FY 2024 IPPS Final Rule Home Page

This is the home page for the FY 2024 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 notice (if applicable), all tables, additional data and analysis files and the impact file. Please see the Long-Term Care Hospital PPS page for files related to​​​ Long-Term Care Hospital.

FY 2024 IPPS Final Rule

1. CMS-1785-F
   
   Date of Display: August 1, 2023
   
   Date of Publication: August 28, 2023
   
   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 2024 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Rural Emergency Hospital and Physician-Owned Hospital Requirements; and Provider and Supplier Disclosure of Ownership; and Medicare Disproportionate Share Hospital (DSH) Payments: Counting Certain Days Associated with Section 1115 Demonstrations in the Medicaid Fraction (§ 412.106)
    

2. CMS-1785-CN

   Date of Display: September 29, 2023

   Date of Publication: TBD

   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 2024 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Rural Emergency Hospital and Physician-Owned Hospital Requirements; and Provider and Supplier Disclosure of Ownership; and Medicare Disproportionate Share Hospital (DSH) Payments: Counting Certain Days Associated with Section 1115 Demonstrations in the Medicaid Fraction; Correction

FY 2024 Final Rule and Correction Notice Data Files

1. FY 2024 Final Rule Impact File (ZIP): This file contains data elements by provider that were used in calculating the FY 2024 rates and impacts.
2. AOR/BOR File (ZIP): Since we are finalizing to calculate the relative weights for FY 2024 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 2022, using the V39 Grouper).
4. FY 2024 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 2024 IPPS Final Rule are derived from the March 31, 2023 quarterly update of the FY 2021 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. 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 and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
8. FY 2024 Final Rule and Correction Notice Wage Index Public Use Files (ZIP): Open Attached Zip file. Attached is a PDF with a description of each zip file. There are two zip files, one for the final rule and one for the correction notice.
   • FY 2024 Final Rule/Correction Notice Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2024 Final Rule/Correction Notice Average Hourly Wage by Provider and CBSA Public Use File
   • FY 2024 Final Rule/Correction Notice Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2024 Final Rule/Correction Notice Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2024 Final Rule/Correction Notice AHW by Provider Area Listing
9. FY 2024 IPPS Final Rule and Correction Notice: Medicare DSH Supplemental Data File (ZIP) (ZIP): This spreadsheet has 5 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 Correction Notice FY 2024 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 Final Rule FY 2024 Factor 3 and data used to calculate Factor 3 to implement Section 3133 of the ACA, Improvements to Medicare DSH Payments. The fourth tab contains the 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 2024. The fifth tab includes the Medicare DSH estimates for the Factor 1 calculation. 
10. Hospital Readmissions Reduction Program Supplemental Data File: (ZIP) This file contains the final FY 2024 payment adjustment factors CMS applies to discharges that occur on or after October 1, 2023. 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.
11. FY 2025 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 2025.
12. Supplementary Provider-level file with Beneficiary Characteristics (ZIP): This file is a supplemental file to Table III.  Provider Deciles by Beneficiary Characteristics in the Appendix of the final rule and contains the percentage of discharges at each hospital for each of the following characteristics: race/ethnicity, dual eligibility for Medicaid and Medicare, Medicare low income subsidy (LIS) enrollment, a joint indicator for dual or LIS enrollment, presence of an ICD-10-CM Z code indicating a “social determinant of health” (SDOH), presence of a behavioral health diagnosis code, receiving ESRD Medicare coverage, qualifying for Medicare due to disability, living in a rural area, and living in an area with an area deprivation index (ADI) greater than or equal to 85.
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, 2023. 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.
14. FY 2024 Correction Notice Imputed State Floors (ZIP): Contains multiple tabs demonstrating step by step calculation of the imputed floor

FY 2024 Final Rule and Correction Notice Tables

1. Table 1A-1E (ZIP): This excel spreadsheet contains the FY 2024 Operating and Capital National Standardized Amounts.
2. FY 2024 Final Rule and Correction Notice Tables 2, 3, 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 (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 6F – Revised Procedure 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;
5. Tables 8A, 8B, and 8C (ZIP): Tables 8A and 8B contain the FY 2024 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the FY 2024 LTCH statewide average cost-to-charge-ratios.
6. Table 15 (ZIP): FY 2024 Hospital Readmissions Reduction Program Payment Adjustment Factors: This table contains the final FY 2024 payment adjustment factors CMS applies to discharges occurring on or after October 1, 2023.
7. Tables 16A and 16B Hospital Value-Based Purchasing (VBP) Program Adjustment Factors:
   • Table 16A (ZIP): Contains updated proxy adjustment factors under the Hospital VBP Program that were calculated using historical baseline and performance periods. These proxies for the FY 2024 Hospital VBP payment adjustment factors will not be used to adjust hospital payments. This file includes the proxy adjustment factors published for the FY 2024 IPPS Final Rule (CMS-1785-F).
   • Table  16B (ZIP): Contains the actual payment adjustment factors under the Hospital VBP Program for FY 2024. These actual factors are based on the finalized baseline and performance period for FY 2024 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2024. (Updated 10/25/2023).
8. Table 18 Final Rule and Correction Notice (ZIP): FY 2024 Medicare DSH Uncompensated Care Payment Factor 3. 

FY 2024 MAC Implementation Files

This page contains the following files as described in the Fiscal Year (FY) 2024 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes Change Request (CR) 13306.

1. MAC Implementation File 1 (ZIP) (ZIP) – Certain FY 2024 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) (ZIP) – Certain FY 2024 LTCH PPS factors, including High Cost Outlier (HCO) threshold, and Cost-of-Living adjustment (COLA) factors. 
3. MAC Implementation File 3 (ZIP) (ZIP) – A list of hospitals that will receive the statutory reduction to the annual payment update for FY 2024 under the Hospital Inpatient Quality Reporting (IQR) Program .
4. MAC Implementation File 4 – Reserved for Future Use 
5. MAC Implementation File 5 (ZIP) (ZIP) – Instructions to Fill Out the PSF for the Wage Index and Reclassification. 
6. MAC Implementation File 6 (ZIP) (ZIP) – FY 2024 MS-DRG Grouper Changes.
7. MAC Implementation File 7 (ZIP) (ZIP) – FY 2024 MS-DRGs Subject to the Replaced Devices Policy.
8. MAC Implementation File 8 (ZIP) (ZIP) – (Updated 11/30/2023) FY 2024 New Technology Add-on Payment.  
9. MAC Implementation File 9 (ZIP) (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 2024.