FY 2025 IPPS Final Rule Home Page

This is the home page for the FY 2025 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 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 http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html.

FY 2025 IPPS Final Rule

CMS-1808-F

Date of Display: August 1, 2024

Description: Medicare and Medicaid Programs and the Children’s Health Insurance 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 2025 Rates; Quality Programs Requirements; and Other Policy Changes

We note that the FY 2020 low wage index hospital policy and the related budget neutrality adjustment are the subject of pending litigation in multiple courts.  On July 23, 2024, the Court of Appeals for the D.C. Circuit held that the Secretary lacked authority under 1886(d)(3)(E) or 1886(d)(5)(I)(i) of the Act to adopt the low wage index hospital policy for FY 2020, and that the policy and related budget neutrality adjustment must be vacated.   Bridgeport Hosp. v. Becerra, Nos. 22-5249, 22-5269, 2024 WL 3504407, at *7-*8 & n.6 (D.C. Cir. July 23, 2024).  As of the date of this Rule’s publication, the time to seek further review of the D.C. Circuit’s decision in Bridgeport Hospital has not expired.  See Fed. R. App. P. 40(a)(1).  The government is evaluating the decision and considering options for next steps.

FY 2025 Final Rule Data and Supplemental Files

1. FY 2025 Final Rule Impact File (ZIP): This file contains data elements by provider that were used in calculating the FY 2025 rates and impacts. 
2. AOR/BOR File (ZIP): This zip file for the FY 2025 final rule contains one excel spreadsheet with multiple tabs: one for the After Outliers Removed (AOR) and one 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. All text files in the zip file are for 508 compliance.
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 2023, using the V40 Grouper).
4. FY 2025 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 2025 IPPS Final Rule are derived from the March 31, 2024 quarterly update of the FY 2022 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. In addition, the FR FY 2025 normalization factor is included on the second tab.
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 (including the revised CBSA delineations for FY 2025) and a list of Urban CBSAs and Constituent Counties for Acute Care Hospitals Files.
8. FY 2025 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 5 zip files:
   • FY 2025 Final Rule Wage Index PUFs; S3 Part II and Occ Mix Data
   • FY 2025 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Occupational Mix Factor by Provider
   • FY 2025 Final Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wages and Pre-Reclass Wage Indexes by CBSA
   • FY 2025 Final Rule AHW by Provider Area Listing
9. Imputed State Floors Public Use File (ZIP): Contains multiple tabs demonstrating step by step calculation of the imputed floor.
10. FY 2025 IPPS Final Rule Medicare DSH Supplemental Data File (ZIP): This spreadsheet has 4 tabs (text files for each tab are included for Section 508 compliance):   The first tab is the File Layout for second tab of the spreadsheet. The second tab contains the FY 2025 final rule 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 a 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 2025. The fourth tab contains the Medicare DSH estimates to support the calculation of the final Factor 1.
11. Hospital Readmissions Reduction Program Supplemental Data File: The final FY 2025 readmissions payment adjustment factors will be available in the fall of 2024. After hospitals have been given an opportunity to review and correct their calculations for FY 2025, we will post Table 15 and this supplemental data file to display the final FY 2025 readmissions payment adjustment factors that will be applicable to discharges occurring on or after October 1, 2024.
12. FY 2026 New Technology Add-On Payment 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 2026.
13. 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.
14. Outlier Reconciliation Public Use File (ZIP): Contains data used to identify hospitals that would have met the criteria to be referred for outlier reconciliation under CR 13566 as if they had been in place at the time of final cost report settlement as well as the data for these hospitals that was used in the calculation of the outlier reconciliation amounts used for the FY 2025 outlier threshold.

FY 2025 Final Rule Tables

1. Table 1A-1E (ZIP): This excel spreadsheet contains the FY 2025 Operating and Capital National Standardized Amounts.
2. FY 2025 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.4d (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 6J. – Complete CC List; Table 6J.1- Additions to the CC List; and Table 6J.2 – Deletions to the CC List; Table 6K. – Complete CC Exclusions List.  Tables 6P.1a-6P.4d (ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes and Analysis with Application of the NonCC Subgroup Criteria): See summary tab in excel spreadsheet called “CMS-1808-F TABLE 6P ICD-10-CM and ICD-10-PCS Codes for MS-DRG Changes and Analysis with Application of the NonCC Subgroup Criteria.xlsx” for a complete description of all tables.
5. Tables 8A, 8B, and 8C (ZIP): Tables 8A and 8B contain the FY 2025 IPPS operating and capital statewide average cost-to-charge-ratios. Table 8C contains the FY 2025 LTCH statewide average cost-to-charge-ratios.
6. Table 15: FY 2025 Hospital Readmissions Reduction Program Payment Adjustment Factors; Table 15 of the final rule is not available at this time, as discussed in the final rule. After hospitals have been given an opportunity to review and correct their calculations for FY 2025, we will post Table 15 to display the final FY 2025 readmissions payment adjustment factors that will be applicable to discharges occurring on or after October 1, 2024.
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 2025 IPPS Final Rule (CMS-1808-F).
   • Table 16B: Contains the actual payment adjustment factors under the Hospital VBP Program for FY 2025. These actual factors are based on the finalized baseline and performance period for FY 2025 and will be used to adjust base operating DRG payments to eligible hospitals for discharges occurring in FY 2025. Note: Table 16B will be available in the Fall of 2024.
8. Table 18 Final Rule (ZIP): FY 2025 Medicare DSH Uncompensated Care Payment Factor 3.