIP)

• IRF Rate Setting Final Rule
  This file contains data for each of the 1,142 inpatient rehabilitation facilities used to estimate the policy updates in the final inpatient rehabilitation prospective payment system regulation. The 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 (79 FR 45871) and the standard deviations from the average lengths of stay.
• IRF Wage Index Final Rule
  These files contain the urban and rural Core-Based Statistical Area FY 2015 IRF wage index tables.
• Tier Comorbidities – ICD-9-CM (Unchanged from FY 2013)
  This file contains the list of comorbidities (ICD-9-CM codes) that will be used to determine placement in tiers for IRF discharges occurring on or after October 1, 2014. It contains the ICD-9-CM codes, the abbreviated code labels, the appropriate tier, and any RICs for which the ICD-9-CM codes are excluded from the tiers. Note that this list is unchanged from the list that was used for IRF discharges occurring on or after October 1, 2012.
• 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 when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. 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.  4-15-2015 – This file has been revised to make the following corrective edits:
  • Code K26.1 - Choice A - Code Title:  Acute duodenal ulcer with perforation
  • Code K56.60 - Choice B - Code Title:  Unspecified intestinal obstruction 
• Added code G40.411 (the code title is present; the code was inadvertently left off of the list).
• Deleted one of code G81.93. The code was duplicated in the list.
• Deleted one of code L03.113. The code was duplicated in the list.
• Added a letter “B” choice to combination code:
• Codes That Meet Presumptive Compliance Criteria — ICD-9-CM (for compliance review periods beginning on or after October 1, 2015) (79 FR 45871)
  This file contains the list of diagnoses (ICD-9-CM codes) that are used for determining presumptive compliance with the IRF 60 percent rule. (Effective for compliance review periods beginning on or after October 1, 2015.) It contains the ICD-9-CM codes and the code labels.
• Codes That Meet Presumptive Compliance Criteria — 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 when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes and the code labels.  Note that this list will only be used for compliance review periods beginning on or after October 1, 2015 if ICD-10-CM is the required medical data code set for use on Medicare claims and IRF-PAI submissions at that time.  Otherwise, please refer to the Draft Codes That Meet Presumptive Compliance Criteria – ICD-9-CM.
• Impairment Group Codes That Meet Presumptive Compliance Criteria — ICD-9-CM (for compliance review periods beginning on or after October 1, 2015) (79 FR 45871)
  This file contains the list of impairment group codes that meet presumptive compliance criteria for the 60 percent rule. (Effective for compliance review periods beginning on or after October 1, 2015.) It contains the ICD-9-CM codes excluded from the impairment group codes and the code labels.
• Impairment Group Codes That Meet Presumptive Compliance Criteria — 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 when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions. It contains the ICD-10-CM codes excluded from the impairment group codes and the code labels.  Note that this list will only be used for compliance review periods beginning on or after October 1, 2015 if ICD-10-CM is the required medical data code set for use on Medicare claims and IRF-PAI submissions at that time.  Otherwise, please refer to the Draft Impairment Group Codes That Meet Presumptive Compliance Criteria – ICD-9-CM.
• ICD-9-CM to ICD-10-CM Code Translation and the Use of Combination Codes in the IRF PPS
  This file contains a document that outlines the use of combination diagnosis codes in the IRF PPS for the following ICD-10-CM code lists:  Tier Comorbidities, Codes That Meet Presumptive Compliance Criteria, and Impairment Group Codes That Meet Presumptive Compliance Criteria.