DRG National Average Payment Table Update

1 National Average Payment Table Update The National Average Payment for each DRG is calculated by multiplying the current relative weight of the DRG by the National Average hospital Medicare base rate. The National Average hospital Medicare base rate is an Average of the sum of four categories: Hospital Submitted Quality Data and is a Meaningful EHR User, Hospital Did NOT. Submit Quality Data and is a Meaningful EHR User, Hospital Submitted Quality Data and is NOT a Meaningful EHR User, Hospital Did NOT Submit Quality Data and is NOT. a Meaningful EHR User, using dollar amounts from new data published in the Federal Register FY 2021 Final Rule Correction Notice, Table 1A. National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index greater than 1) or Table 1B.

2 National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index less than or equal to 1). This information is provided as a benchmark reference only. There is no official publication of the Average hospital base rate;. therefore, the National Average payments provided in this Table are approximate. DRG Description RW GMLOS AMLOS National Payment Rate 001 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC $170, 002 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC $93, T 003 ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND $111, NECK WITH MAJOR PROCEDURES. T 004 TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK $69, WITHOUT MAJOR PROCEDURES.

3 005 LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT $60, 006 LIVER TRANSPLANT WITHOUT MCC $27, 007 LUNG TRANSPLANT $68, 008 SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT $31, 010 PANCREAS TRANSPLANT $21, 011 TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC $29, 012 TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC $22, 013 TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC $16, National Average Payment Table Update 014 ALLOGENEIC BONE MARROW TRANSPLANT $75, 016 AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC $39, 017 AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC $28, 018 CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY $219, 019 SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS $39, 020 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC $60, 021 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC $44, 022 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC $28, t 023 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC $33, OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR.

4 T 024 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT $23, MCC. T 025 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC $26, T 026 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC $18, T 027 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC $14, t 028 SPINAL PROCEDURES WITH MCC $34, t 029 SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS $19, t 030 SPINAL PROCEDURES WITHOUT CC/MCC $13, T 031 VENTRICULAR SHUNT PROCEDURES WITH MCC $25, T 032 VENTRICULAR SHUNT PROCEDURES WITH CC $13, T 033 VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC $10, 034 CAROTID ARTERY STENT PROCEDURES WITH MCC $23, 035 CAROTID ARTERY STENT PROCEDURES WITH CC $13, 036 CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC $10.

5 037 EXTRACRANIAL PROCEDURES WITH MCC $19, 038 EXTRACRANIAL PROCEDURES WITH CC $9, 039 EXTRACRANIAL PROCEDURES WITHOUT CC/MCC $6, t 040 PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC $23, t 041 PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL $13, NEUROSTIMULATOR. t 042 PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC $11, 052 SPINAL DISORDERS AND INJURIES WITH CC/MCC $10, 053 SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC $6, Calculated with an Average hospital Medicare base rate of $5, Each hospital's base rate and corresponding Payment will vary. The National Average hospital Medicare base rate is an Average of the sum of four categories: Hospital Submitted Quality Data and is a Meaningful EHR User, Hospital Did NOT Submit Quality Data and is a Meaningful EHR User, Hospital Submitted Quality Data and is NOT a Meaningful EHR User, Hospital Did NOT Submit Quality Data and is NOT a Meaningful EHR User, using dollar amounts published in the Federal Register FY 2021 Final Rule Correction Notice, Table 1A.

6 National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index greater than 1) or Table 1B. National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index less than or equal to 1). MS-DRGs 998 and 999 contain cases that could not be assigned to valid DRGs. Note: If there is no value in either the geometric mean length of stay or the arithmetic mean length of stay columns, the volume of cases is insufficient to determine a meaningful computation of these statistics. 2020 Optum360, LLC i National Average Payment Table Update DRG Expert Volume I. DRG Description RW GMLOS AMLOS National Payment Rate T 054 NERVOUS SYSTEM NEOPLASMS WITH MCC $8, T 055 NERVOUS SYSTEM NEOPLASMS WITHOUT MCC $6, T 056 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC $12, T 057 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC $7, 058 multiple sclerosis AND CEREBELLAR ATAXIA WITH MCC $10, 059 multiple sclerosis AND CEREBELLAR ATAXIA WITH CC $6, 060 multiple sclerosis AND CEREBELLAR ATAXIA WITHOUT CC/MCC $5, 061 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT $17, WITH MCC.

7 062 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT $11, WITH CC. 063 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT $10, WITHOUT CC/MCC. T 064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC $11, T 065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS $5, T 066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC $4, 067. NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC $8, 068. NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC $5, 069 TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC $4, T 070 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC $9, T 071 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC $5, T 072 NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC $4, National Average Payment Table Update 073 CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC $8, 074 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC $5, 075 VIRAL MENINGITIS WITH CC/MCC $9, 076 VIRAL MENINGITIS WITHOUT CC/MCC $5, 077 HYPERTENSIVE ENCEPHALOPATHY WITH MCC $9, 078 HYPERTENSIVE ENCEPHALOPATHY WITH CC $5, 079 HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC $4.

8 080 NONTRAUMATIC STUPOR AND COMA WITH MCC $12, 081 NONTRAUMATIC STUPOR AND COMA WITHOUT MCC $4, 082 TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC $13, 083 TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC $7, 084 TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC $5, T 085 TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC $13, T 086 TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC $7, T 087 TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC $5, CONCUSSION WITH MCC. 088 $8, CONCUSSION WITH CC. 089 $6, 090 CONCUSSION WITHOUT CC/MCC $5, T 091 OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC $9, T 092 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC $5, T 093 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC $4, 094 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC $21, 095 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC $14, 096 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC $13, 097 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC $22, 098 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC $12, 099 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC $8.

9 T 100 SEIZURES WITH MCC $11, T 101 SEIZURES WITHOUT MCC $5, 102 HEADACHES WITH MCC $6, 103 HEADACHES WITHOUT MCC $4, 113 ORBITAL PROCEDURES WITH CC/MCC $12, Calculated with an Average hospital Medicare base rate of $5, Each hospital's base rate and corresponding Payment will vary. The National Average hospital Medicare base rate is an Average of the sum of four categories: Hospital Submitted Quality Data and is a Meaningful EHR User, Hospital Did NOT Submit Quality Data and is a Meaningful EHR User, Hospital Submitted Quality Data and is NOT a Meaningful EHR User, Hospital Did NOT Submit Quality Data and is NOT a Meaningful EHR User, using dollar amounts published in the Federal Register FY 2021 Final Rule Correction Notice, Table 1A.

10 National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index greater than 1) or Table 1B. National Adjusted Operating Standardized Amounts; Labor/Nonlabor (if wage index less than or equal to 1). MS-DRGs 998 and 999 contain cases that could not be assigned to valid DRGs. Note: If there is no value in either the geometric mean length of stay or the arithmetic mean length of stay columns, the volume of cases is insufficient to determine a meaningful computation of these statistics. ii 2020 Optum360, LLC. DRG Expert Volume I National Average Payment Table Update DRG Description RW GMLOS AMLOS National Payment Rate 114 ORBITAL PROCEDURES WITHOUT CC/MCC $8, 115 EXTRAOCULAR PROCEDURES EXCEPT ORBIT $8, 116 INTRAOCULAR PROCEDURES WITH CC/MCC $11, 117 INTRAOCULAR PROCEDURES WITHOUT CC/MCC $6, 121 ACUTE MAJOR EYE INFECTIONS WITH CC/MCC $7, 122 ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC $3, 123 NEUROLOGICAL EYE DISORDERS $4, 124 OTHER DISORDERS OF THE EYE WITH MCC $8, 125 OTHER DISORDERS OF THE EYE WITHOUT MCC $4, 135 SINUS AND MASTOID PROCEDURES WITH CC/MCC $12, 136 SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC $7, 137 MOUTH PROCEDURES WITH CC/MCC $8.