Medicare Hospital Inpatient MS-DRG Payment Rate Lookup by Hospital
Medicare pays an inpatient stay as one MS-DRG for the whole admission, not per code and not per day. Type an MS-DRG, a discharge date and the hospital. It returns the national amount and that hospital’s own, itemized stage by stage, from the CMS fiscal year in force that day. Free for 5 codes a day.
The hospital’s payment, per discharge date and hospital
Results
27130. New York, date of service Oct 1, 2026.
The release behind these figures
Every amount above is computed from the CMS file below, held in a pinned archive so a number printed in a report can be produced again later, unchanged. The date of service chooses the file. Archive last rebuilt Oct 5, 2026.
- Release
- pfs-2026-10
- CMS file
- 2026 October (quarterly MPFSDB update, CR 14588)
- Prices dates of service
- Oct 1, 2026 onward
- Conversion factor
- $33.40
All 17 CMS physician releases in this archive
Source & method
- Amounts: CMS’s IPPS Table 1A to 1E (the standardized amounts and the capital Federal rate), Table 5 (every MS-DRG’s relative weight, mean lengths of stay and transfer flags) and the IPPS Impact File (each hospital’s wage index, teaching factor, disproportionate share adjustment, cost-to-charge ratios and geographic adjustment factor), for every fiscal year from FY 2020 to FY 2027. A discharge date is priced under the fiscal year in force that day. The figures on this page come from the FY 2027 IPPS (CMS-1849-F), read from FY 2027 IPPS Final Rule Impact File.xlsx (sha256 8429983219b8d384), and every table is checked field by field against CMS’s own text copy of the same file on every build.
- The arithmetic is CMS’s, stage by stage, and every stage is shown. The Addendum of each final rule states the formula: the relative weight times the labor-related standardized amount times the wage index, plus the nonlabor share times the cost-of-living adjustment, then the teaching and disproportionate share factors, the uncompensated care amount, the readmissions and value-based purchasing adjustments, and a separate capital payment. Each stage is rounded half up to the cent from the unrounded Federal portion, which is what reproduces CMS’s own Web Pricer. Nothing here is a floating-point number: every figure is an integer in a declared unit, because a cent decided by the last bit of a rounding is a cent that cannot be defended in a deposition.
- The fiscal year is chosen by the DISCHARGE date, and it is never prorated. There is no mid-year IPPS release: CMS publishes one set of rates per fiscal year and amends it retroactively, in its own words “applicable to discharges occurring on or after October 1, as if they had been included in” the original. 6 of the 8 fiscal years here carry at least one such instrument, 10 in total, and this archive holds the newest published version of each table with every superseded version pinned by URL and sha256.
- Per-hospital factors come from CMS’s public ratesetting model, not from the file the contractors pay from. CMS’s own disclaimer on the impact file says its variables “may not reflect what is used for actual payment” and points to the quarterly Provider Specific File, which CMS does not publish as a flat file. Every figure on this site states that, names which file each input came from, and lists what CMS pays that no published file carries, including the hospital-acquired condition penalty and the per-diem pass-through amounts.
- Live source to verify: CMS acute inpatient PPS files for download.
Medicare hospital inpatient payment, explained
Two claims come out of one inpatient stay, and this page is one of them
When a patient is admitted, the hospital bills for the admission on a UB-04 and is paid one MS-DRG for the whole stay: the room, the nursing, the operating room, the supplies, the drugs and the implants, all in one amount. The surgeon bills separately on a professional claim and is paid under the Physician Fee Schedule for the operation. Those are different parties’ money on different claims, so a hospital charge tested against the surgeon’s fee is tested against the wrong one, and a surgeon’s charge tested against the MS-DRG is tested against a figure that covers the entire hospital stay.
The lookup above opens on both, so the difference is visible rather than described: MS-DRG 470 in the inpatient card, and CPT 27130 in the code box, which is what the other cards price. It does not claim the one produces the other. CMS assigns an MS-DRG with its own grouper software, from every diagnosis and procedure on the hospital’s claim and from the patient’s age, sex and discharge status. This site runs no grouper: the MS-DRG is read off the claim, exactly as the discharge date is.
How Medicare builds an inpatient payment
CMS states the formula in the Addendum of every final rule, in the same words each year. The relative weight for the MS-DRG is multiplied by the labor-related standardized amount times the hospital’s wage index, plus the nonlabor share times any cost-of-living adjustment. The result is the operating Federal payment, and every later stage is taken off it: the indirect medical education factor for a teaching hospital, the disproportionate share adjustment, the flat uncompensated care amount CMS publishes per discharge, and the readmissions and value-based purchasing adjustments, which can be negative. A separate capital payment is the weight times the capital Federal rate, $540.03 in the FY 2027 IPPS, times that hospital’s geographic adjustment factor.
Two details decide whether a figure is right. The labor share is 62 percent where the wage index is at or below 1.0000 and 66.0 percent above it, and CMS publishes a different standardized amount for each side, so the table itself changes at 1.0000. And CMS publishes four columns of that amount, keyed to whether the hospital reported quality data and is a meaningful electronic health record user: in the FY 2027 IPPS the full column totals $6,848.98 and the column for a hospital CMS models as neither totals $6,634.74, a difference of $214.24 for every unit of relative weight.
Why the discharge date decides the file, down to the day
Medicare pays an admission under the federal fiscal year its discharge falls in, and the fiscal year runs 1 October to 30 September. A stay that begins on 28 September and ends on 2 October is priced entirely under the new year’s rates, with no proration and no blend. 42 CFR 412.64(a) sets the unit as the discharge, and CMS’s own Web Pricer asks for the discharge date and refuses one before 1 October 2019, which is where this archive starts as well.
There is no mid-year release to catch. Unlike the physician, DMEPOS, laboratory and drug schedules, CMS publishes one set of IPPS rates a year and then amends it retroactively through correction notices, correcting amendments and, once, an interim final rule. 6 of the 8 fiscal years here were amended that way, by 10 instruments in total, each applicable “to discharges occurring on or after October 1… as if they had been included in” the original. So there is no day inside a fiscal year on which the superseded figure was ever correct, and this archive carries the newest published version of each table with every version it replaced pinned by sha256.
| Fiscal year | Discharges priced | Final rule | Rates version | Corrections |
|---|---|---|---|---|
| FY 2027 IPPS | Oct 1, 2026 to now | 91 FR 49570 | F | none |
| FY 2026 IPPS | Oct 1, 2025 to Sep 30, 2026 | 90 FR 36536 | F | none |
| FY 2025 IPPS | Oct 1, 2024 to Sep 30, 2025 | 89 FR 68986 | IFC | 2 |
| FY 2024 IPPS | Oct 1, 2023 to Sep 30, 2024 | 88 FR 58640 | F | 2 |
| FY 2023 IPPS | Oct 1, 2022 to Sep 30, 2023 | 87 FR 48780 | CA | 2 |
| FY 2022 IPPS | Oct 1, 2021 to Sep 30, 2022 | 86 FR 44774 | CA | 2 |
| FY 2021 IPPS | Oct 1, 2020 to Sep 30, 2021 | 85 FR 58432 | CN | 1 |
| FY 2020 IPPS | Oct 1, 2019 to Sep 30, 2020 | 84 FR 42044 | CN | 1 |
Source: each fiscal year’s own final rule and every correcting instrument CMS issued against it, pinned by URL and sha256 in lib/cms/ipps-releases.json. In the rates column, F is the final rule, CN a correction notice, CA a correcting amendment and IFC an interim final rule with comment period. The version that governs differs table by table inside one year, because CMS reissues some tables and not others.
Which hospitals get no figure, and why
Maryland is the case most easily got wrong, because CMS lists Maryland hospitals in the impact file with a full set of factors and does not pay them under the IPPS at all. 43 of them appear in the FY 2027 IPPS file, and a lookup that read the file without the rule would print a wage-index-adjusted number Medicare never pays. Critical access hospitals and children’s hospitals are the opposite case: they are absent from every impact file, because a critical access hospital is paid 101 percent of its own reasonable cost from its cost report and a children’s hospital is excluded by statute. Each gets the regulation or the manual sentence it is excluded by, never a blank.
Puerto Rico is a fourth case and it is paid, just from a different table. CMS publishes a separate Table 1C for the 52 Puerto Rico hospitals in this fiscal year, keyed to meaningful electronic health record use alone, and leaves their readmissions and value-based purchasing columns empty because CMS’s own column description says those hospitals are exempt from the adjustment. The tool prices them from Table 1C and says so, and where CMS’s own headings do not let it choose a column it shows no figure rather than a guessed one.
The two rules that move an inpatient figure most
The cost outlier is the first. A catastrophic admission can cost several times what its MS-DRG pays, and 42 CFR 412.84 adds 80 percent of the excess once the case’s cost passes this claim’s own payment plus the year’s fixed-loss threshold, which is $49,346.00 in the FY 2027 IPPS. Cost is not charges: CMS converts the billed charges with the hospital’s own operating and capital cost-to-charge ratios first. The 6 burn MS-DRGs in 412.84(l) are paid at 90 percent instead. This tool computes an outlier only from the claim’s total covered charges, and says in CMS’s own terms when it has none.
The transfer is the second, and it reduces the payment rather than adding to it. A hospital that transfers a patient is paid a graduated per diem under 42 CFR 412.4(f), capped at the full MS-DRG amount: the payment divided by the MS-DRG’s geometric mean length of stay, doubled for the first day. A transfer to another acute hospital triggers it on any MS-DRG. A transfer to a post-acute setting triggers it only on the 294 MS-DRGs CMS flags in Table 5 for this year, of which 63 are also flagged Special Pay and paid under a further split. MS-DRG 470’s geometric mean is 2.0 days, so a short stay ending in a transfer can pay materially less than the figure above.
Key terms in a hospital inpatient rate lookup
- MS-DRG
- Medicare Severity Diagnosis Related Group: the one group CMS assigns an admission to, and the unit it pays by. The FY 2027 IPPS carries 768 of them, 2 with no published relative weight because CMS treats them as ungroupable or invalid.
- Relative weight
- What CMS says that MS-DRG costs relative to the average admission. It multiplies the standardized amount, so it is the whole difference between one admission and another: 0.2022 at the bottom of the FY 2027 IPPS and 45.1272 at the top.
- Standardized amount
- The national base payment for one unit of relative weight, published in CMS’s Table 1A and 1B, split into a labor-related and a nonlabor-related share. Only the labor share is adjusted by the wage index.
- Wage index
- The post-reclassification index CMS publishes per hospital, which adjusts the labor share. It runs from 0.3500 to 1.9343 across the 3,074 hospitals in the FY 2027 IPPS file.
- Geometric mean length of stay
- CMS’s published typical stay for an MS-DRG, in days. It is not a coverage limit: its job is to set the per diem when a transfer cuts the stay short.
- Cost outlier
- The extra payment for a case whose cost passes the year’s fixed-loss threshold, $49,346.00 in the FY 2027 IPPS. Charges are converted to cost first with the hospital’s own cost-to-charge ratios.
- CCN
- The CMS Certification Number, six digits, that identifies a hospital to Medicare. It is the unit every per-hospital factor is published at, which is why this tool asks for a hospital rather than a state. Its first two digits are the state code.
How bill reviewers use MS-DRG rates
A medical billing expert reads the MS-DRG and the discharge date off the UB-04, prices them under the fiscal year CMS had in force that day, picks the hospital that billed them, and sets that hospital’s figure beside the billed total for the admission. Because every amount traces to an archived CMS file rather than to a link that may be retired, it can be produced again later unchanged. Two claim facts belong in the figure rather than in a footnote: the total covered charges, which decide whether a cost outlier is paid, and the discharge status, which decides whether a transfer reduced the payment.
For the surgeon’s fee on the same admission, use the Medicare rate lookup. For the hospital’s own payment when the patient was not admitted, use the hospital outpatient lookup, and for the same procedure in a freestanding surgery center the ASC fee schedule lookup. For implants and supplies billed separately, see the DMEPOS fee schedule lookup; for drugs, the Part B drug payment limits. New Jersey no-fault claims have their own hospital fee schedules in the NJ PIP fee schedule lookup. For the whole workflow from a stack of bills to a signed report, see Desk.
Medicare hospital inpatient rates, answered
What is the Medicare MS-DRG payment rate?
It is what Medicare pays a hospital for an inpatient admission: one MS-DRG for the whole stay, per admission, not per service and not per day. CMS groups every admission into one MS-DRG, gives that MS-DRG a relative weight, and multiplies the weight by a standardized amount. The FY 2027 IPPS carries 768 MS-DRGs, 766 of them with a published relative weight, running from 0.2022 to 45.1272. MS-DRG 470, major hip and knee joint replacement or reattachment of lower extremity without mcc, carries a weight of 1.9560 and comes to $14,452.90 nationally before any hospital's own factors. Because the unit is the admission, a bill line tested against this figure is tested against the wrong unit.
Why does the same MS-DRG pay a different amount at two hospitals?
Because most of the payment moves with the hospital. CMS adjusts the labor-related share of the standardized amount by that hospital's own wage index, then adds its indirect medical education factor, its disproportionate share adjustment, its uncompensated care amount and a separate capital payment adjusted by its geographic adjustment factor. CMS's FY 2027 IPPS impact file states a wage index for 3,074 hospitals, from 0.3500 to 1.9343. Holding everything else CMS publishes about a hospital equal, MS-DRG 470's operating Federal payment alone runs from $10,997.86 at a wage index of 0.7112 to $19,966.92 at 1.7431. On top of that, 1,326 of the 3,074 hospitals carry a teaching factor and 2,570 carry a disproportionate share adjustment, and neither is paid to the rest.
Why does the discharge date decide the rate, and not the admission date?
Because Medicare pays an inpatient stay under the fiscal year its discharge falls in. 42 CFR 412.64(a) sets the unit as "each inpatient hospital discharge in Federal fiscal year 2005 and subsequent fiscal years", and CMS's own IPPS Web Pricer asks for the discharge date, which is the through date in FL 6 of the UB-04. A stay that begins in September and ends in October is priced entirely under the new fiscal year, at the new rates, with no proration. This archive holds 8 fiscal years, FY 2020 to FY 2027, and the earliest discharge it can price is Oct 1, 2019, which is also the earliest CMS's own pricer accepts.
Which hospitals get no MS-DRG figure, and why?
Three kinds, and each gets CMS's own reason rather than a blank. Maryland hospitals are not paid under the IPPS at all: CMS's FY 2027 IPPS final rule says they "are not paid under the IPPS and are ineligible to receive empirically justified Medicare DSH payments and uncompensated care payments", yet CMS still lists 43 of them in this fiscal year's impact file with a wage index and a DSH adjustment, so a lookup that read the file without that rule would print a number Medicare never pays. A critical access hospital is paid 101 percent of its own reasonable cost under Pub. 100-04 ch. 3 s30.1.1, settled from its cost report rather than from a published rate. A children's hospital is excluded by statute. Neither of the last two appears in any IPPS impact file, so there is nothing to show and the tool says which rule excludes it.
What is a cost outlier, and when does Medicare pay one?
It is an extra payment for a case that costs far more than its MS-DRG pays. 42 CFR 412.84(g) converts the billed charges to cost with the hospital's own operating and capital cost-to-charge ratios; where that cost exceeds this claim's own payment plus the fiscal year's fixed-loss threshold, CMS pays 80 percent of the difference, or 90 percent for the 6 burn MS-DRGs 412.84(l) names. The FY 2027 IPPS threshold is $49,346.00, from 91 FR 50384. It is the single biggest reason a large inpatient bill pays more than its MS-DRG rate, and this tool computes it only when you give it the claim's total covered charges. Without them it says so rather than quietly leaving it out.
What happens when the patient is transferred rather than discharged home?
The hospital is paid a graduated per diem instead of the full MS-DRG amount. 42 CFR 412.4(f)(1) divides the payment by the MS-DRG's geometric mean length of stay, pays twice that for the first day and once for each later day, and caps the total at the full amount. A transfer to another acute hospital triggers it on any MS-DRG; a transfer to a post-acute setting triggers it only on the MS-DRGs CMS flags, which is 294 of the 768 in the FY 2027 IPPS, and 63 of those are also flagged Special Pay, which 412.4(f)(6) pays under a different split again. Which MS-DRGs qualify is not computed here: it is read from CMS's own Table 5 columns. The reduction needs the length of stay and the two-digit discharge status from the claim, and where they are missing the tool states that the figure is the full amount.
Why does this figure differ from CMS's own IPPS Web Pricer?
Because CMS publishes two per-hospital datasets and they disagree. The IPPS Impact File is public and is what this tool reads; the quarterly Provider Specific File is what the Medicare contractors and CMS's Web Pricer actually pay from, and CMS does not publish it as a flat file. CMS's own disclaimer on the impact file says its variables "may not reflect what is used for actual payment (e.g: Wage Index, DSH, IME)". Measured across twelve Web Pricer runs, the published file moves the per-claim total by between -9.8 and +2.5 percent: the wage index agrees exactly every time, and the teaching factor, the DSH percentage and the cost-to-charge ratios usually do not. The gaps are visible in the file itself. CMS publishes a per-discharge uncompensated care amount for 2,267 of the 3,074 hospitals in the FY 2027 IPPS and a zero for the other 807, while paying one to hundreds of hospitals in that second group. Four more things CMS pays are in no impact file at all, including the hospital-acquired condition penalty and the per-diem pass-through amounts, and every figure here says so in its own notes.
How do bill reviewers use MS-DRG rates in an expert report?
They read the MS-DRG and the discharge date off the UB-04, price them under the fiscal year in force that day, pick the hospital that billed them, and set that hospital's figure beside the billed total for the admission. Three things have to travel with it. The unit is the whole stay, so it is compared with the admission's total rather than with any line. The claim facts that change it, the total covered charges and the discharge status, belong in the figure rather than in a footnote. And CMS's comparison at a sole community or Medicare-dependent hospital, 419 and 166 of them here, is settled over a whole cost reporting period rather than on one claim, so this tool shows both amounts and picks neither.